Over the past two decades, Eastern and Southern Africa, together with the rest of the world, has achieved a significant decline in under-five mortality. In 1990, 1 in 6 children died before their fifth birthday; by 2012, this number had dropped to 1 in 13, a more than 50 per cent decline.
In fact, in the past several years, ESA has been among the best performing regions in the world. Countries such as Ethiopia, Malawi and Tanzania have already reduced the under-five mortality rate by two-thirds or more. Together with other low-income countries in the region, Madagascar, Mozambique, South Sudan, Uganda and Zambia, they have all achieved reductions, in absolute terms, of more than 100 deaths per 1,000 live births.
Despite these successes, ESA still has high rates of mortality. Out of the 20 countries with the highest under-five mortality in the world, five are in this region: Angola, Burundi, Lesotho, Somalia and South Sudan, with 14 in West and Central Africa, and one in Asia. High levels of fertility have also led to a rather gradual decrease in the absolute number of child deaths, from 1.7 million in 1990 to 1.2 million in 2012.
Across the region, children continue to die from causes that can be easily prevented. More than 40 per cent of child deaths were caused by pneumonia (17 per cent), malaria (14 per cent), or diarrhea (10 per cent). Undernutrition is also a big killer, contributing to nearly half of all under-five deaths.
At the same time, disparities in child survival persist. Children born in the poorest households are almost twice as likely to die before the age of five as children in the wealthiest households. Young children born in a rural area or to a mother who has very little or no education are also at greater risk of dying.