State of the World’s Children

1. What is the under-5 mortality rate?

The under-5 mortality rate tells us the probability of a child dying between birth and exactly five years of age, expressed per 1,000 live births. It is a measure of children’s health and wellbeing. Child survival is the likelihood of a child surviving until the age of five.

2. What do the Millennium Development Goals say about child survival?

The Millennium Development Goals (MDGs) provide the global community with a blueprint on how to meet the needs of the world’s poorest people. Many of the MDGs are related to child survival. Greater progress on child survival requires the achievement of all the health-related MDGs:

• MDG 1: Eradicate extreme poverty and hunger.
• MDG 4: Reduce child mortality.
• MDG 5: Improve maternal health.
• MDG 6: Combat HIV and AIDS, malaria and other major diseases.
• MDG 7: Ensure environmental sustainability including access to safe drinking water and basic sanitation.

3. Which regions of the world are facing a crisis in child survival?

Sub-Saharan Africa and South Asia are two regions facing this crisis. Around 50 per cent of child deaths happen in sub-Saharan Africa, and another 32 per cent are found in South Asia. Around the world, 60 ‘priority countries’ have high rates of child mortality. Of these, only seven – Bangladesh, Brazil, Egypt, Indonesia, Mexico, Nepal and the Philippines – are considered to be on track to meet MDG 4.

4. What are the main threats to child survival?

There are four main threats to child survival:
a. Undernutrition, an underlying cause of up to 50 per cent of child deaths.
b. Pneumonia, malaria, HIV and AIDS, and other diseases.
c. Lack of safe drinking water and basic sanitation, which can lead to diseases related to diarrhoea.
d. Poor healthcare of pregnant and nursing mothers. This often translates to poor health for her baby.

5. Are these child deaths preventable?

Yes. The encouraging side of this picture is that almost all of these child deaths are preventable with simple and low-cost treatments.

• Vitamin A supplements and breastfeeding for infants up to 6 months of age can help prevent undernutrition in babies and children.
• Nets treated with insecticide can protect children from the mosquitoes that cause malaria.
• Safe drinking water and basic sanitation facilities can help children avoid diarrhoea.
• Affordable vaccinations, immunizations and antibiotics can prevent or treat childhood diseases, such as pneumonia and measles.
• Affordable treatments (antiretroviral drugs) can protect children with HIV from developing AIDS and help prevent the transmission of the virus from mothers to their children.
• If births are attended by a trained health worker and pregnant women are given enough care before, during and after childbirth, the health and lives of newborns and mothers can be saved.

6. What has been done in the past to reduce the number of preventable child deaths?

In the past 60 years, countries and international organizations like UNICEF have used many ways to increase the chances that more children live past their fifth birthday:

• Particular diseases affecting children, such as smallpox, polio and measles, have been targeted in large-scale, one-time immunization campaigns. Because of one such campaign, completed in 1977, smallpox has been eradicated.
• Rather than focusing on only one disease, packages of health interventions for children and mothers have also proven to be effective in reducing child deaths. Such packages may combine vitamin A supplementation, immunization, raising awareness about exclusive breastfeeding, providing insecticide-treated mosquito nets and monitoring babies’ growth.

7. What does UNICEF say we should do to increase the chances of child survival?

In the State of the World’s Children report for 2008, UNICEF makes a call to unite for child survival. This means that from the community to the global levels, we must harmonize our efforts to save the lives of children who are dying from mainly preventable causes. To achieve this, UNICEF promotes community partnerships, continuums of care, ‘scaling up’ health programmes and global health partnerships. Find out more about what each of these strategies means below.

8. What do we mean when we say ‘community’?

A ‘community’ often refers to a group of people who share the same geographical area, language and heritage. As far as health is concerned, members of a community may also experience the same deprivations in their rights to quality health care, nutrition, safe water and sanitation.

9. Why are communities important?

In many parts of the world, the culture and customs of the local community are almost as important as the laws of the national government. Through their regular interaction with families, community leaders – including local politicians, elders, religious leaders, teachers and health-care workers –can help families change their behaviours, including customs and practices that affect the health and survival of women and children.

10. What is a community health worker?

Community health workers are a bridge between the health-care system (hospitals and clinics) and the communities to which they belong. They have been trained in basic health care and provide their communities with information about health issues that affect them, offer preventive measures and supply simple treatments. Community health workers advise members of their community on when they need to see a medical doctor in the health centre, and they help during immunization and other public health campaigns. They are found in many countries of the world and are known by different names, including health promoters, health volunteers or village health workers. Their work is especially important in more remote and poorly connected parts of a country.

11. What is a community partnership in health care?

A community partnership in health care (for mothers, newborns and children) is when community members are involved in ensuring their own health and well-being and that of their children. One example of a community partnership for child health is to train community members to be health workers. Another example is to spread messages among families in the community about healthier practices. Such practices include good nutrition, hand washing before meals and feeding infants only breast milk for the first six months of their life.

12. How can a community partnership ensure child survival?

Many countries of the world do not have strong health systems and face a shortage of doctors and nurses. In such countries, most child deaths occur at home before the child’s family has been able to seek medical care, which is often far away. Many thousands of children’s lives can be saved if every community has access to a package of basic health care. This package would include childhood immunizations, insecticide-treated mosquito nets, health messages, and a network of community health workers to provide families with simple treatments for childhood illnesses and also advise on how to recognize when a child should be taken to the health clinic or hospital for more urgent care.

