IN 2013, an estimated 6.3 million children under five died, 2.9 million of them in the World Health Organisation (WHO) African region. This is equivalent to five children under five years of age dying every minute. Two thirds of these deaths can be attributed to preventable causes. A third of all these deaths are in the neonatal period.
Pneumonia, diarrhoea, malaria and HIV are the main causes of death in infants and young children. In Africa, about 473,000 children die from pneumonia, 300,000 from diarrhoea, and a further 443,000 from malaria every year. In 2012, 230,000 new HIV infections were recorded among children under five years of age.
â€œAlthough tremendous progress has been made in identifying and treating infants and children with HIV, much remains to be done to scale up and sustain effective prevention, care and treatment, especially of pneumonia and diarrhoea,â€ said Matshidiso Moeti, WHO regional director for Africa.
Pneumonia is the single biggest killer of children worldwide, accounting for nearly one in seven deaths among young children, with an estimated over 950,000 deaths annually. Most of the deaths occur in resource-constrained countries, with 50 percent in sub-Saharan Africa.
Globally, diarrhoeal diseases account for nearly one out of every six deaths in children under five years of age, equivalent to over 578,000 deaths per year. Diarrhoeal disease occurs more commonly in HIV-infected people, with worse outcomes than in uninfected children. Persistent diarrhoea in particular is associated with a high risk of death in HIV-infected children. Administration of oral rehydration and zinc in combination with antiretroviral therapy (ART) and restoring immune function are critical for the treatment of diarrhoea in children with HIV.
â€œUnder-nutrition is another critical risk factor in most countries in the African region, and nutrition and food security remains a fundamental challenge to child survival. Breastfeeding is one of the best ways to provide new-borns, infants and young children with the nutrients that they need while protecting them against conditions like pneumonia, diarrhoea and under-nutrition,â€ Dr Moeti added.
The WHO recommends that exclusive breastfeeding starts within one hour after birth and lasts until a baby is six months old. Continued breastfeeding and appropriate complementary foods should be made available for up to two years of age and beyond.
In mid-2013, WHO issued new guidelines for breastfeeding and the prevention of mother-to-child transmission (PMTCT) of HIV. These recommendations were intended for use in resource-poor settings in low-and middle-income countries.
One of the recommendations for PMTCT is to promote the use of ART in all pregnant and breastfeeding women. These recommendations also include providing ART – irrespective of oneâ€™s CD4 count – to all children under five years of age with HIV, all pregnant, and all breastfeeding women with HIV including their infants until they cease to breastfeed.
Health systems in Africa are often not able to adequately address the severe burden of childhood disease. Low total health expenditure with high out of pocket health costs hamper progress in child survival. Hence just as health can drive economic growth, ill-health can push people into poverty and make it very difficult for them to escape the vicious cycle of poverty and disease.
WHO will continue to work with governments and partners to strengthen health systems to reduce unacceptably high infant and child deaths in the African Region.
The author works for World Health Organisation