Fears that Have Refused to Go Away

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For most parents in sub-saharan Africa, the fear that theirchildren would die before reaching five years is still a nightmare
Child mortality is still prevalent in developing countries, despiteefforts made to improve the quality and reach of primary healthcare and their nutritional status. This is contained in the 2008State of the World's Children report released recently by theUnited Nations Children's Fund, UNICEF. According to the report,four million babies die each year in their first month of life andup to half of these die in their first 24 hours. Neonatal mortalityaccounts for almost 40 percent of all under-five deaths and fornearly 60 percent of infant (under-one) deaths.
The highest national rates of neonatal mortality occur inSub-Saharan Africa where one in every six children dies before agefive. The region alone has shown the least progress since 1990,managing to reduce the burden of child mortality by only 14 percentbetween 1990 and 2006. A number of countries in the region arestill registering increases in under-five mortality rates.
In 2006, 49 percent of all deaths of children under age fiveoccurred in sub-Saharan Africa, despite the fact that only 22percent of the world's children are born there. A common factor inthese deaths is the health of the mother. Each year more than500,000 women die in childbirth or from complications duringpregnancy. And babies whose mothers have died during childbirthhave a much greater chance of dying in their first year, than thosewhose mothers remain alive. Even these figures understate the vastscale of the problems that affect child health during the neonatalperiod. For example, more than a million children who survive birthasphyxia each year, go on to suffer such problems as cerebralpalsy, learning difficulties and other disabilities. For everynewborn baby who dies, another 20 suffer birth injury,complications arising from pre-term birth or other neonatalconditions.
The report also said that a significant portion of the neonataldeaths are caused by severe infections such as pneumonia and sepsis(a serious blood-borne bacterial infection that is also treatedwith antibiotics). Diarrhoeal diseases account for 17 percent ofunder-five deaths. Malaria, measles and HIV/AIDS, all together, areresponsible for 15 percent of child deaths. Again, many conditionsand diseases interact to increase child mortality beyond theirindividual impacts, with under nutrition contributing up to 50percent of child deaths. Unsafe water, poor hygiene practices andinadequate sanitation are not only the causes of the continued highincidence of diarrhoeal diseases, they are a significantcontributing factor in under-five mortality caused by pneumonia,neonatal disorders and under-nutrition.
Of concern are the countries that have registered scant progresssince 1990 or have an under-five mortality rate that is stagnant orhigher than it was in 1990. Of the 46 countries in sub-SaharanAfrica, only Cape Verde, Eritrea and Seychelles are on track tomeet Millennium Development Goals, MDG (4) and nearly half thecountries have registered either no change or an increase in childmortality rates since 1990. The world over, Sierra Leone, Angolaand Afghanistan occupy the first second and third ranks,respectively, in under-five mortality rate. Nigeria occupies the12th position. Apart from Afghanistan, African countries occupy thefirst 38 positions. The region as a whole only managed to reducechild mortality at an average annual rate of one percent from1990-2006 and double-digit reductions will be needed during each ofthe remaining years, if it is to meet MDG (4). The MDG (4) targetsto reduce by two-thirds, under-five mortality rate between 1990 and2015.
The report further said that pneumonia kills more children than anyother disease - more than HIV/AIDS, malaria and measles combined.It is a major cause of child deaths in every region. Children withpneumonia may exhibit a wide range of symptoms, depending on ageand cause of the infection. Common symptoms include rapid ordifficult breathing, cough, fever, chills, headaches, loss ofappetite 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 havemajor overlaps in terms of symptoms, the requirements for theireffective management and the feasibility of providing care in thecommunity. In effect, especially in very young children, it may beimpossible 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 thatprotect their lungs from the pathogens that cause pneumonia.Under-nourished children, particularly those who are notexclusively breastfed or have inadequate zinc intake, or those withcompromised immune systems, run a higher risk of developingpneumonia. Children suffering from other illnesses, such asmeasles, or those living with HIV, are more likely to developpneumonia. Environmental factors, such as living in crowded homesand being exposed to parental smoking or indoor air pollution, mayalso play a role in increasing children's susceptibility topneumonia and its consequences. Prevention is, therefore, seen asimportant than cure in reducing child deaths from pneumonia. Thekey preventive measures for children are adequate nutrition(including exclusive breast feeding, vitamin A supplementation andzinc intake), reduced indoor air pollution, and increasedimmunisation rates with vaccines that help prevent children fromdeveloping infections that directly cause pneumonia, such ashaemophilus influenzae type b.
On HIV, the UNICEF report said that sub-Saharan Africa accounts foralmost 90 percent of paediatric HIV infections. It also said thatworldwide, 2.3 million children under age 15 are living with HIVand nearly 530,000 children were newly infected with the virus in2006 - mostly through mother-to-child transmissions. Girls are atparticular risk of contracting HIV, both because of theirphysiology and because of social and cultural imbalances in theirrelationships with men and boys. It pointed out that once apregnant woman is infected with HIV, there is a 35 percent chancethat without intervention, she will pass the virus on to hernewborn during pregnancy, birth or breast feeding. As regardstreatment, antiretroviral drug therapy can greatly reduce thechances that transmission will occur and is essential to stemmingthe rise in child mortality rates in countries where AIDS hasreached 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 saidthat in developing countries, one in five persons do not use safewater and roughly half are without adequate sanitation. Therepercussions, it said, are often deadly. For example, the numberof children under five worldwide, dying from diarrhea is estimatedat almost two million per year. An estimated 88 percent of diarrheadeaths are attributed to poor hygiene practices, unsafe drinkingwater supplies and inadequate access to sanitation.
The report said that empowering women especially at the communitylevel, is essential both to lowering the number of deaths amongchildren under five and to reaching MDG (5), which aims to reducematernal mortality by three quarters by 2015. Yet the low status ofwomen in many societies and their limited decision-making powerwithin the household, often present serious challenges to achievingsignificant progress in either area.
In Nigeria, Burkina Faso and Mali, almost 75 percent of therespondents said that their husbands alone make decisions aboutwomen's health care. It said that interventions that have enhancedwomen's empowerment and leadership at the community level were beenimportant in improving the health status of women and children. Forexample, in Ghana, the prevalence of guinea worm disease, which isspread 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 providedcommunity education. As a result, incidence of the disease fell by36 percent between 2002 and 2003.
The State of the World Children report, is UNICEF's flagshippublication on children in the world. It is a barometer formeasuring how countries are treating children. It is an advocacytool used in calling for action on behalf of children in the world.It is published yearly.