UNICEF Report: Child Health

Disparities in the survival and health prospects of children from different backgrounds are not random. They systematically follow the contours of social disadvantage linked not only to wealth but also to ethnicity, education and rural-urban divides, among other factors. One of the most important lessons learned from efforts to improve child – and maternal – health in the past 15 years is that approaches focusing on overall progress will not eliminate the disparities that leave the poorest women and children at the highest risk. While even the poorest countries have achieved considerable progress, inequities persist. In terms of child survival, while the absolute gap has substantially narrowed since 1990, great inequities remain between rich and poor countries.
Current situation of child health

• For approximately 1 million children in 2015, their first day of life was also their last.
• Globally, the neonatal mortality rate (probability of dying during the first 28 days of life) is declining less rapidly than the mortality rate for children between 1 month and 5 years of age. This means that the share of under-five deaths occurring during the neonatal period is increasing. In 2015, neonatal deaths accounted for 45 per cent of total deaths, 5 per cent more than in 2000.
• The rising share of deaths in the neonatal period reflects the faster decline in mortality of children aged 1 to 59 months than of newborns.
• Still, of the 5.9 million under-five deaths in 2015, almost half were caused by infectious diseases and conditions such as pneumonia, diarrhoea, malaria, meningitis, tetanus, measles, sepsis and AIDS. Pneumonia and diarrhoea remain leading causes of death in the three regions with the highest under-five mortality: Eastern and Southern Africa, South Asia and West and Central Africa.
• The burdens of both disease and mortality are often highest among the most disadvantaged. There are marked regional variations around the broad neonatal trend. In sub-Saharan Africa, newborn deaths account for about one third of the deaths of children under age 5.
• In regions with lower levels of child mortality, neonatal deaths comprise approximately half of the total. South Asia, on the other hand, has both high overall child mortality and a high share of neonatal deaths.
• In 2015, about 80 per cent of these deaths occurred in South Asia and sub-Saharan Africa, and almost half occurred in just five countries: the Democratic Republic of the Congo, Ethiopia, India, Nigeria and Pakistan. Children living in fragile states and conflict-affected countries face elevated risks.
• According to the World Development Report 2011, they are more than twice as likely to be undernourished as children in low- and middle-income countries, and twice as likely to die before age 5.
• The relative child mortality gap between sub-Saharan Africa and South Asia on one side and high-income countries on the other has barely changed in a quarter of a century. Children born in sub-Saharan Africa are 12 times more likely than their counterparts in high-income countries to die before their fifth birthday, just as they were in 1990. A child born in Sierra Leone today is about 30 times more likely to die before age 5 than a child born in the United Kingdom. Women in sub-Saharan Africa face a 1-in-36 lifetime risk of maternal mortality, compared to 1 in 3,300 in high-income countries. The lifetime risk in Chad is 1 in 18

Highlight of this report:
Migration and informal Settlements

• Globally, access to land, credit and property rights has a further impact on child survival prospects.
• Marginalized groups living in informal settlements, illegal dwellings or urban slums are vulnerable to health threats because of overcrowding, unsanitary conditions, high transportation costs, discriminatory practices and lack of access to basic services.
• These factors also create barriers to demand, impeding the initial and continued use of services by the most disadvantaged. When combined with low rates of immunization, this situation exacerbates the transmission of diseases such as pneumonia, diarrhoea, measles and tuberculosis.

Climate Change

• Climate change brings added risks. When water becomes scarce because of drought, the poorest children and families are most likely to resort to unsafe water sources, making them more vulnerable to diseases such as cholera and diarrhoea.
• Climate change is also associated with an increased incidence of vector-borne infectious diseases such as malaria, as well as with food insecurity, rising air pollution, diarrhoeal disease and malnutrition.

Sanitation

• Inadequate drinking water, sanitation and hygiene accounted for around 1,000 under-five deaths per day.
• Use of unimproved sanitation facilities and, specifically, the prevalence of open defecation are also implicated in stunting because they expose children to health problems that can interfere with normal growth.
• While progress on sanitation has been slow in many countries, there are encouraging indications that more rapid progress is possible.
• In Nepal, a Social Movement for Sanitation has mobilized local communities and civic authorities in some of the poorest parts of the country, creating 27 open defecation-free districts. Such initiatives have the potential to generate large returns for child survival.
• One evaluation in Mali found a 57 per cent reduction in diarrhoea-related deaths of children under age 5, and a 13 per cent reduction in child stunting, in open defecation-free communities.

Child Brides

• Around the world, child brides are less likely than adult women to receive adequate medical care while pregnant. The lack of care, and the fact that girls are not physically mature enough to give birth, put both mothers and their babies at risk.
• Complications during pregnancy and childbirth are the second leading cause of death for girls between ages 15 and 19.49 And babies born to mothers under age 20 are 1.5 times more likely to die during the first 28 days than babies born to mothers in their twenties or thirties.
• When a woman is denied opportunities to manage her reproductive health, she and her children suffer. Short birth spacing, for example, is a risk factor for preterm birth and limited access to contraception is one barrier to safe spacing. Globally, an estimated 216 million married women need, but lack, access to modern contraceptive methods.
• If women who want to avoid pregnancy had access to these methods, unintended pregnancies would drop by 70 per cent.
• Reducing the number of unintended pregnancies, in turn, could avert 60 per cent of maternal deaths and 57 per cent of under-five child deaths.

Rural - Urban divide

• The rural-urban divide also contributes to unequal chances in child survival. Children born in rural areas are 1.7 times more likely to die before age 5 than children in urban areas Looking specifically at disparities linked to wealth and residence, a new comparison uses household survey data to chart child survival trajectories between 2015 and 2030 in a group of eight countries starting out from different positions.

Nutrition

• Half of all deaths of children under age 5 are attributable to under nutrition, and large disparities exist in related indicators such as stunting.
• Stunting rates among the poorest children are more than double those among the richest. In West and Central Africa, progress on stunting has been slow, with less than a 25 per cent reduction between 1990 and 2014. And in over one third of low-income countries with available trend data, the gap between the richest and poorest households in stunting reduction has been widening.
• Household wealth and Maternal Education
• Household wealth is one determinant of a child’s chance to survive, but maternal education is also a strong predictor. Across much of South Asia and sub-Saharan Africa, children with mothers who received no education are almost three times as likely to die before age 5 as children of mothers with secondary education.
• Education enables women to delay and space births, secure access to maternal and child health care and seek treatment for children when they fall ill. If all mothers achieved secondary education, there would be 1.5 million fewer annual deaths of children under age 5 in sub-Saharan Africa and 1.3 million fewer in South Asia.

Conclusion
These projections illustrate the need for the fastest progress among the worst-off groups. Reaching the most marginalized households is more than an ethical imperative; it is a precondition for ending the preventable deaths of newborns, children under age 5 and their mothers.
 

By: Vishal