Malta makes 'dramatic leap' in cutting child deaths

Malta has made "the most dramatic leap" forward in reducing child deaths since 1990, a global report published yesterday by Unicef has shown.

Malta has managed to slash its under-five mortality rate from 14 per 1,000 births in 1990 to five in 2002, above Malaysia and Egypt, the other two front-runners, according to the report entitled Progress For Children.

Sweden had the lowest rate among industrialised countries with only three under-five deaths per 1,000 births, and Norway, Denmark and Iceland all at four.

Japan, Finland, the Netherlands, Austria, Germany, Luxembourg, Greece, the Czech Republic, Malta and Monaco were at five - ahead of the US and Italy.

However, the new country-by-country data reveal alarmingly slow progress on reducing child deaths despite the availability of proven, low-cost interventions.

The United Nations Children's Fund in fact reported "alarmingly slow progress on reducing child deaths" - one in 12 children worldwide does not live to five, with half of all those deaths occurring in sub-Saharan Africa.

Unicef said that while 90 countries were on track to meet the target of reducing child deaths by two-thirds by 2015, 98 countries were considerably off track and globally the pace of progress was far too slow.

At the current rate of progress, the average global under-five death rate will have dropped by roughly one-quarter by 2015, far below the two-thirds reduction agreed to by world leaders.

Progress For Children ranks countries on their average annual rate of progress since 1990, which is the baseline year for the global goal of reducing child mortality by two-thirds by 2015 - a goal agreed to by all governments as part of the UN's Millennium Development Goals.

The goal of a two-thirds reduction assumed an average annual rate of progress of roughly 4.4 per cent between 1990 and 2015. The report reveals that no region has met that standard, though nearly 50 individual countries have. Some 78 countries have failed to average even two per cent progress per year in reducing child mortality.

Child mortality rates vary considerably among regions and countries, but the most disturbing findings are those countries whose annual rate of progress has been negative. In several countries in sub-Saharan Africa and the Commonwealth of Independent States, children are less likely to make it to their fifth birthday than they were in 1990.

HIV/AIDS remains one of the chief underlying causes affecting child mortality trends, particularly in sub-Saharan Africa. Botswana, Zimbabwe and Swaziland, which registered the second, third and fourth fastest increases in under-five deaths, also have the world's highest national HIV prevalence rates - about 37, 25 and 39 per cent, respectively.

Other key factors behind spiking child mortality rates, as in the case of Iraq and Afghanistan, are the effects of armed conflict and social instability. Iraq, in fact, has lost the most ground since 1990.

Despite a slight improvement, Sierra Leone continues to have the world's highest rate of child mortality, with more than one in four children dying before the age of five.

Inadequate birthing conditions - meaning little or no health care for mothers, and the lack of skilled attendants during deliveries - cause the largest proportion of preventable deaths. Malnutrition contributes to more than half of all child deaths. Unsafe water and poor sanitation are also contributing factors.

The US had eight child deaths per 1,000 in 2002, down from 10 in 1990. But it also will have to make big strides to reach its target of three by 2015.

Child mortality refers to the number of children who die before their fifth birthday and is measured per 1,000 live births. For example, in 2002, the most recent year for which comprehensive data are available, industrialised countries had an average child mortality rate of seven deaths per 1,000 live births; the least developed countries had a rate of 158 deaths per 1,000 births. Unicef considers child mortality rates the basic measure of a country's advancement.

The 10 countries which registered most progress: