Enhancing evidence-based policy decisions for neonatal and child survival the highest mortality countries

More than six million children died before their fifth birthday in 2013, with the majority of those deaths occurring in low and middle-income countries.

Despite child mortality rates dropping by almost half between 1990 and 2013, the world is unlikely to meet the Millennium Development Goal of a two-third decrease in deaths by 2015.

Researchers at the School have been instrumental in the development of the Lives Saved Tool, a computer programme that enables policy makers to identify which policies and interventions are most likely to save children’s lives.

Simon Cousens, professor of epidemiology and medical statistics at the School, advises the World Health Organization (WHO) and the United Nations Children’s Fund (Unicef) on child morbidity and mortality estimates. Alongside Joy Lawn, professor of maternal reproductive and child health epidemiology, he developed a statistical model that produced national estimates of neonatal deaths by cause.

These estimates were fed into the 2005 Lancet Neonatal Survival series, for which Cousens developed a computer model to estimate the number of neonatal deaths that could be prevented with different interventions. He then produced a model for childhood mortality for another Lancet series on nutrition.

In 2008 the Bill & Melinda Gates Foundation provided funding through the Johns Hopkins School of Public Health to integrate the models which led to the Futures Institute launching it as the Lived Saves Tool, freely available on its website.

A key input for the tool are estimates of the impact of different interventions on child mortality rates. Cousens played an important role in setting the standards and rules for calculating the impact of different interventions.

Since its launch the tool has been adopted as a policy and decision-making tool by a wide range of international agencies, organisations and governments. In November 2009 the science academies of seven African countries used the Lived Saves Tool in a report highlighting the most efficient ways of saving the lives of mothers, newborns and children.

Save the Children also used the tool for their Missing Midwives report in 2011 to show that 1.3million newborn babies could be saved every year by using eight key interventions. And Born Too Soon, The Global Action Report on Preterm Birth, produced in May 2012 by the WHO, Save the Children and others, used the tool to identify packages and interventions to aid the survival of preterm babies.

Individual countries such as Malawi, Nigeria, Burkina Faso, Ethiopia and China have also used the Lived Saves Tool in the formulation of health policy.