**3.3 Under-five mortality**

Under-five mortality rate (U5MR), referred to as the probability to die before the fifth anniversary, is a key indicator to measure the socio-development of a country and child health [28–30]. In the last few decades, tremendous progress has been done to reduce the probability of a live birth to die before his/her fifth birthday, even though the levels of U5MR still are higher in SSA countries compared with other regions in the world. Yet, it is important to identify appropriate targets and devise effective interventions if SSA countries to reduce mortality among children under 5 years of age [28]. Again, that is where leadership comes into play because main causes of infant morbidity and mortality have been extensively studied worldwide and the region, but still progress has been very limited so for. Data from 29 countries showed that SSA countries register on average 83 deaths per 1000 live births (**Figure 3**). Alarmingly, this figure is far above the target of SDG-3.2 which aims 25 deaths per 1000 live births [31]. Furthermore, there are significant inequalities across SSA countries which need to be tackled collectively if national Governments want to reach SDG-3.2 [32]. Indeed, U5MR ranged from 41 deaths per 1000 live births in Mauritania to 158 deaths per 1000 live births in Central African Republic. Additional efforts targeting Central Africa are crucial to improve child health as shown in this chapter. A previous work showed that socioeconomic indicators are worse in Central Africa compared with other regions in the region [33]. The region has also been

*The Role of Leadership in Sub-Saharan Africa in Promoting Maternal and Child Health DOI: http://dx.doi.org/10.5772/intechopen.105773*

suffering with poor leadership through dictatorship and armed conflict. For instance, the Democratic Republic of the Congo has suffered since 1965 with poor leadership, lack of transparency, corruption, among others. Likewise, Central African Republic has been very unstable and until now, the country does not have effective government due to armed conflict. Gabon, the Republic of Congo, and Cameroon have been relatively stable, but they lack clear vision and accountability, and rampant corruption is knocking the doors every time. Such context is not conducive to boost economic development, and thereafter, improve MCH in the countries.

#### **3.4 Child health: stunting and wasting**

Over the last four decades, child (mal)nutrition has crystalized interest in both scientific and policymaking spheres [34–37] for several reasons. First, child malnutrition is a major public concern in SSA countries; it represents both a cause and a manifestation of poverty. Second, poor nutrition among young children has shortand long-term consequences. For instance, child malnutrition increases the risks of morbidity from infectious diseases and mortality; it affects cognitive and mental/ brain development and work productivity in adulthood. Finally, there is increasingly evidence that poor nutrition yields to poor reproductive outcomes, obesity, and chronic diseases in later life [7, 9, 34, 38–42]. At some point, one might wonder if poor brain development could explain the rampant poor leadership observed in SSA countries. First, most "leaders" come from poor households where they suffered from poor nutrition in their 1000 first days in life. Second, most people ruling did not have a chance to attend kindergarten where children are taught good behaviors in early life, such as sharing, listening, respect, love, among others. Turning back to data available on 27 countries (**Figure 4**), findings indicated that on average, 32% of children are stunted, with significant geographical variations in the region. Indeed, the percentage of children stunted varies from 16.5% in Gabon to 55.9% in Burundi. Such figures do not health in achieving SDG-3.2, since poor nutritional status among children is a major cause of morbidity and mortality. Furthermore, previous studies have documented the interlinkages between slow growth in height during childhood and impaired health, and poor school and economic performance [8, 9, 43]. With regard to wasting, findings showed that on average, 6.6% of children are affected. The lowest and highest percentage of wasted children were observed in Rwanda (1.1%) and Niger (18.0%), respectively. Like stunting, wasting during gestation and childhood has short- and long-term consequences later in life [44]. The Dutch famine of 1944 –1945 is illustrative of such chaos [45]. This study showed that exposure to famine during gestation resulted in antisocial personality and affective disorders, among others. Yet, these traits are very important to develop/foster a strong leadership. Even though people ruling developed countries are not perfect, one might admit that commitments toward public service are likely indication of social personality and affective traits, which in turn engage rulers to build their countries and treat people well somehow. In contrast, people ruling SSA countries do not feel accountable, more likely because they have antisocial personality and affective disorders, as a result of poor nutrition during pregnancy and early childhood.

Within this background showing clearly that key indicators of MCH are SSA countries is still of great concern while being a major public health issue, the region needs a significant shift through a strategic vision and leadership to devise and implement sound policies to improve MCH and therefore help SSA countries to achieve globally SDG-3.

**Figure 4.** *Stunting and wasting among children in sub-Saharan Africa.*
