UNICEF Calls for More Action to Halt Preventable Child Deaths Around the World

UNICEF Calls for More Action to Halt Preventable Child Deaths Around the World

The State of the World's Children 2008 Report Brings Attention Back to Child Survival

"The means are at hand. It is now a question of will and of action — for there is no enterprise more noble, or reward more precious than saving the life of a child."

— UNICEF, The State of the World's Children 2008

January 2008 — Twenty-five years ago, UNICEF's The State of the World's Children report launched the first "child survival revolution." Cataloguing a series of life-saving interventions, the report was a clear call to action on behalf of children dying from preventable and treatable diseases. UNICEF's The State of the World's Children 2008 report returns to the topic of child survival. The report documents the tremendous progress in children's health in recent decades, highlights the strategies and partnerships that have proven most effective, and outlines the challenges that remain. Like its predecessor a quarter century ago, The State of the World's Children 2008 makes clear that the most significant barriers do not require medical innovation, but political will and commitment.

On March 13, a House Foreign Affairs subcommittee will hold a hearing on child survival issues, including those addressed in UNICEF's report. For more information, please see the "Call to Action" section of this document.

Poor Countries Not on Track to Meet Child Health Goals

UNICEF reports that, for the first time, the number of children worldwide dying before reaching their fifth birthday dipped below 10 million, to 9.7 million. Between 1960, when approximately 20 million children did not live past the age of five, and 2006, child mortality rates fell by 60 percent. Despite this progress, more than 26,000 children under age five still die every day from largely treatable and preventable causes.

Much of the developing world is not on track to meet international goals for child survival. Millennium Development Goal (MDG) 4 — which the United States and every other nation pledged to achieve — calls for a two-thirds reduction in child mortality rates (from the 1990 level) by 2015. According to UNICEF's report, of the 60 poor countries that account for 93 percent of global child deaths, only seven are on track to meet MDG 4. The failure to achieve adequate progress is most acute in South Asia and Africa. Of the 46 countries in sub-Saharan Africa, only three are on track to meet MDG 4. Almost half have made no progress in child death rates since 1990.

Many children in developing countries die for want of basic medical attention for ailments rarely fatal in the developed world. One in five child deaths — 2 million annually — are due to pneumonia (see below), and diarrheal diseases account for nearly another 2 million. Forty percent of child deaths occur among newborns, most from severe infections, birth asphyxia (difficulty breathing), or complications due to preterm birth. Measles, malaria, and HIV/AIDS together account for 15 percent of child deaths.

The interventions necessary to prevent these deaths are well established. Essential newborn care, such as immunizing mothers against tetanus, clean delivery conditions, drying and wrapping a baby immediately after birth, promoting breastfeeding, immunization, and treating infections with antibiotics could save 1 million babies a year. A 2-cent capsule containing a vitamin A supplement given two to three times a year helps prevent blindness and death. An additional 500,000 children could be saved if all had access to this nutritional supplement. Providing insecticide-treated bed nets to families in malaria-ridden areas could prevent another million deaths a year.

Investing in child survival is critical to building a sustainable future. Not only will providing proper health care result in children around the world growing into productive, healthy members of society, but it will also result in improvements in maternal health and population dynamics. Families will have less children as the odds for survival increase, and can better care and provide for the children they do have.

Pneumonia: The Forgotten Killer

Pneumonia, perhaps more than any other disease, clearly illustrates both the tragedy and opportunity of child mortality. Pneumonia, UNICEF reports, kills more children than any other disease — more than AIDS, malaria, and measles combined. Children in developing countries often contract pneumonia as a direct result of their impoverished environment. Lack of proper nutrition, including micronutrients like vitamin A, and the nutrition-sapping effects of multiple bouts of diarrhea makes children more susceptible to diseases that are far less prevalent in the developed world. Also, UNICEF reports, living in crowded homes or being exposed to smoke from indoor cooking fires can also increase a child's odds of developing pneumonia.

When properly diagnosed, pneumonia can be treated inexpensively with antibiotics. UNICEF promotes a community-based approach to managing pneumonia, empowering families and caregivers to administer treatment according to advice from local health workers. An analysis of this strategy at sites in Tanzania and six other countries found a resulting 37 per cent decrease in child deaths due to pneumonia.

Success at the Community Level

In 1999, UNICEF reports, 47 percent of India's children under three were underweight. The causes, the report states, were largely due to "the inadequate knowledge of caregivers concerning correct infant and young child feeding, frequent infections worsened by bad hygiene, high population pressure, the low status of women and girls, and suboptimal delivery of social services." The Indian government instituted a strategy of providing basic healthcare to children through a network of community workers, but the quality of care provided by the workers was inconsistent.

UNICEF partnered with the Indian government to better train the workers in six states and 1,000 villages. After three years, more than 6 million patients were reached, and surveys were conducted to assess the impact of the program. More children were being breastfed, and vitamin A supplementation and immunization rates were higher. Undernutrition levels fell as well. All of this was achieved at a relatively low cost to the government — approximately US$150-$200 per village per year.

Although the program is still underway and more can be accomplished, these findings and developments show what an inexpensive, comprehensive, collaborative approach to child survival can achieve.

UNICEF Leading the Way in Africa

Further progress in child survival will require new and innovative approaches and a clear plan to deliver proven child survival interventions to the most vulnerable children. UNICEF recently launched an initiative concentrating on more than 16 million people in parts of 11 countries in West and Central Africa that have high under-five child death rates. The Accelerated Child Survival and Development (ACSD) program integrates low-cost, highly-effective interventions that dramatically improve child survival over a short period of time. ACSD provides an incredibly important global model not only in the impact it has shown is possible, but because it focuses on closely tracking results, and identifying and addressing bottlenecks in service delivery.

Working in partnership with the African Union, UNICEF has developed a strategic framework from rapidly scaling up primary health service coverage to reduce child mortality. Providing even a minimum package of high-impact, low-cost interventions could reduce under-five mortality by 30 percent. Implementation of a full package of services could reduce child mortality rates by more than 60 percent, and put countries on track toward meeting MDG 4.

U.S. Lacks Plan to Reach Child Survival Goal

Despite a pledge to work toward the Millennium Development Goals, the United States has no strategy to help achieve the global target of a two-thirds reduction in child mortality. While Congress has spared child survival funding from proposed cuts in recent years, funding remains well below estimates of the U.S. share of the global resource estimates.

Without a coherent strategy to reduce child deaths, the modest resources that are directed toward child survival are subject to budgeting decisions at odds with public health goals. In his budget justification for the 2008 fiscal year, President Bush proposed spending US$6.5 million on maternal and child health programs in Jordan, where some 4,000 children under age five die annually. In Ethiopia, however, which suffers nearly 100 times as many child deaths in a year, the president proposed a maternal and child health budget of just US$6 million. This would amount to $1,625 per child death in Jordan, and just over $15 in Ethiopia.

If the United States is to contribute meaningfully to the achievement of Millennium Development Goals stressed in UNICEF's The State of the World's Children  report, Congress must demand a comprehensive child survival strategy to guide budgeting decisions rationally according to disease burden.

A Call to Action

On March 13, the Africa and Global Health Subcommittee of the House Foreign Affairs Committee will hold a hearing on child survival. The hearing is expected to draw attention to a number of child survival issues, including the Child Survival Act. Members of Congress must address these critical issues in order to put the world on track to achieving MDG 4. The U.S. must develop a strategy to ensure child health funding is directed to the most effective interventions in the areas with the greatest need. The bipartisan U.S. Commitment to Global Child Survival Act, currently introduced in the House and Senate, would require a comprehensive strategy to reduce child mortality that prioritizes countries with the highest number and most severe rates of death. Congress should act on this legislation, ensure that the strategy is adequately funded.

The U.S. should also give direct support to UNICEF's innovative child survival programs, including the Accelerated Child Survival and Development program. UNICEF estimates that a minimum health package scaled up in Africa would cost about $1,000 per life saved. A modest U.S. investment of $100 million could potentially save 100,000 young lives next year, and prevent thousands more cases of permanent mental and physical disability due to severe illness.