The Know, Do, and Quality Gaps in International Maternal and Child Health Care Interventions

Abstract

Tremendous progress has been made in reducing the mortality rates for young children, especially in low- and middle-income countries, with annual deaths down from 12.6 million in 1990 to 6.3 million in 2013.¹ Although it is unlikely that number 4 (reduce child mortality) of the Millennium Development Goals set by the United Nations in 2001² will be achieved by the deadline this year, an even more ambitious goal for the elimination of preventable deaths among newborns and children younger than 5 years by 2030 is likely to be set by the United Nations General Assembly in the fall of 2015.³ Discussions about these laudable goals often center on claims such as, “we know what works, we just need to do it.” In fact, estimates of coverage of proven interventions for child survival are significantly lower than needed to maximize the effects, with the most important coverage gaps seen in the areas of family planning, interventions for newborns, and case management of childhood diseases, such as diarrhea, pneumonia, and malaria.⁴ This is often referred to as the know-do gap. In this issue, Mohanan et al⁵ provide a distressing description of this gap related to the diagnosis and treatment of diarrhea and pneumonia by health care practitioners in Bihar, India.