Child survival: a message of hope but a call for renewed commitment in UNICEF report

Abstract

A recent UNICEF report Committing to Child Survival: A Promise Renewed Progress Report 2013 presents a comprehensive analysis of levels and trends in child mortality and progress towards MDG 4. The global under-five mortality rate has been cut nearly in half (47%) since 1990. However, during this same period, 216 million children are estimated to have died before their fifth birthday. Most of these deaths were from leading infectious diseases such as pneumonia, diarrhoea or malaria, or were caused by preventable neonatal causes such as those related to intra-partum complications. The highest mortality rates in the world are observed in low-income countries in sub-Saharan Africa and South Asia. Sub-Saharan Africa faces a particular challenge in that it not only has the highest under-five mortality in the world but it also has the fastest population growth. Progress is possible, however, and sharp reductions in child mortality have been observed at all levels of national income and in all regions. Some of the world's poorest countries in terms of national income have made the strongest gains in child survival. Within countries, new analysis suggests that disparities in under-five mortality between the richest and the poorest households have declined in most regions of the world, with the exception of Sub-Saharan Africa. Furthermore, under-five mortality rates have fallen even among the poorest households in all regions. The report highlights the growing importance of neonatal deaths; roughly 44% of global under-five deaths - now 2.9 million a year - occur during the neonatal period, with up to 50% dying during their first day of life and yet over two-thirds of these deaths are preventable without intensive care. The report stresses how a continuum of care approach across the whole life cycle is the most powerful way of understanding and accelerating further progress.

Figures

Figure 1

Declines in under-five mortality have saved millions of lives worldwide. Number of under-five deaths, 1990–2012 and projected 2013–2028.

Figure 2

Many low income countries have made significant progress in reducing child deaths. Decline in under-five mortality rate, 1990–2012 and GDP per capita in 2012.

Figure 3

Countries with high levels of child marriage tend to have high levels of early child bearing. % of women aged 20–24 who were first married or in union by age 18 and % of women aged 20–24 who gave birth by age 18, in selected countries with available data, 2005–2011.