Child survival: should the strategy be redesigned? Experience from Bangladesh

This paper examines recent studies which focus on the effectivenessof primary health care activities and concludes that in Bangladeshthe potential for substantially improving child survival andgrowth is severely curtailed by unbalanced strategies. Morespecifically the paper argues: (1) that focusing interventionson at-risk children at about 6 months of age is more efficientand less costly in preventing malnutrition than monthly monitoringof growth; (2) that attempts to reduce deaths from diarrhoeawith vertical oral rehydration therapy (ORT) programmes willnot have a major impact unless other interventions are directedto the persistent diarrhoea-malnutrition complex; (3) that theimpact of diarrhoea on growth is transient and community effortsto control diarrhoea are unlikely to show a sustained improvementin children's nutritional status; (4) that the benefits of breast-feedingare still under-valued in view of its vital role in preventingdeaths in poor malnourished children; (5) that given the numerousconstraints on full Expanded Programme on lmmunization (EPI)implementation, tetanus toxoid and measles vaccinations formthe most cost-effective immunization strategy for child survival.