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Levels & Trends in Child Mortality: Report 2018
by WHO, Unicef, UN Population Division
Children from the highest mortality countries are up to 60 times more likely to die in the first five years of life than those from the lowest mortality countries.
An estimated 6.3 million children under 15 years of age died in 2017, or 1 every 5 seconds, mostly of preventable causes, according to new mortality estimates released by UNICEF, the World Health Organization (WHO), the United Nations Population Division and the World Bank.
The vast majority of these deaths – 5.4 million – occur in the first five years of life, with newborns accounting for around half of the deaths.
"Without urgent action, 56 million children under five will die from now until 2030 – half of them newborns," said Laurence Chandy, UNICEF Director of Data, Research and Policy. "We have made substantial progress to save children since 1990, but millions are still dying because of who they are and where they are born. With simple solutions like medicines, clean water, electricity and vaccines, we can change that reality for every child."
Globally, in 2017, half of all deaths under five years of age took place in sub-Saharan Africa, and another 30 per cent in Southern Asia. In sub-Saharan Africa, 1 in 13 children died before their fifth birthday. In high-income countries, that number was 1 in 185.
"Millions of babies and children should not still be dying every year from lack of access to water, sanitation, proper nutrition or basic health services," said Dr. Princess Nono Simelela, Assistant Director-General for Family, Women and Children''s Health at WHO. "We must prioritize providing universal access to quality health services for every child, particularly around the time of birth and through the early years, to give them the best possible chance to survive and thrive."
Most children under 5 die due to preventable or treatable causes such as complications during birth, pneumonia, diarrhea, neonatal sepsis and malaria. By comparison, among children between 5 and 14 years of age, injuries become a more prominent cause of death, especially from drowning and road traffic. Within this age group, regional differences also exist, with the risk of dying for a child from sub-Saharan Africa 15 times higher than in Europe.
"More than six million children dying before their fifteenth birthday is a cost we simply can''t afford," said Timothy Evans, Senior Director and Head of the Health Nutrition and Population Global Practice at the World Bank. "Ending preventable deaths and investing in the health of young people is a basic foundation for building countries human capital, which will drive their future growth and prosperity."
For children everywhere, the most risky period of life is the first month. In 2017, 2.5 million newborns died in their first month. A baby born in sub-Saharan Africa or in Southern Asia was nine times more likely to die in the first month than a baby born in a high-income country. And progress towards saving newborns has been slower than for other children under five years of age since 1990.
Even within countries, disparities persist. Under-five mortality rates among children in rural areas are, on average, 50 per cent higher than among children in urban areas. In addition, those born to uneducated mothers are more than twice as likely to die before turning five than those born to mothers with a secondary or higher education.
These deaths – particularly the regional and socio-economic disparities – reflect the broader influence of sustainable social and economic development on children’s health. Basic health services like vaccination, medical treatment, adequate nutrition and clean water and sanitation become matters of life and death when children and young adolescents don’t have access to them.
Reducing inequalities is essential for ending these preventable childhood deaths, and for ensuring that no one is left behind.
UN Under-Secretary-General for Economic and Social Affairs Liu Zhenmin said: "Reducing inequality by assisting the most vulnerable newborns, children and mothers is essential for achieving the target of the Sustainable Development Goals on ending preventable childhood deaths and for ensuring that no one is left behind."
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More than 224 million children around the world last year suffered from malnutrition
by Medicins Sans Frontieres / Save the Children
More than 224 million children around the world last year suffered from malnutrition. It is the underlying contributing factor in nearly half of the deaths of children under five years of age.
Malnutrition can lead to a weakened immune system meaning children are more vulnerable to disease. These diseases can lead to further malnutrition, creating a vicious cycle of malnutrition and disease. MSF first introduced specific therapeutic foods to treat malnutrition on a large scale as long ago as 2005, which has been widely used since; but access to specific and necessary nutrition remains one of the major challenges in reducing child mortality, especially in conflict-affected countries, where they are most vulnerable.
More than half a million children in conflict zones could die from extreme hunger before the end of the year, new research by Save the Children shows.
The charity estimates 4,500,000 children under the age of five will need treatment for life-threatening malnutrition this year in the most dangerous conflict zones for children, an increase of nearly 20% since 2016.
But at current rates, two in three of these severely malnourished children are set to miss out on vital treatment this year, with 590,000 expected to die as a result. That’s an average of 1,600 children under the age of five dying from extreme hunger every day, or one child every minute.
Save the Children’s new analysis comes as humanitarian agencies grapple with chronic funding shortfalls to many UN emergency appeals for conflict zones, and as warring parties acting in defiance of international humanitarian law increasingly prevent supplies from reaching children in need of help.
Global hunger is on the rise after declining for more than two decades, with the UN citing conflict as the main reason for that reversal.
