In 2012, approximately 6.6 million children worldwide – 18 000 children per day – died before reaching their fifth birthday, according to a new report released today by UNICEF, the World Health Organization (WHO), the World Bank Group and the United Nations Department of Economic and Social Affairs/Population Division. This is roughly half the number of under-fives who died in 1990, when more than 12 million children died.
“This trend is a positive one. Millions of lives have been saved,” said Anthony Lake, UNICEF Executive Director. “And we can do still better. Most of these deaths can be prevented, using simple steps that many countries have already put in place – what we need is a greater sense of urgency.” The leading causes of death among children aged less than five years include pneumonia, prematurity, birth asphyxia, diarrhoea and malaria. Globally, about 45% of under-five deaths are linked to undernutrition.
About half of under-five deaths occur in only five countries: China, Democratic Republic of the Congo, India, Nigeria, and Pakistan. India (22%) and Nigeria (13%) together account for more than one-third of all deaths of children under the age of five.
Newborn children are at particularly high risk “Care for mother and baby in the first 24 hours of any child’s life is critical for the health and wellbeing of both,” says Dr Margaret Chan, Director-General at WHO. “Up to half of all newborn deaths occur within the first day.” The lives of most of these babies could be saved if they had access to some basic health-care services. These include skilled care during and after childbirth; inexpensive medicines such as antibiotics; and practices such as skin-to-skin contact between mothers and their newborn babies and exclusive breastfeeding for the first six months of life.
Progress, challenges While the global average annual rate of reduction in under-five mortality accelerated from 1.2% a year for the period 1990-1995 to 3.9% for 2005-2012, it remains insufficient to reach Millennium Development Goal 4 which aims to reduce the under-five mortality rate by two-thirds between 1990 and 2015. “Continued investments by countries to strengthen health systems are essential to ensure that all mothers and children can get the affordable, quality care they need to live healthy, productive lives,” said Keith Hansen, Acting Vice President of Human Development at the World Bank Group.
Sub-Saharan Africa, in particular, faces significant challenges as the region with the highest child mortality rates in the world. With a rate of 98 deaths per 1000 live births, a child born in sub-Saharan Africa faces more than 16 times the risk of dying before his or her fifth birthday than a child born in a high-income country.
However, sub-Saharan Africa has shown remarkable acceleration in its progress, with the annual rate of reduction in deaths increasing from 0.8% in 1990 -1995 to 4.1% in 2005-2012. This is the result of sound government policies, prioritized investments and actions to address the key causes of child mortality and reach even the most difficult to reach populations.
Global and national action to improve child health
Both globally and in countries, a series of initiatives are in place aimed at improving access to maternal and child health care, inspired by the United Nations Secretary-General’s widely endorsed Global Strategy for Women’s and Children’s Health which aims to save 16 million lives by 2015 through a “continuum of care” approach. As part of this strategy, focus on specific areas is given through: A Global Vaccine Action Plan that is working towards universal access to immunization by 2020. Vaccination against preventable diseases is one of most effective country-driven and globally-supported actions, as it currently averts an estimated two to three million deaths every year in all age groups from diphtheria, tetanus, pertussis (whooping cough), and measles. In 2012, an estimated 83% (111 million) of infants worldwide were vaccinated with three doses of diphtheria-tetanus-pertussis (DTP3) vaccine. Some 176 countries have signed on to A Promise Renewed – the call to action spearheaded by the Governments of Ethiopia, India and the United States, together with UNICEF in a global effort to stop children from dying of causes that are easily prevented. The United Nations Commission on Life-Saving Commodities for Women and Children is helping countries improve access to priority medicines such as basic antibiotics and oral rehydration salts. Earlier this year, WHO and UNICEF joined other partners in establishing a new Global Action Plan for Pneumonia and Diarrhoea which aims to end preventable child deaths from these two major killers of under-fives by 2025. The plan promotes practices known to protect children from disease, such as creating a healthy home environment, and measures to ensure that every child has access to proven and appropriate preventive and treatment measures. Similarly, partners are working on Every Newborn: a global action plan to end preventable deaths. The aim is to launch this global newborn action plan in May 2014 and provide strategic directions to prevent and manage the most common causes of newborn mortality, which account for around 44% of all under-five mortality. UNICEF, WHO and the World Bank Group all support the Scaling Up Nutrition (SUN) global movement in its efforts to collaborate with countries to implement programmes to address poor nutrition at scale with a core focus on empowering women.
“Global partnerships to further accelerate the reduction of under-five mortality globally and in sub-Saharan Africa are essential,” said Wu Hongbo, Under-Secretary-General for Economic and Social Affairs at the United Nations. “In this regard, it is critical that national governments and development partners redouble efforts through to the end of 2015 and beyond.”
