An estimated 8.8 million children worldwide die before their fifth birthday, with most deaths caused by preventable diseases, a new World Health Organisation report shows writes Rita Mu.

Lancet report shows preventable diseases like pneumonia and diarrhoea are killing children. Image: Irena

The report, published earlier last month in medical journal, The Lancet, showed 68 per cent of deaths of children under the age of five were caused by infectious diseases in 2008.

Pneumonia, at 18 percent, was the highest cause of death , followed by diarrhoea at 15 percent, and malaria with 8 percent.

The report found 41 percent of deaths most commonly occurred in neonates, with birth complications, birth asphyxia and sepsis (blood or other tissue poisoning) the most common single causes.

Author of the report, Professor Robert Black, from Johns Hopkins Bloomberg School of Public Health in the US, said pneumonia has been one of the main causes of child deaths for a long time.

“Historically pneumonia was the largest cause of death in what are now low mortality countries and continues to be in high mortality countries,” he said.

“Young children do not have immunity to the pathogens that cause pneumonia and are at risk of serious infection. This risk of severe disease is increased if children are undernourished.”

Of the 193 countries investigated in the report, half of the deaths of children under the age of five occurred in five countries: India; Nigeria; Democratic Republic of the Congo; Pakistan and China. In the Western Pacific, child deaths were concentrated in China, Philippines and Vietnam. Australia was one of the countries with the least number of deaths in the Western Pacific.

The results of the study were collected by the Inter-agency Group for Child Mortality Estimation, which consists of representatives from the World Health Organisation (WHO), United Nations Children’s Fund (UNICEF), UN Population Division, World Bank and academic institutions.

The study, funded by the WHO, UNICEF and the Bill & Melinda Gates Foundation, was used to assess the progress of the UN Millennium Development Goal 4 (MDG 4), a global effort to reduce mortality of children younger than five years of age by two-thirds between 1990 and 2015.

A separate study comparing the levels and trends in under-five child mortality between 1990 and 2008, also published in The Lancet, revealed the global mortality rate of children under the age of five years in 2008 (8.8 million deaths) had declined by 28 per cent since 1990 (12.5 million deaths) despite a continuous increase in the population of children under five years of age.

Olivia Lawe–Davies from the Department of Child and Adolescent Health and Development of the WHO, said HIV/AIDS is the likely reason to why the highly concentrated regions are off-track to achieve MDG 4.

“Often the countries making the least progress are those affected by high levels of HIV/AIDS, economic hardship or conflict. In many developing countries, one-quarter of pregnant women do not receive a single antenatal care visit from a skilled health professional,” she said.

“Other reasons for being off-track include the limited impact that has been made in addressing determinants of ill health such as malnutrition, unsafe and unhealthy environments, and low levels of access to and utilization of quality health care services.”

Lawe-Davies said there is still a lot more to do to reach MDG 4.

“Progress towards the health MDGs is being made, but it is unequal and fragile.

“Child health is improving, but serious challenges remain. Still, about two-thirds of child deaths are preventable through access to practical, low-cost interventions, and effective primary care. Stronger health systems are crucial for improving access to care and prevention,” she said.

Latin America/Caribbean and Central and Eastern Europe and the Commonwealth of Independent States regions had the greatest progress, with more than 50 per cent reduction in under-five child mortality between 1990 and 2008.

The best performing countries with 4.5 per cent or higher annual rates of decline in under-five child mortality were:

• Nepal
• Bangladesh
• Eritrea
• Lao People’s Democratic Republic (Laos)
• Mongolia
• Boliviali
• Malawi

The average annual rate of decline of under-five child mortality worldwide has increased from 1.4 per cent between 1990 and 2000 to 2.3 per cent decline between 2000 and 2008.

According to the report, the increased rate of decline corresponds to the introduction of insecticide-treated bed nets for malaria, prevention of mother-to-child transmission and paediatric HIV, and the introduction of vaccines such as the Haemophilus influenzae type B vaccine (or Hib vaccine) to treat diseases such as pneumonia and meningitis. Further progress on measles, tetanus, and vitamin A supplementation in the last two decades are also likely reasons for the decline.

Dr Kristine Macartney, deputy director at the National Centre for Immunisation Research and Surveillance said since the introduction of Hib vaccines, the number of children dying from diseases such as pneumonia and meningitis has declined.

“A vaccine to prevent infections such as pneumonia from the seven most common strains of the pneumococcal bacteria has been available in developed countries for around a decade now…Vaccines that cover even more types (strains of the bacteria) – up to 13 types – are also now being registered for use in many developed countries,” she said.

“Prior to the introduction of immunisation, Hib was the most common cause of bacterial meningitis in Australian children. However, since the introduction of Hib capsular polysaccharide-protein conjugate vaccines, the incidence of invasive Hib disease has declined dramatically.”

According to the report, with less than five years to reach MDG 4 there is a demand for frequently updated national data on the causes of child mortality to guide national and global programmatic priorities and research.

Lawe-Davies said to continue to reduce the rate of mortality of children under five years of age and meet the “ambitious, but achievable” MDG 4, more investment is needed from public and private partners worldwide.

An estimated US$ 50 billion is needed to reach MDG 4, according to Lawe-Davies.

“There is an urgent need to increase investment in the health of women and children, to scale-up existing interventions delivered through effective, community-based health services and to align financial and technical support with the national health policy and strategy,” she said.

“The launch of the International Health Partnership Plus, the related Global Campaign for the Health MDGs, and several large bilateral donor pledges in recent months are important steps in the right direction.”