Severe Acute Malnutrition, or SAM, is the most extreme and dangerous form of undernutrition. Symptoms include jutting ribs and loose skin, with visible wasting of body tissue; or swelling in the ankles, feet and belly as blood vessels leak fluid under the skin.
Severely malnourished children also have substantially reduced immune systems and are far more likely to contract and die of diseases like pneumonia, cholera and malaria than healthy children. Even where children survive, the effects of malnutrition can be life-long and affect physical and mental development.
Helle Thorning-Schmidt, CEO of Save the Children International, said:
“In 2018 no child should be dying from hunger. But the number of hungry people on our planet has started to rise again. This is shameful. Hunger is not inevitable.
“Many of these children are in warzones. Time after time we are seeing starvation used as a weapon of war when deliveries of food are obstructed by the warring parties in places like Yemen, Syria and South Sudan.
“We must stop this dangerous trend. All warring parties must abide by their obligations under international law to allow humanitarian access. We also need to see an increase in funding from the international community to save more children’s lives.”
The charity’s mortality estimate includes 300,000 children in the war-torn Democratic Republic of Congo (DRC), where nutrition programmes run by aid organisations and the UN have less than 10 percent of the funding they need.
Over 35,000 malnourished children may also die in Yemen, where obstructions to deliveries of food and medicine by all sides – including a coalition of Arab states backed and armed by Britain – have pushed the country to the brink of famine.
But in the three states of northeast Nigeria hardest hit by conflict, Borno, Adamawa and Yobe, cases of untreated severe acute malnutrition are now estimated to fall to about 12,000 after two years of sustained action. While this is still troubling – about 2,000 of these children could be expected to die without treatment – it represents a substantial drop on previous years. In 2016, there were an estimated 300,000 untreated cases and 60,000 deaths in the three states.
Save the Children is appealing for urgent donations to help aid workers and local health partners reach more children through treatment and feeding programmes in war zones across the world. It takes 150 sachets of enriched peanut paste to save a malnourished child’s life and help them recover.
The aid agency is calling on governments around the world to protect children in conflict – including from hunger – and to hold those responsible for blocking food and medicine to account.
Case Study: Democratic Republic of Congo
13-month-old Kasadi was close to death when she was brought into a clinic supported by Save the Children in the Democratic Republic of Congo (DRC).
Her mother Kapigna had fled into the bush after an attack on her village, leaving the family’s food and belongings behind. And after weeks in the bush, Kasadi began to starve.
When she arrived at the clinic, Kasadi weighed just four kilograms, less than half the weight of a healthy baby her age. She was also suffering from pneumonia and diarrhoea.
But after a course of antibiotics and three days of nutrition treatment her weight increased to 5.2 kilograms. Save the Children has given Kapigna a two-month supply of enriched peanut paste to help Kasadi put on more weight and fully recover.
“In our hospital, the three diseases that affect children the most are measles, pneumonia, and meningitis. Malnutrition is usually combined with one of the three illnesses,” says Didier Musanya Kabaz, the baby’s nurse. “When the child is malnourished, it’s very easy for the child to get ill. The functions of the organs are heavily affected, increasing the susceptibility to diseases.”
Case Study: Yemen
In the past year Save the Children and its local partners have treated 65,000 children for malnutrition across Yemen. But in June the Saudi-led coalition launched an assault on the country’s main port of Hodeidah, threatening to sever a lifeline for vital supplies of food, fuel and aid. After more than three years of war, a quarter of children under the age of five living in the city were malnourished even before the assault began.
One-year-old Nusair was lucky to survive (see here for full case study). He was suffering from a deadly combination of severe malnutrition and diarrhoeal disease when he reached a health facility supported by Save the Children. His mother Suad had braved landmines, checkpoints and airstrikes to get him there.
Nusair faced death a second time during his treatment when an airstrike hit near the hospital he was attending. Dozens died in the blast – but he and his mother survived.
“My dream is simple – the war must stop so we can live in peace,” his mother says. “The casualties of this war are ordinary people, civilians.”
* Save the Children previously identified the ten most dangerous conflicts for children – based on conflict intensity, the number of children living near to conflict, and ‘grave violations’ against children recorded by the UN in 2016.
They are: Syria, Afghanistan, Somalia, Yemen, Nigeria, South Sudan, Iraq, the Democratic Republic of Congo (DRC), Sudan, and the Central African Republic (CAR).
Based on an analysis of UN Humanitarian Needs Overview (HNO) malnutrition estimates for 2018, 4,555,699 children under the age of five will need treatment for Severe Acute Malnutrition this year in nine of the ten most dangerous conflict zones for children.
