Fears that Have Refused to Go Away

For most parents in sub-saharan Africa, the fear that their children would die before reaching five years is still a nightmare

Child mortality is still prevalent in developing countries, despite efforts made to improve the quality and reach of primary health care and their nutritional status. This is contained in the 2008 State of the World's Children report released recently by the United Nations Children's Fund, UNICEF. According to the report, four million babies die each year in their first month of life and up to half of these die in their first 24 hours. Neonatal mortality accounts for almost 40 percent of all under-five deaths and for nearly 60 percent of infant (under-one) deaths.

The highest national rates of neonatal mortality occur in Sub-Saharan Africa where one in every six children dies before age five. The region alone has shown the least progress since 1990, managing to reduce the burden of child mortality by only 14 percent between 1990 and 2006. A number of countries in the region are still registering increases in under-five mortality rates.

In 2006, 49 percent of all deaths of children under age five occurred in sub-Saharan Africa, despite the fact that only 22 percent of the world's children are born there. A common factor in these deaths is the health of the mother. Each year more than 500,000 women die in childbirth or from complications during pregnancy. And babies whose mothers have died during childbirth have a much greater chance of dying in their first year, than those whose mothers remain alive. Even these figures understate the vast scale of the problems that affect child health during the neonatal period. For example, more than a million children who survive birth asphyxia each year, go on to suffer such problems as cerebral palsy, learning difficulties and other disabilities. For every newborn baby who dies, another 20 suffer birth injury, complications arising from pre-term birth or other neonatal conditions.

The report also said that a significant portion of the neonatal deaths are caused by severe infections such as pneumonia and sepsis (a serious blood-borne bacterial infection that is also treated with antibiotics). Diarrhoeal diseases account for 17 percent of under-five deaths. Malaria, measles and HIV/AIDS, all together, are responsible for 15 percent of child deaths. Again, many conditions and diseases interact to increase child mortality beyond their individual impacts, with under nutrition contributing up to 50 percent of child deaths. Unsafe water, poor hygiene practices and inadequate sanitation are not only the causes of the continued high incidence of diarrhoeal diseases, they are a significant contributing factor in under-five mortality caused by pneumonia, neonatal disorders and under-nutrition.

Of concern are the countries that have registered scant progress since 1990 or have an under-five mortality rate that is stagnant or higher than it was in 1990. Of the 46 countries in sub-Saharan Africa, only Cape Verde, Eritrea and Seychelles are on track to meet Millennium Development Goals, MDG (4) and nearly half the countries have registered either no change or an increase in child mortality rates since 1990. The world over, Sierra Leone, Angola and Afghanistan occupy the first second and third ranks, respectively, in under-five mortality rate. Nigeria occupies the 12th position. Apart from Afghanistan, African countries occupy the first 38 positions. The region as a whole only managed to reduce child mortality at an average annual rate of one percent from 1990-2006 and double-digit reductions will be needed during each of the remaining years, if it is to meet MDG (4). The MDG (4) targets to reduce by two-thirds, under-five mortality rate between 1990 and 2015.

The report further said that pneumonia kills more children than any other disease - more than HIV/AIDS, malaria and measles combined. It is a major cause of child deaths in every region. Children with pneumonia may exhibit a wide range of symptoms, depending on age and cause of the infection. Common symptoms include rapid or difficult breathing, cough, fever, chills, headaches, loss of appetite and wheezing. In young infants, severe cases of pneumonia, can cause convulsions, hypothermia, lethargy and feeding problems. According to the report, in childhood, pneumonia and malaria have major overlaps in terms of symptoms, the requirements for their effective management and the feasibility of providing care in the community. In effect, especially in very young children, it may be impossible to tell whether high fever, coughing and fast breathing, is evidence of either pneumonia or malaria and in such cases, children often receive treatment for both.

It also said that healthy children have natural defences that protect their lungs from the pathogens that cause pneumonia. Under-nourished children, particularly those who are not exclusively breastfed or have inadequate zinc intake, or those with compromised immune systems, run a higher risk of developing pneumonia. Children suffering from other illnesses, such as measles, or those living with HIV, are more likely to develop pneumonia. Environmental factors, such as living in crowded homes and being exposed to parental smoking or indoor air pollution, may also play a role in increasing children's susceptibility to pneumonia and its consequences. Prevention is, therefore, seen as important than cure in reducing child deaths from pneumonia. The key preventive measures for children are adequate nutrition (including exclusive breast feeding, vitamin A supplementation and zinc intake), reduced indoor air pollution, and increased immunisation rates with vaccines that help prevent children from developing infections that directly cause pneumonia, such as haemophilus influenzae type b.

On HIV, the UNICEF report said that sub-Saharan Africa accounts for almost 90 percent of paediatric HIV infections. It also said that worldwide, 2.3 million children under age 15 are living with HIV and nearly 530,000 children were newly infected with the virus in 2006 - mostly through mother-to-child transmissions. Girls are at particular risk of contracting HIV, both because of their physiology and because of social and cultural imbalances in their relationships with men and boys. It pointed out that once a pregnant woman is infected with HIV, there is a 35 percent chance that without intervention, she will pass the virus on to her newborn during pregnancy, birth or breast feeding. As regards treatment, antiretroviral drug therapy can greatly reduce the chances that transmission will occur and is essential to stemming the rise in child mortality rates in countries where AIDS has reached epidemic levels. The report said that with proper care, infants who are HIV positive can remain healthy indefinitely, though their long term prospects for survival are unknown.

The report also touched on safe water and basic sanitation. It said that in developing countries, one in five persons do not use safe water and roughly half are without adequate sanitation. The repercussions, it said, are often deadly. For example, the number of children under five worldwide, dying from diarrhea is estimated at almost two million per year. An estimated 88 percent of diarrhea deaths are attributed to poor hygiene practices, unsafe drinking water supplies and inadequate access to sanitation.

The report said that empowering women especially at the community level, is essential both to lowering the number of deaths among children under five and to reaching MDG (5), which aims to reduce maternal mortality by three quarters by 2015. Yet the low status of women in many societies and their limited decision-making power within the household, often present serious challenges to achieving significant progress in either area.

In Nigeria, Burkina Faso and Mali, almost 75 percent of the respondents said that their husbands alone make decisions about women's health care. It said that interventions that have enhanced women's empowerment and leadership at the community level were been important in improving the health status of women and children. For example, in Ghana, the prevalence of guinea worm disease, which is spread by water and can incapacitate an infected person for months, required a comprehensive eradication campaign. Women volunteers, who were more familiar with the improved water sources than men, conducted door-to-door surveillance, distributed filters, identified potentially contaminated water supplies and provided community education. As a result, incidence of the disease fell by 36 percent between 2002 and 2003.

The State of the World Children report, is UNICEF's flagship publication on children in the world. It is a barometer for measuring how countries are treating children. It is an advocacy tool used in calling for action on behalf of children in the world. It is published yearly.

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