World's forgotten children

This editorial makes the claim that child mortality is an international health crisis that has not received the attention it deserves. The thesis is that, "while the world's attention has understandably been focused on the growing HIV/AIDS pandemic and the resurgence of such diseases as tuberculosis and malaria, progress in reducing child mortality has in many of the world's poorest countries slowed, stopped, and in some cases reversed".

In what sense have these children been "forgotten"? The editorial points to these figures:

• In 2003, 10.8 million children will die before they reach the age of 5 years.
• Roughly 6 million of them will die of diseases that "could have easily been prevented or treated".
  
  • 2 million will die from diarrhoea, which is usually treatable with simple oral rehydration therapy.
  • Pneumonia - for which antibiotics are available - will claim the lives of an additional 2.1 million children.
  • Another 1 million children will die from malaria, which can be prevented by insecticide-treated bed nets or treated with anti-malarials.
  • Hundreds of thousands will die from measles, a disease for which there is a cheap, effective vaccine.
• Worldwide, 26% of children under the age of 2 do not receive diphtheria, pertussis, and tetanus immunisation; 28% do not receive oral rehydration therapy; 40% do not receive antibiotic treatment for pneumonia; 58% are not breastfed exclusively during the first 4 months of life; 52% do not receive vitamin A supplementation; 32% do not have access to iodised salt; and 25% are malnourished (contributing to 60% of child deaths).
• In 2000, the average worldwide child morality rate was 67 deaths per 1000 live births. However, in Africa the average rate was 150 deaths per 1000 live births, a rate 8 times that of Europe. In Burundi, Lesotho, Madagascar, Mauritania, Nigeria, Sierra Leone, and Tanzania, there has been little or no change in child mortality rates over the past 50 years.

If, the article continues, children are dying and tools are available to save their lives, why aren't they being saved and what can be done about it? With these questions in mind, The Lancet helped organise a 6-day meeting in February 2003 in Bellagio, Italy. The purpose of the gathering was to share the results of a research process that had been carried out by 3 groups in an effort to understand the problem fully. These groups include:

• the Child Health Epidemiology Research Group, which examined why children are dying;
• the Multi-Country Evaluation of Integrated Management of Childhood Illness, which evaluated programmes that focus on promoting children's growth and development, rather than simply fighting disease; and
• the WHO/World Bank/UNICEF Working Group on Child Health and Poverty, which explored ways to overcome the health effects of inequalities in income - both between and within countries.

The paper concludes by making the point that research and discussion of the extent of, and various approaches to, the problem of child mortality is not by itself enough. What is required, the authors say, is the political will and commitment to provide the needed resources.

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This editorial is a prelude to a 5-part series on child survival published by The Lancet. Click here to access an overview of that series.

Source:

Summarised and reprinted with permission from Elsevier (The Lancet, 2003, Vol No 361, page 1). Click here for the Lancet Home Page.