Findings of an analysis published Online First in The Lancet revealed that worldwide only nine out of 137 developing countries are on track to achieve both Millennium Development Goals (MDGs) 4 and 5 to improve women’s and children’s health, with the remaining 128 developing nations failing to achieve the goals. According to current trends, 31 developing countries worldwide are set to achieve MDG 4, i.e. reducing the under-5 mortality rate by two-thirds between 1990 and 2015 and 13 countries will accomplish MDG 5, i.e. reducing maternal mortality ratio by three-quarters during the same period.

Study leader Rafael Lozano and his colleague Christopher Murray at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, WA, USA evaluated progress towards the Millennium Development Goals using crucial sources of data missing from previous analyses.

MDGs are undoubtedly the largest-ever collective global health goal. Numerous progress reports published in 2010 initiated a heated debate between academics, government officials, and other analysts because of the data and estimation approaches used as several key data sources were omitted in the reports, such as vital registration, national surveys, censuses, and surveillance systems of maternal mortality.

Lozano and Murray’s new study includes these additional data sources together with improved models of estimation and their findings reveal, that mortality rates for children below the age of 5 years decreased from 84.1 deaths per 1000 live births in 1990 to 52.8 deaths per 1000 live births in 2011, a 2.2% annual rate of decline. The fraction of global under-5 deaths in sub-Saharan Africa however has increased from 33% in 1990 to 49% in 2011.

According to the authors, child mortality is a severe indication of the extent to which countries differ in their death rates. They say: “In 2011, the childhood mortality in Sweden, Italy, and Greece is about 0.5 deaths per 1000 live births, whereas in Niger and Equatorial Guinea it is around 87, a 173-times difference.”

So far, significant progress has been achieved in the developing world with countries like Botswana, China and Rwanda speeding up progress towards reducing child mortality, which suggests that the goals can be achieved if politicians are willing.

In 1990 maternal mortality claimed 409,100 deaths decreasing to 273,500 deaths in 2011. Between 2005 and 2011maternal deaths where reduced by 73,700 deaths, 28.6% of this decline occurred in India, with Ethiopia, Pakistan, Nigeria, Indonesia, China and Afghanistan accounting for a further 32.1% of the decline.

The authors say:

“The major hindrance to the use of resources effectively to scale up coverage of key interventions is health system bottlenecks such as in the health workforce health system infrastructure, health information systems, supply chain logistics, and managerial capacity.”

They acknowledge that altering figures may confuse authorities and advocates, however, they contend:

“To argue that we should use old data or forge premature consensus on methods and data sources for the sake of consensus could undermine real accountability for making progress. We must always use the best evidence for assessing trends in global health. An important antidote to policy concern over the robustness of measurement will be wider discussion of the results’ strengths and limitations of different approaches to measurement.”

Peter Byass and Wendy J Graham from the Universities of Umeå in Sweden and in Aberdeen, UK, say in a linked comment:

“The publication of various global estimates should be considered as public health actions, with effects modulated by the frequency of updates. Release of global estimates could usefully come within an agreed framework analogous in some respects to the Consolidated Standards of Reporting Trials guidelines for reporting randomized clinical trial outcomes. This idea warrants further investigation and debate in view of the probable deluge of global estimates as the 2015 deadline for achievement of the MDGs approaches. There is a need not only to judge overall achievements towards the MDGs, but also to learn lessons about the contribution of a different kind of public health intervention: measurement and publication.”

Written by Petra Rattue