As part of The Lancet's Millennium Development Goals special issue, UNICEF is publishing the latest (2009) UN estimates of child mortality, which tell of great progress in many regions of the world. Unfortunately, the planet as a whole is not on target to meet MDG4, of reducing mortality in children aged under 5 years by two thirds between 1990 and 2015.
Highlights from the estimates:
- Globally, the number of deaths among children under age 5 has fallen from 12.4 million in 1990 to 8.1 million in 2009. This means that more than 22,000 children under 5 die each day― 12,000 fewer than in 1990.
- Since 1990 the global under-5 mortality rate has fallen by a third― from 89 deaths per 1000 live births in 1990 to 60 in 2009. All regions except sub-Saharan Africa, southern Asia, and Oceania have seen reductions of at least 50%.
- Northern Africa and eastern Asia have made the most progress in reducing child mortality, by 68% and 58% respectively.
- 10 countries with under-5 mortality above 40 per 1000 live births reduced their rate by at least half, with Bangladesh, Eritrea, Laos, Madagascar, Nepal, and Timor-Leste recording at least a 60% reduction.
- In sub-Saharan Africa one in every eight children (129 per 1000 livebirths) dies before his or her 5th birthday. This is double the average for developing regions (66 per 1000) and around 20 times that of high-income countries combined (6 per 1000).
- The number of countries with under-5 mortality of 100 per 1000 live births or more is down from 52 in 1990 to 31 in 2009. All these 31 countries are in sub-Saharan Africa.
- However, there are encouraging findings from sub-Saharan Africa. Four of the ten countries with more than a 50% reduction in under-5 mortality between 1990 and 2009 are located in sub-Saharan Africa, as are five of the six countries with a reduction of more than 100 deaths per 1000 live births. Nearly half of world's under-5 deaths occurred in only five countries: India, Nigeria, Democratic Republic of Congo, Pakistan, and China.
- Countries that have made the most progress, especially in sub-Saharan Africa, have seen rapid expansion of basic public health and nutrition interventions, such as immunisation, breast feeding, vitamin A supplementation, and safe drinking water. But coverage of interventions against malaria, diarrhoea, and malaria—which cause more than half of the under-5 deaths in sub-Saharan Africa—remain low.
- In southern Asia, more than half of under-5 deaths are in the neonatal period, ie, aged 28 days or younger. Solutions such as the Janani Suraksha Yojana programme in India, which direct women to centres with skilled birth attendance, need to be expanded to reduce this burden.
- Undernutrition is an underlying cause of at least a third of all under-5 deaths and improved coverage of specific nutrition interventions, such as early and exclusive breastfeeding, will reduce not only undernutrition but also the prevalence of pneumonia and diarrhoea.
Continued progress and acceleration of declining child mortality will require more investment and innovation, especially in the three regions that are not currently on track to achieve MDG 4: sub-Saharan Africa, southern Asia, and Oceania.
Media enquiries for UNICEF to Christopher de Bono, UNICEF Chief of Media, UNICEF HQ New York. T) 1-212 303 7984 / (cell) 1-646 209 1590. E) cdebono@unicef.org
For full Comment, see: http://press.thelancet.com/childmort.pdf
Note to editors: Generating accurate estimates of under-5 mortality poses a considerable challenge because of the limited data available for many developing countries. In response, experts at UNICEF, WHO, the World Bank, the UN Population Division (UNPD), and members of the academic community formed the Inter-agency Group for Child Mortality Estimation (IGME).
To meet MDG4, the required reduction is two thirds between 1990-2015, which translates to an Average Annual Rate of Reduction (AARR) of 4.4%. Countries with mortality rates of 40 or higher are on-track if their AARR is equal to or greater than 4.0%. The reason the threshold is set at 4.0% rather 4.4% is to allow for the margins of uncertainty around the estimates. All countries with mortality lower than 40 per 1,000 live births are also considered to be on track.
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