Malawi and Millennium Development Goal 4: a Countdown to 2015 country case study

Malawi is one of the only countries in sub-Saharan African that achieved Millennium Development Goal (MDG) 4: reducing deaths in children under the age of five by two-thirds between 1990 and 2015.  This paper examines Malawi’s success in improving child survival.  The article is part of a series of Countdown In-Depth Country Case Studies.MethodsFive district-representative household surveys were used to estimate child and newborn deaths from 2000 to 2014.  The study calculated the coverage of high-impact maternal, newborn, and child health indicators interventions.  The Lives Saved Tool (LiST) was used to estimate the number of child lives saved in the years 2000-2013 as a result of various interventions.  The authors reviewed documentation on the policies and programmes affecting the health of women and children, and analysed health financing indicators.Key findingsThe study finds that early adoption and effective implementation of evidence-based policies to address the major causes of child deaths was a key driver in Malawi’s achievement of MDG 4.  Results from the LiST analysis indicate that approximately 280,000 children’s lives were saved between 2000-2013. The findings show that increased coverage for treatment and prevention of childhood diarrhoea, pneumonia, malaria, and programmes to improve child nutrition were key factors to the success.  Improvements in the quality of care around birth also contributed to some of the improvements in child survival.   The paper notes that despite Malawi’s success in achieving MDG4, important work remains to be done.  Newborn survival is improving much slower than child survival, and increased attention is needed, including care for small and sick babies.  The study highlights that Malawi has the highest rate of preterm births worldwide. The authors call for increased coverage and implementation of effective newborn interventions, including improvements in the quality of care around birth for the mother and baby.  The study also suggests a need for increased government spending on health and targeted funding to newborn health.To see a policy brief, summarising the study’s key findings in infographic format, click here.To see the infographics produced by Countdown to 2015 & MamaYe, click here, here and here.To download the article for free, click here.Kanyuka, M., Ndawala, J., Mleme, T., Chisesa, L., Makwemba, M., Amouzou, A., Borghi, J., Daire, J., Ferrabee, R., Hazel, E., Heidkamp, R., Hill, K., Álvarez, M.M., Mgalula, L., Munthali, S., Nambiar, B., Nsona, H., Park, L., Walker, N., Daelmans, B., Bryce, J., & Colbourn, T. (2016). Malawi and Millennium Development Goal 4: a Countdown to 2015 country case study. The Lancet Global Health, (15), 1–14.