BEING Born to die

DESPITE industrialised countries being on track to meet the Millenium Development Goal (MDG) 4 goals by reducing their under-5 mortality rate, many countries in Africa are lagging well behind, with one in seven children in sub-Saharan Africa dying before their fifth birthday.

In a sub-region of this region - west and central Africa - this was even higher, at one in six children, according to figures published in The Lancet.

Figures released by Unicef, based on the work of the inter-agency Group for Child Mortality Estimation, show that the overall average annual rate of reduction is much higher from 2000-2008 than it was 1990-2000.

However, the rate of decline is still grossly insufficient for the world overall to achieve MDG4.

The latest data, relating to 2008, has heightened concerns that many regions (and countries within them), are not on track to meet MDG4, which aims to reduce under-five mortality by two thirds between 1990 and 2015.

The highest under-five mortality rates continue to be in Africa, with 132 deaths per 1000 live births across the whole continent.

In sub-Saharan Africa, the rate is 144 deaths per 1000 live births. This is 24 times the rate in industrialised countries.

Africa reduced its under- five mortality rate by 21percent between 1990-2008 but this is not enough to reach MDG4. Asia has done better, reducing its own rate by 38percent, but also insufficient to reach MDG4.

The highest numbers of deaths also occurred in sub-Saharan Africa, with 4,4 million children under five dying during 2008 - half of the total world deaths.

Due to high fertility in this region, combined with high mortality, numbers of deaths have actually increased from 4million in 1990 to 4,4 million in 2008.

The authors highlight that the effect of interventions such as various vaccination programmes and insecticide-treated bed-nets, may have happened too recently to appear in the estimates.

Some other key findings are:

l The estimated global mortality for children under five in 2008 is 65 per 1000 live births, compared with 90 in 1990;

l ·Around 8,8 million children under five died during 2008, compared with 12,5 million in 1990;

l In 2008, around 10000 fewer children died every day, as compared to 1990 - the baseline year for the MDGs. Together, Africa (51percent) and Asia (42percent) represented 93percent of all deaths globally;

l In terms of progress towards MDG4, the best performing region is Latin America and the Caribbean, which has reduced under-five mortality by 56percent between 1990 and 2008, and is on track to meet MDG4;

l Ninety-nine percent deaths occurred in developing countries, with one percent in high-income countries.

Mortality in developing countries (71 deaths per 1000) was 12 times that in industrialised countries (6 per 1000);

l Under-five mortality is increasingly concentrated: 75percent of the world's under-five deaths in 2008 occurred in only 18 countries. Half of the deaths occurred in only five countries - India, Nigeria, Democratic Republic of Congo, Pakistan and China;

l At country level, the best performers (based on the average annual rate of reduction among countries with under-five mortality of 40 or higher) include Nepal, Bangladesh, Eritrea, Laos, Mongolia, Bolivia and Malawi - which have all consistently achieved annual rates of reduction of under-five mortality of 4,5percent or higher.

Additionally, Niger, Malawi, Mozambique and Ethiopia have achieved absolute reductions of more than a 100 per 1000 live births since 1990. These countries are providing proof of the concept that MDG4 is achievable, even in the poorest environments;

l Most of the recent survey data incorporated in these estimates generally reflect mortality over the preceding 3-5 years.

Thus the major improvements in coverage in recent years for insecticide-treated bednets for malaria, prevention of mother-to-child transmission and paediatric HIV, HiB vaccine and further progress on measles, tetanus, and vitamin A supplementation, for instance, might not yet be fully reflected in these mortality data.

Dr Danzhen You of Unicef in New York commented in The Lancet article: "Accelerated progress can be achieved, even in the poorest environments, through integrated, evidence-driven and community-based programmes that focus on addressing the major causes of deaths, including pneumonia, diarrhoea, newborn disorders, malaria, HIV and under-nutrition.

"(Progress can be achieved) reaching the unreached with a basic package of interventions, using data for action and advocacy." - Health-e News