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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 22; 335(7620): 580.
PMCID: PMC1988986

Mortality among under 5s falls below 10 million for first time

The annual number of deaths of children aged 5 years or younger reached a record low last year, says Unicef, falling for the first time to less than 10 million—to 9.7 million, down from 12.7 million in 1990.

“More children are surviving today than ever before. Now we must build on this public health success to push for the achievement of the millennium development goals,” said Unicef's chief, Ann Veneman. But she also said that there is no room for complacency.

“The loss of 9.7 million young lives each year is unacceptable. Most of these deaths are preventable—and, as recent progress shows, the solutions are tried and tested,” she added.

Of the 9.7 million children who died in 2006, 4.8 million were from sub-Saharan Africa and 3.1 million from south Asia, the figures show. West and Central Africa had the highest death rates, with 186 deaths per 1000 children aged under 5, whereas the figure in rich industrialised nations is six per 1000.1000.

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The findings also show that China and India have achieved big reductions in child mortality, as have countries in Latin America and the Caribbean, but that previous gains have been reversed in southern African nations with a high prevalence of HIV and AIDS and in countries with current or recent armed conflicts, such as Sierra Leone, Sudan, and the Democratic Republic of the Congo.

Some of the progress in reducing child mortality has resulted, Unicef says, from the greater application of known basic health interventions. These include immunisation against measles, exclusive breast feeding, vitamin A supplementation, the use of bed nets treated with insecticide, and the treatment of malaria, pneumonia, diarrhoeal diseases, severe malnutrition, and HIV and AIDS.

Unicef estimates that achieving the millennium development goal of reducing child mortality by two thirds between 1990 and 2015 would “avert an additional 5.4 million child deaths by 2015.”

Peter Salama, Unicef's chief medical officer, said that the results so far were a cause for optimism and that the millennium development goals could be met. He said, “The reason is that not only have we gone below the 10 million barrier for the first time but we're also seeing more regions making progress—admittedly some more than others.

“We're seeing some very poor countries, such as Ethiopia, Mozambique, Malawi, Madagascar, Nepal, and Bangladesh, actually making tremendous progress, proving that these goals are actually quite feasible. So what we need to do is to learn from these success stories and replicate them in other countries.”

He said that Unicef viewed the findings as “a tipping point.” Other data that Unicef would be publishing in the next few months showed that the key interventions were “all going in a positive direction.”

“We're not only going to see progress actually maintained, but we are going to see an acceleration in the goals towards child survival,” Dr Salama predicted.

The results draw on findings from demographic household surveys and multiple indicator cluster surveys conducted in over 50 countries during 2005-6, Unicef said.

The data also show that in 2006 neonatal causes accounted for 3.6 million deaths among children aged under 5. Pneumonia accounted for 1.8 million deaths, diarrhoeal diseases for 1.6 million, malaria for 780 000, measles for 390 000, and AIDS for 290 000.

The lack of antibiotics to treat acute respiratory infections is something Unicef is trying to rectify, Dr Salama said. This was particularly true at the community level, he said. “Most children who are dying from pneumonia actually don't make it to a facility, so they die at home. It is important that we have . . . a system for getting [antibiotics] to the most peripheral and underserved populations.”


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