The 2013 Progress Report on Committing to Child Survival: A Promise Renewed shows that major progress has been made in lowering child mortality in all regions of the world and at all levels of national income. Nonetheless, even bigger gains are needed if the world is to meet Millennium Development Goal 4 – reducing under-5 mortality by two thirds by 2015. UNICEF’s Web series on A Promise Renewed focuses on some of the successful and innovative programmes that have helped save the lives of millions of children around the world.
Ceará state in northeast Brazil once battled alarming rates of infant mortality, until a community-based effort helped bring a dramatic turnaround. For the doctor who led the effort, child health remains an urgent cause.
Paediatrician Anamaria Cavalcante (left) has played a vital role in reducing child deaths in Brazil's Ceará state. When she began her efforts, nearly 1 in 10 children in the state never celebrated their first birthday.
FORTALEZA, Brazil, 14 October 2013 – “I still remember years ago the moment that it really struck me how bad the situation was,” recalls Anamaria Cavalcante. “I was working as a paediatrician in the neonatal unit of the Albert Sabin State Children’s Hospital here in Fortaleza. One day, I heard a scream and the crashing of cups coming from the emergency unit. A mother had just come into emergency with her five children who were in a very bad state of malnutrition. The nurse had come out with a tray full of cups of milk to give to the children, but when the kids saw the milk, they jumped up and literally attacked the nurse because they were so hungry and thirsty. All the cups crashed down and broke, spilling the milk all over the floor. It was the moment I knew we had to do much more to help save the lives of children here in Ceará.”
Long considered one of Brazil’s poorest states, Ceará is now recognized globally as a success story and a leader in reducing under-1 infant mortality rates, a major factor in the reduction of under-5 child mortality rates across Brazil.
“The leading killer of children in Ceará at the time was dehydration due to diarrhoea,” says Dr. Cavalcante. “By 1986, diarrhoea was responsible for killing half of all infant children. It was shameful, because this was such an easy illness to treat and it was cheap to do so.”
High death toll
By the end of the 1980s, nearly one baby in 10 in Ceará died before its first birthday. Mothers sometimes didn’t even give their newborns a name – they didn’t want to spend the money on registration, ‘just in case’. In towns and villages throughout Ceará, which lies in the heart of Brazil’s semi-arid northeast, church bells rang out every time another child died, a sombre reminder of the high death toll. And whenever a baby died, the ‘anjinho’ (little angel) was buried in a tiny blue coffin lined with blue cloth, the grave marked by a simple blue cross to symbolize a child’s ascent to heaven.
A community health agent in Ceará state, Brazil, speaks with a young mother about the importance of breastfeeding, a simple and effective way to reduce the risk of child mortality.
With the help of Carlile Lavor, Dr. Cavalcante helped lead Ceará’s efforts to reverse the situation of child mortality and malnutrition, and she convinced the state’s governor to put the fight against child mortality at the top of his agenda.
“Anamaria was instrumental in developing the Viva Criança [Long Live Children] programme across Ceará,” explains Francisca Andrade, a UNICEF Brazil paediatrician who coordinated the programme in its first years, from 1987 to 1990.
“We were both inspired by UNICEF’s 1985 State of the World’s Children Report, which focused on child survival. Most of the Viva Criança strategies were based those recommended by UNICEF,” says Dr. Andrade.
A simple solution
One of the most important goals was to tackle the leading killer of children at the time: dehydration due to diarrhoea. “Even the poorest of families and mothers had everything they needed in their own homes to save their children’s lives,” says Dr. Cavalcante. “They just didn’t know that a simple oral rehydration solution that they could make cheaply at home with only water, salt and sugar could literally save their children from dying of dehydration due to diarrhoea.”
“By the end of 1990, just four years after the creation of Viva Criança, we had community health agents going house to house in villages and towns throughout Ceará,” says Dr. Andrade. “They taught mothers how to make oral rehydration solution at home, along with other health skills. At the end of 1990, child deaths attributable to diarrhoea had dropped 54 per cent.”
Children playing in Ceará state, where the work of community health agents has helped reduce diarrhoea deaths and improve child nutrition.
Over the next years, the programme gained the support of government, civil society, faith-based organizations, the private sector, academics, families and dedicated individuals. So successful were their efforts that for the first time in its history, the annual UNICEF Maurice Pate Award was presented in 1993 not to a person or an organization, but to a whole community: The award went to the people and the state Ceará for their achievements in reducing infant mortality and malnutrition.
Continuing their work
Since then, Brazil has achieved a 77 per cent reduction in infant mortality, and in 2012 Brazil met Millennium Development Goal 4: a two-thirds reduction in the mortality rate of children under 5. But while they know that Ceará – and Brazil nationally – has made significant progress, neither Dr. Cavalcante nor Dr. Andrade are satisfied, and they continue their work to save the lives of more children.
Dr. Cavalcante is now teaching at one of the medical schools in Fortaleza, where she encourages her students to volunteer to train ‘Super Child Health Agents’ at the Escolhina Sol community school in one of Fortaleza’s impoverished neighbourhoods. “Child health, education and protection are all related,” Dr. Cavalcante says. “And play – for children to learn and be healthy and happy, they need to be able to play.”
Dr. Andrade continues to work full-time and is responsible for Child Health, Early Childhood Development and HIV/AIDS with UNICEF Brazil in Ceará. “I am very proud to work for UNICEF,” says Dr. Andrade. “We not only continue to help make progress in reducing under-5 mortality across Brazil, but we are also sharing our lessons learnt and experiences with other countries around the world. This is not just about Brazilian children – all children everywhere have the right to health.”