Under-5 Mortality Drops to Record Low

By Christopher Lee
Washington Post Staff Writer
Thursday, September 13, 2007

The number of deaths worldwide among children under 5 dropped to a record low of 9.7 million in 2006, reflecting progress in areas such as malaria prevention, childhood immunizations and breastfeeding rates, global health officials said yesterday.

The new figure, based on surveys in more than 50 countries, represents a substantial decrease from the 20 million deaths in 1960, especially considering that the world's population has more than doubled to 6.6 billion people since then.

"To see under-5 mortality drop below 10 million for the first time is something that we think is worth noting," said Ann M. Veneman, executive director of UNICEF, which released the data. "The rate of child mortality has come down significantly over the years, particularly over the last half-decade, where we have really been applying a lot of the strategies to address the issues of child health."

Last year, there were 72 deaths of children under 5 for every 1,000 live births, compared with 93 deaths per 1,000 births in 1990 and 184 deaths per 1,000 births in 1960. Over the decades, that is a decline of more than 60 percent, UNICEF officials said. (In the United States, the under-5 mortality rate is about eight deaths per 1,000 live births.) Among the leading causes of mortality among children globally are diarrhea, pneumonia and malaria, as well as tetanus and other infections during the first 28 days of life. The frequency and deadliness of such illnesses is often influenced by poverty, poor nutrition and civil conflict.

Veneman attributed much of the gains to measures such as increased use of insecticide-treated bed nets in malaria-prone regions, better diarrhea treatment, wider measles immunization and, in the developing world, a rise to 37 percent in the proportion of women who feed their babies breast milk only, up from 33 percent in 1996. But the trend varied widely. Latin America, the Caribbean, Eastern Europe and East Asia saw rapid declines in death rates, but progress was less evident in parts of Asia and in sub-Saharan Africa, a region that accounts for about half of all deaths of children under 5.

In West Africa and Central Africa the mortality rate was 186 deaths per 1,000 live births, and in AIDS-ravaged eastern and southern Africa it was 131 deaths per 1,000 births.

"Over the past 10 to 15 years in most sub-Saharan African countries, there has been basically no discernable improvement in child mortality," said Ruth Levine, vice president of the Center for Global Development, a nonprofit research organization in Washington.

Many countries in the region have not seen substantial improvements in sanitation, childhood nutrition and access to clean water, and many still have inadequate public health systems, Levine said. Countries such as Sudan, Congo and Zimbabwe have been torn by civil conflict. Still, she said, a renewed focus and funding on malaria prevention, childhood immunizations and child services means things may turn around. "There is justified hope that things are improving now," she said. "But there are so many challenges, particularly in southern Africa where they are dealing with an AIDS pandemic."

Robert Black, chairman of the department of international health at Johns Hopkins University's Bloomberg School of Public Health, said it's worth remembering that South Asia -- Bangladesh, Nepal, India, Pakistan and Afghanistan -- has almost as big a child mortality problem as sub-Saharan Africa.

"And there AIDS is not the problem, even malaria is not much of a problem," Black said. "So, while we can always say AIDS is a problem -- and yes, it is -- the global problem is really these unresolved diseases like pneumonia and diarrhea, and under-nutrition."

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