Worldwide Death Rates Drop For Children

Global Death Rates Drop for Children 5 or Younger
The New York Times
By Denise Grady

Death rates in children under 5 are dropping in many countries at a surprisingly fast pace, according to a new report based on data from 187 countries from 1970 to 2010.

Worldwide, 7.7 million children are expected to die this year — still an enormous number, but a vast improvement over the 1990 figure of 11.9 million.

On average, death rates have dropped by about 2 percent a year from 1990 to 2010, and in many regions, even some of the poorest in Africa, the declines have started to accelerate, according to the report, which is being published online Sunday by The Lancet, a medical journal. Some parts of Latin America, north Africa and the Middle East have had declines as steep as 6 percent a year.

Other reports in recent years have found similar trends, but the new article, based on more detailed information and what its authors say are improved statistical methods, paints the most optimistic picture yet. Health experts say the figures mean that global efforts to save children’s lives have started working, better and faster than expected.

Vaccines, AIDS medicines, vitamin A supplements, better treatment of diarrhea and pneumonia, insecticide-treated bed nets to prevent malaria and more education for women are among the factors that have helped lower death rates, said Dr. Christopher J. L. Murray, an author of the report and the director of the Institute for Health Metrics and Evaluation at the University of Washington, in Seattle. He said the improvements in Africa were especially encouraging. “The very slow progress in Africa has led some people in global health to argue there should be more emphasis on tackling child mortality outside of Africa, especially India,” Dr. Murray said in an interview. “We think it’s important to call out this accelerated progress. The last thing we’d like to see, when at last something is happening, is to pull the plug and move elsewhere.”

The United Nations has set a goal of reducing death rates in children under 5 by two-thirds from 1990 to 2015, but not many countries seem to be on track to reach it.

A third of all deaths in children occur in south Asia, and half in sub-Saharan Africa. Newborns account for 41 percent of those who die. The lowest death rates, per 1,000 births, are in Singapore (2.5) and Iceland (2.6); the highest are in Equatorial Guinea (180.1) and Chad (168.7). In rich countries, some of the worst rates are in the United States (6.7) and Britain (5.3).

Dr. Mickey Chopra, the chief of health for Unicef, said countries with governments that had “fully supported child survival and primary care” had improved quickly, and he cited Malawi, Ethiopia, Tanzania and Rwanda. In addition, he said Botswana had scaled up treatment for H.I.V. and for preventing mother-to-child transmission, and was seeing child mortality rates decline as a result. Zambia also had significant declines, he said, because 75 percent of families had received bed nets to prevent malaria.

But he said the improvements could easily be reversed, because the underlying poverty in many countries had not changed. “If we don’t continue to do these interventions and fund these interventions, we’ll start to see an increase again,” Dr. Chopra warned.

In addition, he said, “There are places where we’re very worried because of conflict, such as Chad, where the immunization rates are too low, less than 20 percent, and also parts of the Democratic Republic of Congo.”

Dr. Flavia Bustreo, director of the Partnership for Maternal, Newborn and Child Health, a group administered by the World Health Organization, said that an important factor in the improvements was “reduced fertility” — women having fewer children, and leaving more than two years between pregnancies, which both increase their children’s odds for survival. Dr. Bustreo noted that nearly a million babies a year died from asphyxia at birth, for lack of simple, routine resuscitation measures. Focusing on those techniques could save many lives, she said.

Dr. Murray’s report was based on official birth and death records, census data and information from detailed surveys in many countries. The research was paid for by the Bill and Melinda Gates Foundation.