The Difficult Task of Evaluating MDG-4

Abstract

Background . The fourth Millennium Development Goal (MDG-4) proposed to reduce under-5 mortality rates (U5MR) by two thirds within 25 years. The article discusses changes in U5MR for 35 sub-Saharan African countries, for which DHS surveys are available. Methods . Analysis of DHS data, reconstruction of time series of U5MR, and comparison with other series. Findings . Few countries were able to achieve MDG-4 from 1985 to 2010, and the few who did seem to have achieved the goal apparently either because of abnormally high baseline or a surprisingly low endpoint. If all countries experienced significant mortality decline, only a minority had a steady decline, and many had periods of rising and falling mortality, for a variety of reasons. Interpretation . Discussion focuses on data quality, on methods for estimating levels and trends in under-5 mortality, and on the circumstances explaining rises and falls in mortality. MDG-4 appeared overambitious for Africa, given high mortality levels, political instability, economic crises, and above all emerging diseases, in particular HIV/AIDS. The last 10 years from 2000 to 2010 appeared as the most favorable period since 1960 in African countries, with the exception of countries with widespread HIV/AIDS.