Child Survival: Should the Strategy Be Redesigned? Experience from Bangladesh

This paper examines recent studies which focus on the effectiveness of primary health care activities and concludes that in Bangladesh the potential for substantially improving child survival and growth is severely curtailed by unbalanced strategies. More specifically the paper argues: (1) that focusing interventions on at-risk children at about 6 months of age is more efficient and less costly in preventing malnutrition than monthly monitoring of growth; (2) that attempts to reduce deaths from diarrhoea with vertical oral rehydration therapy (ORT) programmes will not have a major impact unless other interventions are directed to the persistent diarrhoea-malnutrition complex; (3) that the impact of diarrhoea on growth is transient and community efforts to control diarrhoea are unlikely to show a sustained improvement in children's nutritional status; (4) that the benefits of breast-feeding are still under-valued in view of its vital role in preventing deaths in poor malnourished children; (5) that given the numerous constraints on full Expanded Programme on lmmunization (EPI) implementation, tetanus toxoid and measles vaccinations form the most cost-effective immunization strategy for child survival.