'Race against time' as 50 countries set to miss health-related MDGs

http://www.guardian.co.uk/global-development/datablog/2012/jun/14/race-against-time-health-mdg

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More than 50 countries look set to miss both millennium development goal (MDG) targets for cutting mortality rates for young children and mothers by the 2015 deadline, according to a report.

"Spectacular progress" has been achieved in some of the world's poorest countries – but "all the news is not good", the Countdown to 2015 report from the World Health Organisation (WHO) said.

Of the 75 so-called Countdown countries with the highest rates of child and maternal mortality, 25 have made insufficient or no progress in reducing maternal deaths and 13 have shown no progress in cutting the number of children who die.

The report found 66 countries are unlikely to meet MDG 5a of cutting by three-quarters the maternal mortality ratio between 1990 and 2015.

The countries with the highest rates were Chad, Somalia and Sierra Leone (see table below for the 10 best and worst-performing Countdown countries).

And 52 countries look set to miss the MDG four of a two-thirds reduction in 1990 under-five mortality levels by 2015.

"This is a race against time," said Zulfiqar Bhutta, co-chair of the Countdown initiative. "The pace has picked up, but countries need to make real change happen in the next three years if the world is going to keep its promise to millions of newborns, children and women."

The Countdown report echoes many findings of the WHO's World Health Statistics 2012 survey, published last month, which found that although improvements in the poorest areas have accelerated, "large variations in health … persist both between and within countries".

The report highlighted "significant progress" globally in reducing the under-five mortality rate, which has fallen by 35% in the 20 years to 2010 – from an estimated 88 deaths per 1,000 live births in 1990 to 57 two years ago.

The WHO estimates that around one-fifth of the cut in child mortality was due to better measles immunisation coverage.

The number of maternal deaths also saw a "significant reduction" – from 543,000 in 1990 to 287,000 in 2010.

The availability of contraception, antenatal care and skilled care during birth are crucial for reducing deaths – and a breakdown of these indicators by urban/rural populations, poor/wealthy and the maternal education level (no education compared with education to secondary school level or above) for 86 countries shows the large variations within borders as well as across them.

The World Health Statistics 2012 report found all six WHO regions remain on track to meet MDG six (target 6C: to halt and begin to reverse the incidence of malaria and other major diseases) – although it said there were an estimated 216,000 cases in 2010, with 655,00 deaths, 85% of those under-fives. Global incidence of malaria fell 1.8% a year between 2000 and 2009.

Tuberculosis cases have also been falling, with deaths from TB down by a third since 1990, although multi-drug resistance "continues to present significant problems", the report said.

The number of new HIV cases also fell (to 2.7 million people in 2010 from 3.1 million nine years earlier) – and with increased access to anti-retroviral therapy in low- and middle-income countries, the number of people living with HIV is on the rise, to an estimated 34 million at the end of 2010.

The MDG target for access to safe drinking water has been met but the target for sanitation remains off track – and 2.5 billion people still did not have access to improved facilities in 2010. (MDG target 7c: to halve by 2015 the proportion of the population without access to safe drinking waster and basic sanitation)

Lack of data

The challenges faced by bodies like the WHO in compiling reports on the developing world was highlighted in the World Health Statistics report, which said an estimated 85% of the global population live in countries where cause-of-death data fails to meet high-enough standards.

The WHO said it was "unsatisfactory" that 85 countries (where 65% of the world population live) produce lower quality data – and 74 countries lack such data altogether.

The two most-populous countries, China and India, lack fully functioning civil registration systems, instead using sample registration and modelling to generate representative statistics.

Countries set to miss MDG targets four and/or five

The best-performing Countdown countries

The worst-performing Countdown countries

• Click here to download the Countdown data