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Welch Wanderings

A Global Health Snapshot: Why Are 10 Million Children Dying?

More than 10 million children younger than age 5 die every year from diarrhea, pneumonia, measles, malaria, HIV and other causes. Half of the fatalities occur in India, Nigeria, China, Pakistan, the Congo and Ethiopia.

The geography of child mortality: Each dot represents 5,000 deaths.
Illustration: Paul Mirocha / Source: The Lancet

The Numbers
1 Percent chance that a child in 2004 will die before the age of 5 in an industrialized country.
16 Percent chance that a child will die before age 5 in the 49 least developed countries.
7 Average number of child deaths per 1,000 live births in industrialized countries.
98 in South Asia.
173 in sub-Saharan Africa.
7 Number of African countries that have actually seen an increase in child mortality rates during the past 50 years.
40 Percent of children under age 5 in the developing world whose immune systems are compromised because of vitamin A deficiency; 1 million of these children die each year.
2,000 Number of babies infected with HIV every day. (Most will die before their fifth birthday.)
1,600,000 Number of young children killed worldwide each year by waterborne illnesses because of the lack of potable water.
2,000,000 Number of children worldwide who die each year because they are not immunized.

Sources: UNICEF, WHO

Tragically, an estimated two-thirds of childhood deaths could be prevented by interventions as simple as breastfeeding or supplementing a child’s diet with vitamin A and zinc, says Robert Black, MD, MPH, chair of International Health and coauthor of a five-part series examining global childhood mortality published last year in The Lancet.

Fifty-three percent of all child deaths can be attributed to undernutrition, according to Laura Caulfield, PhD, associate professor with the School’s Center for Human Nutrition. In a recent article, Caulfield and colleagues showed that even children who are small for their age but not malnourished are twice as likely to die as healthier children. The article is the first to demonstrate that undernutrition is responsible for 60 percent of diarrhea deaths, 52 percent of pneumonia deaths and 57 percent of malaria deaths. Caulfield also found that moderately malnourished children were four times as likely to die from malaria.

“We have effective interventions and increasing experience in ways to adapt them to local conditions, but there are signs that the child survival effort has lost its focus.
This must change.”
—Robert Black

Often families have enough food to prevent undernutrition—just an extra 100 to 200 calories a day can make all the difference to a young child. However, some families don’t allocate food so that children get enough or children simply choose not to eat all that is offered. Public health programs teach adults strategies for improving children’s diets, avoiding micronutrient malnutrition and preventing illnesses through improved hygiene, says Caulfield.

The good news, according to Black, is that the Lancet series has reawakened interest in preventing child mortality. With support from the Bill & Melinda Gates Foundation, the Child Survival Partnership (a task force formed by UNICEF, WHO, USAID and others) is uniting existing resources in targeted countries to increase immunizations, vitamin A supplementation, and treatment of diarrhea, pneumonia and malaria. —Karen Blum