Jennifer Yang, Global Health reporter for the Toronto Star. Thursday September 12, 2013.

Innovations in health care delivery and political commitment credited for improved child survival.

Nearly half as many children under 5 are dying today compared to two decades ago, with 90 million deaths prevented since 1990, according to new estimates published by UNICEF and other international agencies.“I think we’re seeing a child survival revolution going on,” said David Morley, president and CEO of UNICEF Canada. “Fewer children are dying today than ever before in human history.”

These latest figures were published in two new reports, jointly released on Thursday by UNICEF, the World Health Organization, the World Bank and the UN Inter-agency Group for Child Mortality Estimation.
They estimate that in 2012, 6.6 million children died before the age of 5, or 18,000 deaths per day. While these numbers are still unacceptably high, they are a huge improvement from 1990, when 12.6 million children died before celebrating their fifth birthdays.

What’s changed over the last two decades? Chalk it up to cheaper and better treatments, innovations in health care delivery and sustained political commitment toward improving child survival, UNICEF deputy executive director Geeta Rao Gupta said in a telephone news conference.

Gupta noted that some of the world’s poorest countries have also defied expectations by making the biggest strides in improving child survival. Bangladesh, Nepal and Malawi, for example, have slashed their under-5 mortality rates by two-thirds or more since 1990 — thus achieving one of the Millennium Development Goals, a set of eight international targets established in 2000.

Despite the progress, there is an urgent need for more to be done, Gupta said. Only two regions (East Asia and Pacific and Latin America and the Caribbean) are on track to meeting the same millennium goal by the 2015 deadline.

Pneumonia and diarrhea continue to be the top killers of young children, collectively accounting for more than 4,600 deaths every day in 2012, according to the report.

“These statistics are all the more outrageous because so many of these deaths . . . are preventable,” Gupta said.

The first month of life is also the most dangerous and nearly 44 per cent of under-5 deaths now occur during the first 28 days. Last year, 2.9 million newborns died within a month of being born, according to the new estimates; roughly one million died on their very first day.

As survival rates continue to improve globally, 81 per cent of under-5 deaths are now concentrated in two regions: South Asia (which has actually seen the biggest reduction of under-5 deaths since 1990) and sub-Saharan Africa, which together account for four out of every five deaths under 5.

Sub-Saharan Africa has the world’s highest child mortality rates, with 98 deaths for every 1,000 babies born. (Canada, by comparison, has a rate of five deaths per 1,000 live births.) But even greater challenges loom: despite making the least progress, the region will have the world’s largest population of under-5 children by 2050.

Leading global health expert Dr. Zulfiqar Bhutta, the new co-director of Sick Kids’ Global Child Health centre, welcomes these updated estimates on child mortality.

He cautions, however, that they are largely based on projections. As the UNICEF report itself points out, less than 3 per cent of causes for under-5 deaths are medically certified and only 60 countries have registration systems for tracking data on child deaths.

Bhutta said he would like to see whether these new estimates are corroborated by two other groups expected to release child mortality estimates in early 2014.