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[OSLO, 17 April 2006] - Of the ten countries in the world that have the worst rates of child mortality, six are in West Africa - a region that has seen more than its share of repression and civil strife over recent years. This conflict has undermined children's chances of survival both directly, causing many to be placed in the line of fire, and indirectly - compromising the provision of basic services that are essential to good health in children. As a result, West Africa faces a particular challenge when it comes to meeting the fourth United Nations Millennium Development Goal (MDG): reducing child mortality by two thirds, by 2015. (Mortality rates are typically measured according to the number of children who die in countries before the age of five.) In all, eight MDGs were agreed on by global leaders during the Millennium Summit held in New York six years ago. In addition to child mortality, the goals focus on halving extreme hunger and poverty, achieving universal primary education, promoting gender equality, reducing maternal mortality and reversing the spread of AIDS, malaria and other diseases. The goals also deal with ensuring environmental sustainability, and the development of partnerships to achieve a range of objectives, such as the establishment of fairer trade rules. Alvin Winford of the Liberian branch of the African Network for the Prevention and Protection Against Child Abuse and Neglect (a group headquartered in the Kenyan capital, Nairobi) believes strides could be made towards reducing child mortality in his country if disease was tackled. In an interview with Øystein Meland, he said the issue of teenage pregnancies also deserved attention. AW: Most West African states have a high rate of child mortality due to social, economic and political developments. Most of these deaths are the direct result of pneumonia, diarrhoea, measles, malaria and malnutrition, which can be prevented if the political will is cultivated - and backed by allocation of the requisite resources of national governments. In Liberia, there is an increasing number of teenage pregnancies. Lots of girls who have not reached the age of 18 are bearing children. With no proper care for themselves as well as their babies, some of their children die during childbirth, while others die before reaching age five due to the lack of good motherhood practices. Some of these girls are just too young to have babies; most of them being single parents, with no skills for earning a living, lack the basic necessities of life for taking care of themselves and their babies. What role does diet play in reducing child mortality rates? AW: The high level of many people living below the poverty line is increasing child mortality. Living on less than one (US) dollar a day, most pregnant women can hardly have a proper diet. The fortunate ones can afford one meal per day. This poor nutrition during pregnancy and during the child’s early life leads to death. It also reduces the flow of breast milk. Could you give us an insight into the state of health facilities in your country at present, now that it has been at peace for almost three years? AW: Most people in rural areas do not have access to health facilities. Some pregnant women and mothers walk far distances, on bad roads, seeking medication. Before reaching the health facilities, at times death occurs - claiming the lives of mother, child or both. The lack of health facilities in these areas gives rise to the use of the traditional midwifery system, where unsterilised instruments are at times used. This contributes to more deaths. The lack of necessary drugs in most public health centres also contributes in large measure. Is the situation necessarily better in urban areas? AW: The rapid rural-to-urban migration as the result of the war has made the capital of Liberia, Monrovia, overpopulated. Most rural dwellers have yet to return home despite the ending of the war. With no running sewage system, poor hygiene is occurring: there are inadequate toilet and drinking facilities; waste is deposited in the streets. The debris and stagnant water breeds mosquitoes, hence children contract malaria through mosquito bites. Chloroquine, which was used to treat malaria, seems no longer to be effective. Mosquito nets are not affordable by most communities. What are the most important steps that need to be taken in West African states - and nations further afield in Africa - to tackle child mortality? AW: Practical steps than need to be taken in West Africa in combating child mortality include governments committing resources to preventive programmes from the grass roots to the sub-regional level. Massive public awareness campaigns should be launched at all levels to stimulate behavioural change, taking into consideration the attitudes and beliefs of the different target audiences. Family planning methods, especially child spacing, should be encouraged among both women and men. More health facilities should be set up and equipped with instruments and drugs in rural areas. The road network needs to reach the remotest villages. More training should be made available to health workers, and salaries should be attractive to keep them in the profession - while poverty alleviation programmes need to be encouraged at the community level to enable families to have a proper diet. Hygiene should be encouraged at the local level, immunisation against early childhood disease carried out at all levels, and mosquito nets with required insecticides need to be made available to communities. Myths such as that which States that having more children is a sign of prosperity should be worked against. At present, Liberia is struggling to overcome the effects of years of civil war, with limited resources. How does one make an argument for devoting resources to reducing child mortality in this context, when there are so many other things that demand money and attention - attending to the needs of ex-combatants, for instance, to ensure they are not tempted to return to the battlefield? AW: Liberia's future depends on how the welfare of children is improved now. High mortality rates will affect this future. Liberia needs a strong human resource base. Without a population, this will only be a myth - so children must be prevented from dying now. While it is true that ex-combatants remain a priority so that they will not be lured back to violence due to the volatile situation in the country, what is even more paramount is to save the very future of Liberia by protecting children against mortality. When there is stability and healthy children growing up to become societal assets, the needs and aspirations of all are secured, thus reducing the threat of ex-combatants returning to war - as healthy children make a happy environment. Stopping children from dying when we can is a moral obligation which must not be sidelined. Further information
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