Women, newborns, children, and adolescents: life-saving momentum after a slow start

Higher ambitions: building on success

With all these initiatives working in concert through WHO coordination, childhood deaths began to decline dramatically, with the fastest declines recorded in sub-Saharan Africa. Maternal mortality finally broke free of the historical half-a-million yearly figure, though the decline was still too slow to meet the MDG targets. As so often happens in public health, when deaths from one set of causes begin to recede, they reveal another set of deadly problems hidden beneath. This proved true for neonatal mortality.

Three pregnant woman in the Central African Republic
WHO/C Black

In 2012, WHO published Born too soon: the global action report on preterm birth. The groundbreaking report set out the first-ever national, regional and global estimates of preterm birth. It demonstrated the extent to which preterm birth was on the rise in most countries, ranking as the second leading cause of death globally for young children, after pneumonia. The report made addressing preterm birth an urgent priority for reaching MDG four. To encourage targeted action, the report argued that rapid change is possible and identified the priority interventions that could contribute most substantially to reductions in preterm births, especially in low-resource settings. The Every newborn action plan to end preventable deaths followed in 2014.

Other ambitious goals followed research that allowed simplified approaches to the leading childhood killers. In 2013, WHO and UNICEF issued an integrated global action plan for Ending preventable child deaths from pneumonia and diarrhoea by 2025. The plan responded to some dire statistics. Together, pneumonia and diarrhoea accounted for nearly 30% of all childhood deaths, amounting to the loss of two million young lives every year. Though effective interventions were available for prevention and treatment, only 60% of children with suspected pneumonia received appropriate care. Even fewer were being reached with life-saving treatments: only 31% of children with suspected pneumonia received antibiotics and only 35% with diarrhoea received oral rehydration salts.

"Together, pneumonia and diarrhoea accounted for nearly 30% of all childhood deaths, amounting to the loss of two million young lives every year."

Dr Chan, WHO Director-General

The integrated strategy for ending both diseases made perfect sense. Since the determinants largely overlap, preventive strategies and platforms for delivery could be shared. Maximum benefits would come when effective interventions for both were promoted together. Previous groundbreaking research supported by WHO and USAID had shown that antibiotics for the treatment of pneumonia could be safely and effectively delivered in homes. Apart from the advantage of easy access, home-based treatment of pneumonia spared sick children from the risk of exposure to other pathogens in crowded hospital wards.

Other neglected problems moved into the spotlight. In 2014, WHO issued its first report fully focused on the health needs of the world’s one billion adolescents. Health for the world’s adolescents: a second chance in the second decade provided a state-of-the-art assessment of health status and unmet needs of people in the age group of 10–19 years. Issued as a dynamic, multimedia online report, it explained why adolescents need their own set of interventions, distinct from those designed for children and adults. The report’s evidence and arguments were later included when the Global strategy for women’s and children’s health was revised.