Strategy for the elimination of preventable deaths among children under five in fragile countries: the case of Niger, a reflection guided by the language of the heart in a changing geopolitical context

Abstract

In a context of state fragility marked by political instability and humanitarian challenges, the survival of children under five in Niger remains a major public health concern. In response to this alarming situation, this study aimed to develop a holistic strategy to eliminate preventable deaths among young children, integrating an empathetic approach that respects local and human realities. The main objective of this research was to design a contextual and human-centered strategy to sustainably reduce child mortality in Niger. Specifically, the study aimed to analyze the socio-economic, health, and political factors contributing to preventable deaths, identify effective existing practices, and propose adapted strategic recommendations. A qualitative and quantitative approach was employed. Data were collected through surveys administered to 120 mothers of children under five, semi-structured interviews with 20 health and community actors, as well as focus groups. Documentary analysis further enriched the findings. The study revealed that poverty, distance from healthcare facilities, security instability, and the lack of medical infrastructure are the main factors behind preventable deaths. Identified best practices such as community health relays, mobile clinics, and community radios highlighted the effectiveness of decentralized and participatory approaches. Integrating the "language of the heart," centered on listening and empathy, emerged as essential to strengthen community adherence to child health interventions. The results confirm that eliminating preventable deaths among children under five in Niger requires a strategy that combines medical rigor, cultural adaptation, and the humanization of healthcare services. Only an integrated approach, sensitive to local realities and driven by strong community involvement, will sustainably meet this public health challenge.