Tackling malnutrition in Am Timan, Chad. (MSF)
It’s 7.30 in the morning and the clouds in the sky are holding back the heat. Soon it will rise, forcing people under the trees to find relief in the shade. The day starts early in Am Timan, in the east of Chad. Am Timan hospital, which MSF has worked in since 2006, is already bustling with people. A chorus of babies’ wails echo out from the paediatric ward – the first sign that the little patients are all awake.
Dr Yannick Tsomkeng, an MSF doctor working at Am Timan hospital, starts his medical consultations in the therapeutic feeding unit, in the paediatric ward. "Children arrive in critical health conditions, so compromised that often it’s too late to save them and they pass away within 24 hours of being hospitalised.
Here they’re the first victims of the lack of food, poverty and dangerous nutritional habits,” Dr Yannick says. "At the beginning of the month, the therapeutic feeding centre had already exceeded its capacity. In the last week, 46 severely malnourished children, all suffering from medical complications, have been hospitalised."
By May, the nutritional feeding centre run by MSF, was already over its capacity of 60 beds, with 325 malnourished children admitted in that month alone.
It’s expected that this number will only increase over the coming months. But despite the high numbers of children requiring treatment, and the strain this puts on medical staff, the crisis is not unexpected; nor is it the first time the region has been hit by such worrying numbers of undernourished children.
From May to September each year, hundreds of thousands of people in Chad and in the entire Sahel region endure extreme food insecurity due to the lean period, a result of the dry season coupled with low food stocks. A recurrent nutritional crisis has just started in Chad’s Salamat region, and has spread to other parts of the country.
Fanna, 19 years old, sits on a bed in the nutritional centre with her baby. She struggles to feed her three children. “My boy was sick. He couldn’t eat at all. He kept on vomiting. After four days, he was so weak that he couldn’t react and I decided to bring him to the hospital. It’s hard to stay in the hospital for several days, when there’s no one who can look after the other children,” Fanna says, holding Moussa, eight months old.
Moussa doesn’t complain, despite his feeding tube, which seems so big on his gaunt face. He’s too feeble even to cry. He stares at people around him, with his big brown eyes, in visible pain. He’s been hospitalised due to severe malnutrition and complications.
“I knew there was a nutritional programme in the hospital because my oldest daughter has been hospitalised before, because she was malnourished. We eat once per day. The food is never enough, so my children often get sick. And now it’s even worse, since the harvest is over,” Fanna says.
This food emergency is the result of several factors. Inadequate nutritional practices, climate change, difficult access to land and drinking water, and the poor education and fragile health sys-tems in a country which is in the midst of a deep economic crisis.
In 2017, the nutritional situation deteriorated significantly and the lean season arrived early, throwing nearly 900,000 people into severe food insecurity, according to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Of the country’s 23 regions, 12 have now been declared as facing a ‘nutritional emergency’.
The prevalence of severe acute malnutrition has exceeded the emergency threshold by two per cent in 15 regions. In a country with the sixth highest child mortality rate in the world, the first victims of this cyclical nutritional crisis are inevitably children under the age of five, who are the most vulnerable. In Chad, malnutrition is one of the main causes of child mortality and one child in seven dies before her or his fifth birthday, also according to OCHA.
In order to combat these high mortality rates, in the nutritional feeding centre in Am Timan hospital, during their treatment patients receive special food to help them recover their appetites and responsiveness. They’re fed with therapeutic milk containing sugar, oil, minerals and vitamins, and with a high-protein peanut paste fortified with vitamins and minerals. The children admitted to this programme have a very low weight for their height and severe muscle wasting. They may also have nutritional oedema – characterised by swollen feet, face and limbs. The hope is that they can be discharged when they’re able to eat again, without medical assistance.
When their patients finally reach a stable level of health, MSF teams combine medical treatments with a daily session of cognitive stimulation. Severely malnourished children may have mental and behavioural developmental delays that, if left untreated, can become the most serious lasting consequence of malnutrition.
Emotional and physical stimulation through play can significantly reduce the risk of mental deficiencies and irreversible effects of prolonged malnutrition. For this reason, MSF teams organise ‘stimulation sessions’ every day, with various games for mothers and children undergoing nutritional treatment.
“We realise, day after day, how important play and maternal care are as part of the recovery process. During the stimulation sessions, mothers are encouraged to play with their children using toys, and to interact with them in other playful activities. The results of this are touching. We see children recovering their reactiveness. Above all, they smile and play again together. It’s so important to involve parents and to encourage the emotional care of children,” explains Aya Sonoda, MSF information and education coordinator in Am Timan.
To tackle the nutritional crisis during its peak in the lean season, MSF teams are supporting three health centres in Am Timan to screen and treat malnutrition. They’ll be present until the end of October 2018 to treat malnourished patients with medical complications.
* In more than 70 countries, Médecins Sans Frontières provides medical humanitarian assistance to save lives and ease the suffering of people in crisis situations.
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