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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 December 15; 335(7632): 1227.
PMCID: PMC2137065

Diarrhoeal diseases still kill more than 1.5m children under 5 each year

The number of children under 5 dying each year has fallen to below 10 million for the first time, but a lack of sanitation is still causing many unnecessary deaths, a new report from Unicef revealed this week.

A new statistical review launched to coincide with the United Nations General Assembly’s special session for children, 10-12 December, has published detailed figures on child health worldwide in four categories: health, HIV/AIDS, education, and the protection of children.

Progress for Children gives the latest global, national, and regional statistics on how the world is progressing towards achieving the millennium development goals (MDGs) and the child specific targets set out at the previous special session five years ago.

In 2006, for the first time, the annual global deaths of children under 5 have fallen below 10 million, to 9.7 million—a 60% reduction since 1960. Overall, in most regions, in addition to improvement in child survival rates, progress has also been made in education, gender equality, and child protection.

However, a lack of basic sanitation, along with poor hygiene and unsafe drinking water, still contribute to the deaths of more than 1.5 million children from diarrhoeal diseases each year. The report shows that in 2004, 41% of the world’s population—2.6 billion people—did not have access to adequate sanitation facilities. The year 2008 has been declared the International Year for Sanitation.

Half a million women still die each year from problems relating to pregnancy and childbirth, and pneumonia kills more children than any other illness—“more than AIDS, malaria and measles combined,” according to Unicef. Little progress has been made in increasing the number of under 5s with suspected pneumonia who are taken to health providers for treatment.

Sub-Saharan Africa is the region most clearly lagging behind in progress toward the millennium development goals. For example, the lifetime risk of maternal death is 1 in 22 in sub-Saharan Africa, compared with 1 in 8000 in industrialised countries.

Dr Peter Salama, Unicef’s chief of health, told the BMJ that the 20 countries with the highest under 5 mortality had a high prevalence of either conflict or HIV. In terms of redressing the gap, he noted that progress has been greatest in interventions that require the least formal infrastructure, such as recent outreach programmes to supply insecticide treated bed nets alongside childhood immunisation campaigns. Indicators for interventions dependent on well functioning health systems, such as infectious disease control, show the least success.

Pointing to new British and international initiatives to strengthen health systems in developing countries, Dr Samara maintains that “there is no longer a debate between supporting horizontal and vertical health care.”

It’s now clear that both extending outreach—as in Ethiopia’s innovative new scheme in training 20 000 village health assistants—and strengthening secondary and tertiary structures are needed if Africa’s health problems are to be adequately addressed.


Progress for Children: A World Fit for Children Statistical Review is available at

Articles from The BMJ are provided here courtesy of BMJ Publishing Group