The State of Infant and Under 5 Mortality in The Gambia: A Socioeconomic Perspective to Child Survival

Health is a major driver of economic growth and productivity in both developed and developing countries. Research shows that providing opportunities for access to health and reproductive services together with good nutrition can positively impact society’s welfare (Onarheim, et al, 2016). This is fundamental to the survival of women and children, especially in developing countries, where the absence of good health care can have an adverse impact on their overall wellbeing. Infant mortality, the death of a child before his or her first birthday, and under 5 deaths are some of the adverse consequences of poor health and nutrition care. Their prevalence in Sub-Saharan Africa, particularly The Gambia are critical to development. In 2017 alone, WHO estimated more than 4 million deaths among children under 5 and highlighted that for children in Africa (51 per 1000 live births), the rates are up to six times higher than for children in Europe at 8 per 1000 live births (World Health Organisation, 2019). In The Gambia, much like the rest of Africa, the causes of child death are numerous, interrelated, and complex. Disease, malnutrition, food insecurity and poverty, are among the most prominent. An examination of Gambia’s most recent demographic health survey shows strong correlations between poverty, and infant and under 5 mortality. Shockingly, there is negligible difference between the lowest wealth group and the second and third, but a significant gap between the wealthiest and the other categories. This suggests the absence of a middle class. The picture illustrated by the DHS data shows that age is a critical determining factor in children’s survival. Babies born to mothers under the age of 20 have reduced chances of celebrating their fifth birthday. The impact of child marriage on child deaths creates a major cultural and, in some cases, religious challenge for policy makers. Data also demonstrates differences in prevalence by location (urban versus rural communities) and the sex of the baby, with boys most at risk. Interestingly, rates are also different for communities within rural Gambia. For instance, children born in Kuntaur, Basse and Mansokonko are more vulnerable than children in other parts of rural Gambia. In addition to high infant and under 5 mortality rates, these communities also have the highest rates of malnutrition and hunger, leading to a multitude of challenges for children and their families to survive. Malnutrition is a major contributing factor. Its most severe forms – stunting and wasting - are more prevalent among poor households in The Gambia. Up to 50 percent of children under 5 were found to be anemic by the 2018 micronutrient survey, approximately 56 percent of pregnant women are anemic and up to 50 of non-pregnant women are also anemic. Education is critical. While a mother’s level of education, especially at a secondary level, seems to affect the levels of mortality positively, data shows that very few women in affected communities have access to secondary education. The study proposes a viable and affordable policy solution, which is to invest in reproductive health education at the primary level combined with nutrition education. This will help raise awareness, improve girls’ knowledge on health and nutrition, and have a positive and lasting impact. The country has made significant progress since the 1990s. Access to immunization is free with more than 90 percent coverage and almost all babies are breastfed. Policy shifts such as the 2016 ban on female genital mutilation and child marriage will also contribute positively to children’s chances of survival and reduce the health risk for both women and children. Although health care is the primary responsibility of the government, infant and under 5 mortality are addressed by a multitude of stakeholders including local and international NGOs, as well as United Nations agencies. However, the government’s unsustainable public debt and reliance on donor funding limit its ability to provide the resources and technical capacity required to ensure that women in all parts of the country have access to basic health care and emergency care during labour and delivery.

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