In the ongoing battle against child mortality, especially in low-income countries, hope shines through the veil of despair with low-cost, effective interventions that can significantly reduce the number of deaths among infants aged 0 to 5. These early years, pivotal for a child’s development, are marred by preventable diseases and conditions that claim too many young lives. Yet, the silver lining is found in the simplicity and affordability of solutions that can turn the tide against this tragic loss.

At the forefront of these preventable tragedies is pneumonia, a leading cause of death that can often be averted through inexpensive vaccines and antibiotics. Immunisation campaigns and community health programs can ensure that treatments reach those in need, transforming a potential death sentence into a manageable condition. Simple practices, such as promoting exclusive breastfeeding, can also bolster a child’s immune system against pneumonia and other diseases.

Diarrheal diseases, closely linked to poor sanitation and unsafe water, are another major threat to young lives. However, the provision of oral rehydration solutions (ORS) and zinc supplements offers a beacon of hope. These treatments, costing mere cents per dose, can swiftly restore hydration and save lives. Moreover, investing in clean water initiatives and basic hygiene education provides a sustainable path to disease prevention.

Malaria, a relentless killer in many low-income regions, particularly Sub-Saharan Africa, can be effectively combated with insecticide-treated mosquito nets and prophylactic antimalarial medications. These interventions, surprisingly affordable, can drastically reduce malaria incidence and mortality among vulnerable infant populations.

Neonatal conditions, such as complications from preterm birth, infections, and birth asphyxia, highlight the critical need for improved maternal and newborn care. Skilled birth attendance, a cost-effective strategy, can prevent many such deaths. Additionally, kangaroo mother care (skin-to-skin contact) and basic neonatal resuscitation techniques offer low-cost, high-impact solutions to neonatal mortality.

Lastly, malnutrition — a pervasive threat to child survival — can be addressed through nutrition education, support for exclusive breastfeeding, and the provision of vitamin A and micronutrient powders. These interventions prevent death and promote healthy development, all at a minimal cost.

The narrative of child mortality in low-income countries is not solely one of despair but also one of hope and opportunity. By implementing these low-cost interventions, the global community can make significant strides in saving lives and nurturing the potential of millions of children. It is a testament to the power of simple, affordable solutions facing daunting challenges, offering a brighter future for the world’s most vulnerable populations.

Low-cost interventions that save lives

Pneumonia

• Vaccination: The pneumococcal and Hib vaccines can prevent many pneumonia cases. The cost can vary, but Gavi, the Vaccine Alliance, has negotiated prices as low as USD 1.5 per dose for some vaccines in low-income countries.
• Exclusive Breastfeeding: Encouraging exclusive breastfeeding for the first six months of life can significantly improve a child’s immunity. The costs here are more about education and support systems for mothers.
• Access to Antibiotics: For cases where pneumonia develops, timely administration of antibiotics can save lives. A full course of antibiotics for pneumonia treatment can cost less than USD 0.50 per child.

Diarrheal Diseases

• Rotavirus Vaccination: Rotavirus vaccines effectively prevent the most common cause of severe diarrhoea in children, with costs in Gavi-supported countries around USD 1–3 per dose.
• Clean Water and Sanitation (WASH): Providing access to clean water and promoting handwashing can drastically reduce diarrheal diseases. The cost per child can be very low when spread across communities but varies widely depending on the specific intervention and infrastructure development.
• Oral Rehydration Salts (ORS) and Zinc Supplementation: These are highly effective treatments for diarrheal diseases, costing as little as USD 0.50 for ORS packets and zinc supplements for one treatment course.

Malaria

• Insecticide-Treated Nets (ITNs): Mosquito nets treated with insecticide are a simple, effective way to prevent malaria. The cost per net is typically around USD 2–3, and each net can protect up to two children for up to three years.
• Indoor Residual Spraying (IRS): Spraying the inside of homes with insecticides can also reduce malaria transmission. The cost varies but is generally between USD 3–7 per person per year.
• Antimalarial Drugs: Prophylactic antimalarial drugs for pregnant women and young children in high-risk areas can prevent illness. The cost per treatment is around USD 0.50 to USD 1.
• Artemisinin-based combination therapies (ACTs) are the cornerstone of malaria treatment recommended by the World Health Organization (WHO) for uncomplicated Plasmodium falciparum malaria. The cost of ACTs in low-income countries varies, influenced by factors such as local policies, subsidies, the involvement of global health initiatives, and whether the drugs are purchased in the public or private sector. A typical course is just three days of treatment, and the cost to the healthcare system is less than USD 1.
• Anti-malarial vaccines: The R21 vaccine is the second malaria vaccine recommended by WHO, following the RTS,S/AS01 vaccine, which received a WHO recommendation in 2021. Both vaccines are shown to be safe and effective in preventing malaria in children and, when implemented broadly, are expected to have a high public health impact. Three to four doses are administered at USD 2 — USD 4 per dose.

Neonatal Conditions

• Skilled Birth Attendance: Ensuring that births are attended by skilled health personnel can significantly reduce neonatal deaths. Training community health workers can be relatively low-cost, with significant returns in reduced mortality.
• Thermal Care: Simple practices like kangaroo mother care (skin-to-skin contact) can prevent hypothermia in newborns with negligible cost.
• Basic Neonatal Care: Including clean delivery practices, proper cord care, and early breastfeeding initiation. The cost here is more about training and education than direct intervention costs.

