The world's highest under-five mortality rate is in 

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    The global mortality rate for children younger than 5 has dropped by nearly half since 1990, the United Nations said Tuesday in an annual report on progress aimed at ensuring child survival, but the decline still falls short of meeting the organization’s goal of a two-thirds reduction by next year. Without accelerated improvements in reducing health risks to young children, the report said, that goal will not be reached until 2026, 11 years behind schedule.

    Nearly all of the countries with the highest mortality rates are in Africa, the report said, and two countries that are among the world’s most populous — India and Nigeria — account for nearly a third of all deaths among children younger than 5.

    A collaboration of Unicef, other United Nations agencies and the World Bank, the report provides a barometer of health care and nutrition in every country. A child mortality rate can be a potent indicator of other elements in a country’s basic quality of life.

    The report showed that the mortality rate for children younger than 5, the most vulnerable period, fell to 46 deaths per 1,000 live births last year, from 90 per 1,000 births in 1990. It also showed that the gap in mortality rates between the richest and poorest households had fallen in all regions over most of the past two decades, except for sub-Saharan Africa.

    The report attributed much of the progress to broad interventions over the years against leading infectious diseases in some of the most impoverished regions, including immunizations and the use of insecticide-treated mosquito nets, as well improvements in health care to expectant mothers and in battling the effects of diarrhea and other dehydrating maladies that pose acute risks to the young.

    “There has been dramatic and accelerating progress in reducing mortality among children, and the data prove that success is possible even for poorly resourced countries,” Dr. Mickey Chopra, the head of global health programs for Unicef, said in a statement about the report’s conclusions.

    Geeta Rao Gupta, Unicef’s deputy executive director, said, “The data clearly demonstrate that an infant’s chances of survival increase dramatically when their mother has sustained access to quality health care during pregnancy and delivery.”

    Despite the advances, from 1990 and 2013, 223 million children worldwide died before their fifth birthday, a number that the report called “staggering.” In 2013, the report said, 6.3 million children younger than 5 died, 200,000 fewer than the year before. Nonetheless, that is still the equivalent of about 17,000 child deaths a day, largely attributable to preventable causes that include insufficient nutrition; complications during pregnancy, labor and delivery; pneumonia; diarrhea; and malaria.

     While sub-Saharan Africa has reduced the under-5 mortality rate by 48 percent since 1990, the report said, the region still has the world’s highest rate: 92 deaths per 1,000 live births, nearly 15 times the average in the most affluent countries. Put another way, the report said, children born in Angola, which has the world’s highest rate — 167 deaths per 1,000 live births — are 84 times as likely to die before they turn 5 as children born in Luxembourg, with the lowest rate — two per 1,000.

    The report noted that “a child’s risk of dying increases if she or he is born in a remote rural area, into a poor household or to a mother with no education.”

From: www.nytimes.com Sept. 16, 2014