Monday, 11 June 2012

Reducing child mortality to achieve MDG 4: WHO

7.6 million children under five years of age died in 2010 – nearly 21 000 children each day and almost 900 every hour. Progress has been made in recent decades, but is unequally distributed across regions and countries and within countries. Important challenges remain for the global goal to be achieved


7.6 millionchildren under five years of age died in 2010. 


Just under 8 million under-five children died in 2010; nearly 21 000 children every day. Three-quarters of these deaths were concentrated in just two regions of the world: 46% in the African Region and 28% in South-East Asia. More than half of all child deaths were clustered in only six countries: India, Nigeria, Democratic Republic of the Congo, Pakistan, China, and Ethiopia. Regionally, the highest child mortality rates were in Africa (119 deaths per 1000 live births) and in the Eastern Mediterranean Region (68 deaths per 1000 live births). The risk of a child dying in low-income countries before completing five years of age is nearly 18 times the average for developed regions. Within countries, under-five mortality is higher among children living in rural areas and in the poorest households.
Some 70% of the world’s under-five deaths in 2010 occurred in only 15 countries, and about half in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan and China. India (22%) and Nigeria (11%) together account for a third of under-five deaths worldwide.


Overall, substantial progress has been made towards achieving MDG 4. About 12 000 fewer children died every day in 2010 than in 1990, the baseline year for measuring progress. Improvement in child survival is evident in all regions. The number of countries with under-five mortality rates of 100 deaths per 1000 live births or higher has been halved from 52 in 1990 to 26 in 2010.
Globally, under-five mortality has decreased by 35%, from an estimated rate of 88 deaths per 1000 live births in 1990 to 57 deaths per 1000 live births in 2010. This decline translates into an average annual decrease in child mortality of 2.2%, which remains insufficient to achieve the MDG 4 target of reducing under-five mortality rates by two-thirds between 1990 and 2015. Numbers of under-five deaths have declined from 12.0 million in 1990 to 7.6 million in 2010. While progress has been made, it is unequally distributed. At the regional level, the decline in under-five mortality rates between 1990 and 2010 were more than 50% in three regions: Europe, the Americas and the Western Pacific Region. The highest observed average annual rates of reduction were seen in the European Region (4.4%), nearly three times higher than the rates observed in the African (1.8%) and in the Eastern Mediterranean (1.9%) regions.
As under-five mortality rates have fallen more sharply in richer developing regions, the disparity between Sub-Saharan Africa and other regions has grown. In 1990 a child born in Sub-Saharan Africa faced a probability of dying before age 5 that was 1.5 times higher than in Southern Asia, 3.2 times higher than in Latin America and the Caribbean, 3.7 times higher than in Eastern Asia and 11.8 times higher than in developed regions. By 2010 that probability was 1.8 times higher than in Southern Asia, 5.2 times higher than in Latin America and the Caribbean, 6.6 times higher than in Eastern Asia and 17.7 times higher than in developed regions. The disparity between Southern Asia and richer regions has also grown, though not as much.

Causes of death

58%of deaths in children under age five are caused by infectious diseases. Pneumonia is the largest single cause of death in under-fives. 


Globally, the four major killers of children under age five were pneumonia (18%), prematurity (16%: 14% during the neonatal period and 2% in the post-neonatal period), diarrhoeal diseases (11%), and birth asphyxia (10%: 9% during the neonatal period and 1% in the post-neonatal period). Malaria was still a major killer in Sub-Saharan Africa, causing about 15 percent of under-five deaths in the region.
Of the total 7.6 million children who died before 5 years of age, 4.4 million (58%) died of infectious diseases. Of all infections, pneumonia (1.4 million), diarrhoea (800 000) and malaria (563 000) were the leading causes of death, accounting together for 36% of all under-five deaths worldwide. The majority of these deaths can be prevented by known, simple, affordable and low cost interventions such as exclusive breastfeeding up to 6 months of age, immunization, appropriate use of antibiotics, oral rehydration therapy and zinc, insecticide treated bednets, and anti-malarials.
About 40% of deaths in children younger than 5 years occurred before 28 days of life – the neonatal period. The most important cause of death was preterm birth complications. Birth asphyxia and sepsis were the second and third major causes of death in this early period of life, responsible together for 1.2 million deaths. The risk of dying from these conditions can be mitigated with quality care during pregnancy, safe and clean delivery by a skilled attendant, and immediate postnatal care, including neonatal resuscitation, extra care of low birth weight babies, attention to baby warmth, treatment of neonatal sepsis and early initiation of breastfeeding.


Patterns of the distribution of causes of child deaths vary widely between regions. The lowest proportion of neonatal deaths (30%) occurred in the African Region. On the other hand 96% of all under-five deaths due to malaria and 89% of all deaths due to HIV/AIDS worldwide happened in the African Region. In the remaining five WHO regions, high proportions of under-five child deaths occurred during the neonatal period, ranging from 42% in the Eastern Mediterranean Region to 54% in the Western Pacific Region. The proportion of deaths from pneumonia is lowest in the Americas and Europe. Deaths due to diarrhoeal diseases were responsible for only 4% of deaths in these same regions.


The number of under-five deaths worldwide dropped from 12 million in 1990 to 9.6 million in the year 2000 to 7.6 in 2010. Nearly 60% of the 2 million lives saved in the past decade were due to reductions of deaths caused by pneumonia (455 000 fewer deaths), measles (363 000 fewer deaths), and diarrhoea (361 000 fewer deaths). India, Nigeria, Democratic Republic of the Congo, Pakistan, and China contributed to half the mortality attributable to infections and more than half due to neonatal causes worldwide.

Preventing under-five deaths

78%of children with suspected pneumonia are taken for treatment to an appropriate care provider. 

Situation and trends

Pneumonia is responsible for the deaths of about 1.4 million children under-five annually. Addressing the major risk factors for the illness (malnutrition and indoor air pollution), along with vaccination, is essential for preventing the occurrence of the disease. For deaths to be averted, good quality care is crucial. Vital treatment tools for pneumonia include antibiotics and oxygen.
Appropriate care of the sick child is defined as providers that can correctly diagnose and treat pneumonia. Recent surveys indicate that, worldwide, 78% of children under-five with symptoms of pneumonia are taken to an appropriate provider; in low-income countries, this coverage is 43%. Antibiotics have an essential role in reducing deaths due to pneumonia. In low-income countries, less than one-third (29%) of under-five children with symptoms of pneumonia receive this treatment. Although some 451 000 lives have been saved in the last decade due to the pneumonia deaths averted, estimates suggest that the number of lives saved could reach almost 1 million if both prevention and treatment interventions to reduce pneumonia were universally delivered. Children living in rural areas, poor children, and children with poorly educated mothers are less likely to be taken to appropriate care, as compared to children from urban areas, wealthier families, and those with more educated caregivers.
Some progress has been made in care seeking for pneumonia in recent years. However, accelerated and more aggressive efforts should be taken to scale up effective interventions. It is estimated that only 29% of children with pneumonia in low-income countries receive antibiotics for treatment. In some of these countries, coverage is as low as 10%. Nevertheless, progress is possible – countries such as Egypt and Colombia have been able to significantly increase antibiotic coverage in a relatively short period of time.
Source: WHO

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