Child health

Previous features: South African Health Review, 2006

Each year more than 10 million children still die before their fifth birthday; the vast majority of these deaths occur in poor countries. Three causes - pneumonia, diarrhoea and malaria - account for more than 40 per cent of deaths, and malnutrition is associated with over half of all deaths. A third of all deaths occur in the neonatal period (the first 28 days of life). Other important causes are congenital anomalies, injuries and accidents, and in some countries, AIDS.

In many countries, the gains in child survival achieved during the 1980s have slowed or been reversed in the last decade and the gaps between different regions of the world have increased. In addition, there are large inequalities in child health within countries, with children born in the poorest fifth of the population often having five times higher risk of mortality than those born in the richest fifth. Much needs to be done if we are to stand any chance of meeting the millennium development goal to reduce child mortality by two-thirds by 2015.

It has been estimated that two-thirds of all childhood deaths could be prevented. The constraint is not lack of knowledge, but rather inadequate health systems. Provision of high quality case-management is essential. However, this must be accompanied by efforts to ensure equitable access to health care and achieve wide-scale coverage of preventive interventions, including immunisation, promotion of appropriate feeding practices for infants and young children, and insecticide-treated nets to prevent malaria. Finally, there is increasing recognition that ensuring child survival is not sufficient; strategies need to be developed to ensure that children also achieve their developmental potential.