Saving Lives through Tried and Trusted methods: Evaluation the Intervention of the International Committee of the Red Cross

Summary of published paper

A retrospective study on the under five mortality of children was conducted in Meringue, a district of central Mozambique in October 1994. During the civil war in this country, between 1975-91, immunisations stopped in many areas while epidemics, malnutrition and famines struck most of the country. Humanitarian organisations tried to help reorganise the health services even before the signing of the peace agreement. The ICRC implemented one such programme in Maringue district from the end of 1991. The survey conducted in `1994 set out to measure trends in mortality during the war period and to evaluate the effect of the ICRC intervention on child survival.

The ICRC intervention in the district involved reorganising health services, undertaking EPI vaccinations and vitamin A supplementation. The distribution of vitamin A was introduced in 1993. It was given at first EPI contact and then every six months. Children aged 1-4 years received 200,000 international units and children less than 1twelve months of age received 100,000 IU.

During the civil war period (1975-91) mortality increased rapidly reaching a peak of 473 per 1000 in 1986. It declined again afterwards reaching a plateau of 380 in 1991. The ICRC health intervention further reduced mortality to 269 per 1000 in 1994. This was mostly attributable to the vaccinations and vitamin A supplementation. The mortality decline during the intervention period was highly significant and could not be explained by the trends in the preceding three years. It could be confirmed by analysis of changes in mortality by cause of death which showed that 90% of the changes from 1991-4 were attributable to a decline in mortality from measles, tetanus, and malnutrition, the target diseases of the intervention. In contrast, mortality from other causes of death did not change over the same period.

Among the interventions conducted by the ICRC, the EPI programme seems to have been most successful. Together with vitamin A supplementation, it contributed to most of the 28% mortality decline observed during the three years of the project. The authors of the study concluded that this shows the potential of simple interventions to improve child survival in such severe circumstances.

Reference:
Effects of the Civil War in Central Mozambique and Evaluation of the Intervention of the International Committee of the Red Cross: Garenne. M et al (1997), Journal of Tropical Paediatrics, vol. 43, pp 318-323