The first page of Alfred Malunga's fat village register is taken up by a single family. Mother, father, five children, the last a baby girl named Molly. A red cross has been inked in beside her name.
“I use that sign when someone passes away,” explained Mr. Malunga, the village health worker who maintains the register, two volumes long and 12 centimetres high. “That child died of malaria.”
But turn the page. And the next. There are no more red crosses for 10 pages. Molly is the only child in her village to have died in the past six months.
This is a startling thing in Malawi, one of the poorest nations in the world, chronically short of food and with less than $10 a person spent on health care each year.
And it is part of an equally startling trend: Deaths of children under the age of 5 declined 29 per cent between 2000 and 2004 in Malawi. This country is one laboratory in a health-care revolution that is quietly yielding spectacular results across the developing world: The application of a handful of simple, low-cost measures, from giving families $2 mosquito nets to encouraging breastfeeding, is spurring a sharp decline in child deaths around the world.
For the first time since the United Nations began to keep records in 1960, the number of child deaths fell below the 10-million mark, down to 9.7 million in 2006, the last year for which there is data.
“This really is a historic moment,” said Peter Salama, Unicef's chief medical officer, although he was quick to note that those 9.7 million deaths, almost all of them from preventable or easily treatable causes, are “in no way acceptable.”
Nevertheless, this is undeniable good news from developing countries, made even brighter by the fact that the biggest drops in child deaths have come in some of the poorest places: 20 per cent in Niger, 23 per cent in Mozambique, a stunning 41 per cent in Madagascar. (Sub-Saharan Africa accounts for 50 per cent of all child mortality, even though the region's total population is only half that of India. In West and Central Africa, more than 150 of every 1,000 children born die before the age of 5, compared with fewer than six in Canada.)
Mr. Malunga knows what's responsible for the drop in his area: The biggest reason is that all pregnant women are now given a free insecticide-treated mosquito net for themselves and their children to sleep under. The new access to bed nets – which, even at a heavily subsidized price, are too costly for people here to buy, he said – has cut malaria deaths by about a third in the past few years. “It is malaria that kills most of the children,” he said.
But he is going after more than malaria: He has vaccinated nearly every single child in his 16-village territory – measles used to be a big killer here too, but there hasn't been a case in seven years, he said. No polio since 1990. He gives most children a capsule of vitamin A at least once a year, sometimes twice, if he can get it – and that is enough to boost their immune systems so that if they do get diarrhea or malaria, they are much less likely to die.
He weighs the children every time he sees them, and plots their growth on a chart – in Malawi, 46 per cent of all children show signs of stunting, the result of chronic malnutrition – and refers any who aren't growing well to the emergency nutrition rehabilitation centre. He has persuaded more and more women to breastfeed their babies and delay any introduction of solid food until the age of six months. Traditionally women here give babies maize porridge from the age of one week.
Mr. Malunga has supervised the installation of cement-covered pit latrines and protected water sources in many of the villages, leading to a drop in water-borne illness. He has persuaded many women to take contraceptive pills or get the Depo-Provera injections he does in the clinic – because, he explained, children spaced at least two years apart have much higher chances of survival. He travels village to village talking to groups about HIV (with which 14 per cent of Malawi's adults are infected) and he offers them condoms.
