Data released today by UNICEF and the United Nations Inter-agency Group for Child Mortality Estimation show that the number of children under the age of 5 dying globally has dropped from nearly 12 million in 1990 to an estimated 6.9 million in 2011.
The report combines mortality estimates with insights into the top killers of children under 5 and the high-impact strategies that are needed to accelerate progress.
Fighting disease is largely credited for achievements over the past two decades. About 14,000 fewer children under 5 die each day than was the case 21 years ago – chiefly because of huge strides in tackling polio, measles and malaria.
However, despite the millions of lives saved, almost 19,000 children under 5 still die every day from diseases that are preventable.
Accordingly, UNICEF and partners place a heavy focus on preventable disease.
"We're concentrating our energies much more on the countries where the biggest challenges remain. We're re-focusing on the killers of children that haven't received enough attention yet," says UNICEF Chief of Health Ian Pett.
Those killers include pneumonia, which contributes to 18 per cent of deaths of children under 5, and diarrhoea, which is responsible for 11 per cent.
A malnourished girl sits beside her mother, who prepares a meal in their home in Sullineabad Village, Bihar State, India. An estimated 29 per cent of children in the village suffer from severe acute malnutrition.
Vulnerable regions and vulnerable populations The report shows that all regions of the world have seen a marked decline in under-5 mortality since 1990. Neither a country's regional affiliation nor economic status need be a barrier to reducing child deaths; low-, medium- and high- income countries all have made tremendous progress in lowering their under-5 mortality rates.
But under-5 deaths are increasingly concentrated in sub-Saharan Africa and South Asia. One in every nine children in sub-Saharan Africa dies before reaching the age of 5. And progress in lowering child mortality rates lags behind among disadvantaged and marginalized people, around the world. Undernutrition is a factor in one third of all under-5 child deaths.
If disease and undernutrition are to be tackled successfully, broader issues such as water supply, sanitation and hygiene and education will also have to be addressed.
"It's important that, in all countries, we continue to target the most vulnerable populations," Mr. Pett says. "This isn't just in delivering health services; it's also focusing on the major determinants of health outcomes, such as the mother's education, good communications, good infrastructure and good governance."
Delivering on A Promise Renewed
The report provides further impetus for a renewed global movement to end preventable child deaths. In June of this year, the major conference Child Survival, A Call to Action called for governments and partners to sign A Promise Renewed, a pledge to work toward greater child survival. A Promise Renewed is part of the United Nations Every Woman Every Child movement launched by Secretary-General Ban Ki-moon.
Already, 114 nations – more than half the countries in the world – have signed the pledge, along with 174 civil society organizations and more than 250 leaders from faith-based groups.
Mr. Pett is encouraged by what he calls "enormous political buy-in". "There's still a long, long way to go," he says. "Our ambition is to see no country having an under-5 mortality rate of greater than 20 per 1,000 live births anywhere in the world, and we're halfway there."
UNICEF Executive Director Anthony Lake says, "The global decline in under-5 mortality is a significant success that is a testament to the work and dedication of many, including governments, donors, agencies and families. But there is also unfinished business: Millions of children under 5 are still dying each year from largely preventable causes for which there are proven, affordable interventions."
He stresses, "These lives could be saved with vaccines, adequate nutrition and basic medical and maternal care. The world has the technology and know-how to do so. The challenge is to make these available to every child."