In 1990, an estimated 12 million children around the world died under age five; by 2011, that figure had dropped to 6.9 million. The message, from a new report by the UN Children's Fund (UNICEF), is that with greater commitment to child survival from governments and their partners, these figures can go lower still.
"These new data are cause to celebrate," UNICEF deputy executive director Geeta Rao Gupta said at a press conference launching the 2012 Progress Report on Committing to Child Survival: A Promise Renewed. "But this is unfinished business, and it is not just about numbers. Behind every statistic is an unseen child, and a grieving mother and father."
The vast majority of child deaths are preventable. Almost two-thirds of under-five deaths in 2011 were caused by infectious illnesses such as pneumonia, diarrhoea, malaria, meningitis, tetanus, HIV and measles; by contrast, in countries with very low under-five mortality rates, there were almost no deaths from infectious diseases. More than one-third of under-five deaths could be attributed to undernutrition, and almost 40 percent occurred within the first month of life, often due to preterm or delivery complications.
According to the report, nine low-income countries - Bangladesh, Cambodia, Ethiopia, Liberia, Madagascar, Malawi, Nepal, Niger and Rwanda - have lowered their under-five mortality rate by 60 percent or more over the last two decades. These countries used simple, tried and tested methods to improve child survival: widespread immunization campaigns for diseases like measles and polio; insecticide-treated mosquito nets to prevent malaria; interventions ranging from folic acid supplements to clean delivery practices to improve newborn survival; and exclusive breastfeeding to address undernutrition.
The global drop in under-five mortality works out to a decline of about 3 percent per year, but if the world is to meet the Millennium Development Goals on child mortality and maternal health, child deaths need to fall by 14 percent per year, according to the World Health Organization.
Poorest go without
Under-five deaths are largely concentrated in sub-Saharan Africa, which accounted for almost half of these deaths in 2011, and South Asia, where 33 percent of under-five deaths occurred. In a few instances - Burkina Faso, Chad, Cameroon, the Democratic Republic of Congo, Mali and Somalia - under-five mortality actually rose between 1990 and 2011.
The report also noted wide disparities within countries. Data from 39 countries show that children born into the poorest fifth of a population are almost twice as likely to die before age five as those born into the wealthiest fifth. Other factors that increase risk of under-five death include: being born in rural areas; being born to mothers without basic education; and living in areas affected by violence and political fragility.
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Many of the simplest interventions remain inaccessible in impoverished parts of Africa and Asia. For instance, globally, less than one-third of children with diarrhoea receive oral rehydration salts.
In Uganda, which has registered a 49 percent decline in under-five mortality since 1990, health workers say the cost of vaccines remains a major hindrance, and the country's overburdened health system is struggling to cope with the needs of one of the world's fastest growing populations.
"We have some vaccines which have reduced illness among the children, like pneumococcal and rotavirus, which are not wildly available in health units due to high cost," Jolly Natukunda, a senior paediatric consultant at Mulago National Referral Hospital, Uganda’s largest referral facility, told IRIN.
But according to Mickey Chopra, UNICEF's chief of health, the price of many vaccines has fallen significantly in recent years through negotiations between the GAVI Alliance and manufacturers and suppliers of vaccines. In 2011, pharmaceutical giant Pfizer cut the price of its pneumococcal vaccine - which prevents pneumonia, meningitis and sepsis - by more than 50 percent for developing countries, which now spend just US$3.50 per dose.
A pledge to do more
In June, UNICEF and its partners launched A Promise Renewed, a global effort to reenergize the improvement of maternal, newborn and child survival. Since its inception, more than 110 governments have signed a pledge vowing to redouble efforts to reduce child mortality. The movement aims to rapidly decrease under-five mortality by improving countries' evidence-based plans; strengthening accountability for maternal and child healthcare; and mobilizing support for the principle that "no child should die from preventable causes". It aims to prioritize the world's poorest people.
"A child's death is all the more tragic when caused by a disease that can easily be prevented. That's why we have this global movement to recommit to child survival and renew the promise to end child deaths. This decline shows we can make this happen," UNICEF's Rao said.