Nutritional Deficiencies

• Exclusive Breastfeeding: Promoted for the first six months to provide all necessary nutrients and improve immunity.
• Vitamin A Supplementation: This can significantly reduce child mortality from all causes, with each dose costing as little as USD 0.02 to USD 0.30.
• Micronutrient Powders: Sprinkle on foods can combat malnutrition, costing about USD 0.03 to USD 0.10 per sachet.

How many children between the ages of zero to five live in low-income countries

Unfortunately, there isn’t a single, definitive source with data on the exact number of children aged 0 to 5 living in low-income countries. This is due to a few reasons:

• Defining “low-income countries”: Different classifications are used by organisations like the World Bank. These classifications can change over time.
• Data collection challenges: Gathering accurate data in low-income countries can be difficult due to resource limitations and infrastructure issues.

However, we can look at child poverty data as a proxy. UNICEF reports that 333 million children live in extreme poverty worldwide, meaning they lack necessities like food, shelter, sanitation, healthcare, and education. This data can give us a general idea of the magnitude of the problem.

What can be done?

Governments, NGOs, and civil society play pivotal roles in mitigating child mortality in low-income countries, leveraging their unique positions to initiate, support, and scale up various interventions. Here are ways these entities can collaborate and contribute effectively:

Strengthening Healthcare Systems

• Governments can allocate increased funding to health services, ensuring that healthcare facilities are adequately staffed, equipped, and accessible to the population, including remote areas.
• NGOs often work to fill gaps in healthcare provision, providing training for healthcare workers, supplying medical equipment and medications, and setting up mobile clinics to reach underserved communities.
• Civil Society can advocate for improved healthcare policies and transparency in healthcare funding, ensuring that resources are allocated effectively and equitably.

Promoting Preventative Measures

• All three can collaborate on vaccination campaigns to protect against pneumonia and measles. Education campaigns to promote breastfeeding, proper nutrition, and hygiene practices can also substantially impact the situation.
• NGOs and civil society can support the distribution of mosquito nets and conduct awareness campaigns on their use to prevent malaria, a leading cause of child mortality.

Improving Water, Sanitation, and Hygiene (WASH)

• Governments can invest in infrastructure to provide clean water and sanitation facilities, which are crucial for preventing diarrheal diseases and improving overall health.
• NGOs frequently engage in WASH projects, constructing toilets and facilitating access to clean water through wells and filtration systems.
• Civil Society can mobilise community involvement in maintaining and protecting water and sanitation infrastructure and promote hygiene practices.

Ensuring Food Security and Nutritional Support

• Initiatives to improve access to nutritious food can significantly impact child health. Governments can implement policies and programs to support agricultural productivity, subsidise essential foods, and ensure nutritional programs reach vulnerable populations.
• NGOs may provide direct food aid, support school feeding programs, and teach sustainable farming techniques to communities.
• Civil Society can raise awareness about malnutrition, advocate for policy changes, and support community-based nutrition and gardening projects.

Education and Empowerment

• Educating girls and women has a profound impact on child health outcomes. Governments can ensure equal access to education, while NGOs can provide scholarships or support for girls’ education.
• Civil society, including local communities and parent groups, can advocate for educational reforms and support initiatives that empower women and girls.

Advocacy and Policy Influence

• Civil society organisations can lobby for policies prioritising child health, including environmental protections to reduce pollution and combat climate change, which impacts children’s health.
• They can also be crucial in holding governments and international bodies accountable for their commitments to child health and rights

Collaboration across these sectors is crucial for creating sustainable change. By pooling resources, sharing knowledge, and coordinating efforts, governments, NGOs, and civil society can significantly reduce child mortality rates and improve health outcomes for children in low-income countries. Their combined efforts can address the root causes of child mortality, ensuring that children have the chance to lead healthy, productive lives.

Concluding

The stark reality of child mortality in low-income countries, particularly among infants aged 0 to 5, represents a profound global health challenge. Yet, as outlined, the breadth of low-cost, highly effective interventions available to combat this crisis offers a beacon of hope. These interventions, ranging from vaccinations and exclusive breastfeeding to access to clean water and nutritional supplements, underscore a critical truth: the power to reduce child mortality significantly is well within our grasp.

Moreover, the detailed strategies for pneumonia, diarrheal diseases, malaria, neonatal conditions, and nutritional deficiencies illustrate a clear path forward. The low-cost solutions presented are feasible and offer a high return on investment regarding lives saved and improved health outcomes. The role of artemisinin-based combination therapies (ACTs) in treating malaria, the impact of skilled birth attendance on neonatal survival, and the potential of vitamin A supplementation to bolster child health further highlight the array of tools at our disposal.

The task ahead requires a concerted effort from governments, NGOs, and civil society. Through increased funding, the implementation of health programs, advocacy, and education, these stakeholders can change the trajectory of child health in low-income countries. The call to action is clear: by embracing these low-cost interventions and fostering collaboration across sectors, we can address the root causes of child mortality and ensure that every child has the opportunity to thrive.

This collective endeavour presents a compelling opportunity to redefine the future for millions of children in low-income countries. As we move forward, let the narrative of child mortality be one not of despair but of hope, action, and profound transformation. Together, we can turn the tide against these preventable tragedies, paving the way for a healthier, brighter future for the world’s most vulnerable populations.