Targeting a Thousand Days to Save Millions of Lives

So far this century, the number of preventable deaths among children under 5 has been halved, and this researcher has had a lot to do with it.

 |  Transcript [PDF]

It would be a pretty remarkable legacy to be able to say that you played a role in cutting annual global child mortality numbers in half. That’s exactly something that Zulfiqar Bhutta can say with confidence, and after decades of work on child survival alongside researchers around the world, he is being recognized with the 2022 John Dirks Canada Gairdner Global Health Award.

“I have been, over the last three decades, trying to address the whole global challenge of child survival,” says Bhutta, Chair in Global Child Health and Policy at the Centre for Global Child Health, Hospital for Sick Children in Toronto.

“Specifically I’ve been focused on early life, the first thousand days, where not only is the bulk of child mortality clustered, but some of the issues and complications that many mothers and children have have lifelong consequences, and also consequences that go across generations.”

Those first thousand days include pregnancy, childbirth, and the first two years of life. He used cluster randomized effectiveness trials (cRCTs) to gather data that shaped evidence-driven interventions. Community-based maternal and newborn care, nutrition, and early childhood development intervention packages have changed outcomes for a huge number of families.

“We believe what we have shown is that there are low-cost solutions, there are practical solutions that can be delivered through strategies that reach the most marginalized through community health workers, through platforms that engage families and communities, through self-help awareness that can make a difference to the world as we stand,” says Bhutta.

This work has established new international guidelines to protect maternal and newborn health, especially in low-resource areas. The resulting policies improved action directed at reducing malnutrition, treating persistent diarrhea, and building community-based resources like lady health workers (LHW) in places like Pakistan, South Asia and sub-Saharan Africa. Creating better access in rural, remote and conflict-affected regions has had a remarkable impact on the world’s most vulnerable women and children.

“So between the year 2000 and 2015 the world has gone down from 10 million preventable under five deaths every year to less than five million deaths,” says Bhutta.

“That’s the fastest reduction in child mortality in the history of mankind. And how has that happened? Not through happenstance. It happened because people, my colleagues and many others, worked very hard to make the case that this was an important thing to do, and that it could be done with targeting in the right geographies. And to have today the world recognize at that global level, I think it’s phenomenal and I’m so deeply grateful to the Gairdner Foundation for having recognized it.”

Bhutta is quick to acknowledge the contributions of his colleagues and other people involved in this important work, and he also credits his family for directing his path.

“My mother, God bless her, she’s almost 95. She spent a lifetime bringing up a family on values that had to do with egalitarianism,” says Bhutta.

“It had to do with a sense of social justice. And I think that experience growing up in childhood and in early formative years of one’s life sets you up for a trajectory which inevitably takes you down a course of how can you make a difference in your own life. And my dear wife, what I would like to say to her is thank you for what you did to hold my hand and support me in this journey.”

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