13. What are some examples of healthy practices to save children’s lives?

Some examples of healthy practices are:

• Exclusive breastfeeding of infants until six months of age. This protects the baby from diarrhoea and respiratory infections (major threats to an infant’s life). It also stimulates the baby’s immune system and improves the baby’s response to vaccinations.
• Starting at about six months, feeding babies and children fresh, energy- and nutrient-rich foods, while continuing to breastfeed up to two years or longer.
• Giving young children micronutrients or nutrients required in small amounts, such as vitamin A.
• Better hygiene practices including hand washing to reduce the spread of diarrhoeal diseases.
• Immunizing every child against the six major vaccine-preventable childhood diseases: pertussis (whooping cough), childhood tuberculosis, tetanus, polio, measles and diphtheria before their first birthday.
• In malaria-endemic areas, sleeping under a net that has been treated with insecticide can save children and families from the bites of malaria-causing mosquitoes.
• Taking care of the mental and social development of a child through talking, playing and creating a nurturing home environment.
• Giving clean water and other fluids to sick children to protect them from dehydration and continuing to breastfeed infants even when they are sick.
• Giving pregnant mothers skilled medical care and advice before and during pregnancy, at childbirth and after delivery.
• Making families aware of simple home treatments for diarrhoea and other illnesses and also of how to recognize when sick children need treatment from a health centre.
• Following the advice of a health worker regarding treatment of illnesses, follow-up and referral.

14. What are some real examples of community-level programmes from around the world that could reduce the number of child deaths?

There are many examples of successful community-based approaches that offer hope:

• In Eastern and Southern Africa, the mothers2mothers programme encourages behaviours to help prevent mother-to-child transmission of HIV and provides support groups to those affected by HIV and AIDS.
• In Afghanistan, safe water systems have promoted behaviour change and raised awareness about the importance of clean water.
• In Brazil, the community health workers’ network and in Pakistan, the Lady Health Worker programme, have trained thousands of health workers to look after the basic health-care needs of millions of children in their communities.
• In Ethiopia, Malawi and Sudan, community-level nutrition programmes bring ready-to-use therapeutic foods and other nutrient-dense foods to treat severe and acute undernutrition in homes.
• In Bangladesh, school sanitation and hygiene education projects have involved students as community motivators for better sanitation practices.
• In some rural areas of Cambodia, mother support groups encourage exclusive breastfeeding of infants where rates of breastfeeding have traditionally been low.
• In India, integrated programmes for newborn and early child care at the community level are showing promising results.

15. What is a ‘continuum of care’?

In a continuum of care, health care is provided to a mother before and during pregnancy, at the time of delivery, immediately after childbirth, and to her newborn child as she or he grows into infancy, childhood and adolescence. In such a continuum, each stage builds on the success of the stage before. For example, adolescent girls and young women should have access to information about reproductive health. When they decide to become mothers, regular visits to a health-care practitioner can prevent problems during pregnancy and also make it more likely that they will get the appropriate care at birth. Skilled care before, during and immediately after birth reduces the risk of complications or death for both the mother and the baby. Continued care for children supports their right to health.

16. What does “scaling up” mean?

Scaling up means taking low-cost and effective health services and strategies from the community level to district, state and country levels. Scaling up community health initiatives is a challenge because it needs greater funding, good coordination between levels and strong political leadership to strengthen a country’s health system.

17. What is an ‘integrated approach’ to child health and survival?

An integrated approach combines several low-cost and effective measures that are essential to a child’s health and survival in one package. A strategy that includes immunization, malaria treatment, vitamin A supplementation, maternal care and messages on the importance of safe water, all provided by a community health worker, is one example of an integrated approach. Such packages are also integrated or incorporated into the health system through outreach services, referrals at the local health center and facility-based care (i.e. treatment in clinics and hospitals) for more urgent conditions.

18. What are some of the challenges to achieving the Millennium Development Goals related to child survival?

The MDGs related to child survival can be achieved, but there are some challenges the global community will have to face:

• The health systems of many countries are being disrupted by the AIDS epidemic, natural disasters and armed conflict.
• Links between communities and health systems are weak in many places.
• There is a shortage of trained health workers across sub-Saharan Africa and South Asia.
• At times, there is not enough political will and commitment to improve the health system.
• There is a need for more funding and better coordination among donors, governments and other partners.
• In many countries, laws do not protect children from violence that can have a detrimental effect on their health and survival.
• Side by side, women too, need access to education and empowerment to better take care of their own health and nutrition and that of their children.
• Countries must move towards social equity, so even the poorest children have access to health care.

19. What is a global health partnership to ensure child survival?

The child survival-related Millennium Development Goals will only be achieved if there is greater unity and harmonization in the work of all those who support these goals. A global health partnership seeks to facilitate such harmony in the actions of governments, donors, civil society, communities and other partners uniting for child survival.

20. What can YOU do?

From hygiene-friendly schools in Madagascar, where students are messengers of life-saving sanitation information, to community radio stations in Brazil that host shows about healthy childhoods, young people have the potential to make positive change. Students, youth groups, peer mentors and community performing arts groups all around the world are taking the initiative to bring health awareness to their communities. Here is how you can start:

• Be informed. Learn about the health problems your community faces, and find out if any of these problems can be solved by your community. Inform yourself about the health of children in other communities and across the world.
• Brainstorm about how you could creatively bridge the gap between the problem and the solution.
• Form partnerships with youth groups, your teachers or community leaders to share your ideas on spreading health messages.
• Make a plan to implement your ideas.
• Put your plan to improve the health of children in your community into action! It could begin with a simple poster campaign against littering in your school or a theatre performance about the importance of a safe environment for children.

Get involved in the drive for child health and survival! Making your voice heard can promote the survival and health of young children in your community.