Table of Contents
Chapters
- Fertility Continues to Decline
- Contraceptive Use
- Contraceptive Method Mix
- Awareness and Availability of Contraception
- Other Direct Influences on Fertility
- Fertility Preferences
- Young Women
- Child Survival and Health
- Infant Mortality
- Under-Five Mortality
- Impact of HIV/AIDS
- Child Immunization
- Breastfeeding and Infant and Child Health
- Maternal Health
Highlights
- Is fertility decline slowing?
- The impact of contraception
- Intentions to use family planning
- Injectables becoming popular
- Desired family size falling
- Premarital sex: New findings
- How AIDS affects child survival
- Maternal care falls short
Published by the INFO Project, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA
Volume XXXI, Number 2,
Spring 2003
Series M, Number 17
Special Topics
Under-Five Mortality
During the 1990s under-five mortality levels and trends were similar to those in infant mortality. The same diseases that cause the deaths of many infants also kill many children after infancy but before they reach the age of five. Differences in under-five mortality among 56 developing countries surveyed, however, are greater than differences in infant mortality.
In sub-Saharan Africa under-five mortality is two to three times the average for any other region, at 154 deaths per 1,000 births. Poverty, the spread of infectious diseases including an upsurge in TB and HIV/AIDS, increases in levels of malnutrition, and limited medical services contribute to the continued high levels of under-five mortality in the region (118).
In over half of the 29 countries surveyed in sub-Saharan Africa, under-five mortality rates exceed 150 deaths per 1,000 births. Under-five mortality levels are over 200 in Burkina Faso, Mali, and Mozambique and reach 274 per 1,000 births in Niger. Among 27 surveyed countries in other regions, the highest under-five mortality rates are be-tween 104 and 124 deaths per 1,000 births in Cambodia, Haiti, Mauritania, Pakistan, and Yemen (see Table 12).
Among 37 developing countries with more than one survey since 1990, under-five mortality rates fell in 17, increased in 6, and remained about the same in 14. In Asia under-five mortality in the five countries with multiple surveys decreased substantially. In Latin America and the Caribbean, where under-five mortality rates are lower than in other developing regions, mortality declined substantially in 7 of 12 countries with two or more surveys since 1990.
The six countries with increases in under-five mortality rates are in sub-Saharan Africa: Burkina Faso, Cameroon, Côte d’Ivoire, Kenya, Rwanda, and Zimbabwe. In three other sub-Saharan countries, however—Malawi, Niger, and Uganda—substantial improvements in child survival occurred in the 1990s (see Table 12).
Impact of HIV/AIDS
AIDS will take the lives of 3.7 million children before age five in Africa between 1995 and 2015, the UN estimates. In countries hit hardest by AIDS—Botswana, Kenya, Lesotho, Malawi, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe—projected under-five mortality rates are as much as two to three times higher than they would be in the absence of AIDS (113). Even in countries where the full impact of the HIV/AIDS epidemic has yet to be felt, further reductions in child mortality are unlikely as AIDS deaths overwhelm advances made against other causes of death (3).
One study using DHS trend data for 25 countries since 1990 estimated that in countries with high HIV prevalence rates, HIV was responsible for a substantial proportion of under-five deaths—from 13% in Tanzania to 61% in Zimbabwe (2). Other researchers have estimated that increases in the prevalence of HIV/AIDS offset improvements in child survival in Tanzania between surveys in the 1990s (71).
In all 25 countries studied, however, HIV/AIDS was not the most important factor affecting under-five mortality rates. A family’s social and economic circumstances and the country’s medical infrastructures were more important (2). Another study, covering 39 sub-Saharan countries, found that in Botswana, Namibia, Swaziland, Zambia, and Zimbabwe over 30 deaths per 1,000 births among children under five were due to HIV, while in 18 other countries HIV caused fewer than 10 deaths per 1,000 births (130).
Lauren Goodsmith |
In Morocco and several other surveyed countries, over three-fourths of young children have been fully immunized. But in many countries immunization levels still fall far below the WHO recommendations. |
Child Immunization
The 1990 World Summit for Children set a goal of immunizing 90% of the world’s children under one year of age by 2000 (123). As of the most recent survey, however, levels of full immunization for children ages 12 to 23 months reach 90% or higher only in Egypt, with Honduras close, at 89%. Full immunization among children averaged only 49% among 55 surveyed developing countries. Low levels of immunization have affected child survival in sub-Saharan African countries in particular (118).
The World Health Organization (WHO) Expanded Program on Immunization focuses on six common childhood diseases that can be prevented by immunization: diphtheria, pertussis, and tetanus (DPT), measles, polio, and tuberculosis (BCG). Full immunization includes three doses of the DPT vaccine, three doses of the oral polio vaccine, a measles vaccination, and a BCG vaccination.
Among 29 sub-Saharan countries surveyed, full childhood immunization coverage varies widely, from only 11% of children ages 12 to 23 months in Chad to 78% in Zambia. Similarly, among six North African and Near Eastern countries, immunization levels vary from 21% in Jordan to 92% in Egypt. Among eight Asian countries surveyed, levels of full immunization range from one-third of children in Pakistan to about three-fourths in the Philippines. Average levels of full immunization are highest in Latin America and the Caribbean at 59%. Levels are as low as 26% in Bolivia but over 75% in Ecuador, El Salvador, and Honduras (see Table 12).
In some countries, missing the third dose of vaccine in the DPT and polio series is the reason that complete immuni-zation levels are low. In Uganda, for example, fewer than half of children received the third DPT and polio vaccines, although over 70% received the first in the series (109). In other countries missing a specific vaccine explains why full immunization is not achieved (37). Incomplete vaccinations can reflect flawed service delivery and logistics systems, as well as lack of health services in remote locations, and conflicts or civil unrest that disrupt health services (116, 121).
