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Over 5 Million children aged under 5 years died in 2017-WHO

Publishing Date : 10 September, 2019

Author : TLHABO KGOSIEMANG

World Health Organization’ s 2019 Statistics report says substantial progress has been made in reducing child deaths since 2000, with the global under-5 mortality rate dropping by 49%, from 77 deaths per 1000 live births in 2000 to 39 in 2017. This is equivalent of 1 in 14 children dying before reaching age 5 in 2017, compared with 1 in 13 dying before age 5 in 2000. 


An estimated 5.4 Million children aged less than 5 years died in 2017, of whom 2.5 Million were female and 2.9 Million male. Of these deaths, 2.5 Million occurred during the first 28 days of life. Globally, death rates in the first month of life fell by 41% from 31 per 1000 live births in 2000 to 18 in 2017, a smaller reduction in mortality compared with the 54% reduction in mortality for children aged 1.59 months. Under-5 mortality rates are highest in the WHO African region and in low-income countries, where one child dies out of 14 born. 
More than half of under-5 child deaths are due to diseases that are preventable and treatable through simple, affordable interventions. The leading causes of death in young children over 28 days of age remain pneumonia, diarrhoea, birth defects and malaria. Rates of death from all conditions are higher in low-income countries, but children in low-income countries are more than 100 times more likely to die from infectious diseases than those in high-income countries.

 

Children who die within the first 28 days of birth suffer from conditions and diseases associated with lack of quality care at birth, or skilled care and treatment immediately after birth and in the first days of life. Preterm birth, intrapartum-related complications, infections and birth defects caused the most neonatal deaths in 2017.  Most new born deaths take place in low and middle-income countries, and two regions accounted for almost 70% of new-born deaths in 2017- the WHO Africa Region and South-East Asia region. WHO says it is possible to improve the survival and health of new-borns by achieving high coverage of quality antenatal care, skilled care at birth, postnatal care for mother and baby, and care of small and sick new-borns. In 2017, male children were 11% more likely to die before the age of 5 years. Boys have a higher probability of dying before reaching the age of 5 years than girls for biological reasons, including less lung maturity at birth and less resistance to infectious diseases. New-born boys often weigh more at birth, but have higher perinatal mortality and more frequent congenital malformations. Immunoregulatory genes linked to the X-chromosome confer greater resistance to infectious diseases on girls, who have two X-chromosomes compared with boys, who have one X-chromosome.


The report further said because boys have a higher biological risk of death than girls, as assessment of gender bias in health outcomes cannot be based on equality of the under-5 mortality rate. Rather, mortality rates close to unity are indicative of female disadvantage. The risk of dying before the age of 5 years is higher in boys in all income groups set by the World Bank and in all regions. However, in the WHO South East Asia Region, the risk is almost equal, indicating high rate of avoidable mortality among females under the age of 5 years. Nutrition-related factors contributed to about 45% of deaths in children under the age of 5 years. Malnourished children, particularly those with severe acute malnutrition, have a higher risk of death from common childhood illnesses such as diarrhoea, pneumonia and malaria. In most countries, a higher proportion of boys are malnourished than girls in the age group of 0-5 years. 

 

Sex differences in nutritional status have been attributed to biological differences in morbidity between boys and girls in early life. In addition, boys grow faster during infancy, resulting in greater energy needs. Use of health care services can contribute to differences in mortality rates between boys and girls. However, most studies find that both girls and boys are equally likely to be taken for care when ill, although a bias is observed in some locations.  In a United Nation’s Children Fund review, a higher proportion of boys were taken to treatment centres for pneumonia in six countries out of 67 with data, whereas in one of those 67 countries. Hospitalizations for pneumonia, diarrhoea and fever were found to be higher in boys than girls, whereas case fatality rates were higher in girls than in boys, perhaps as a result of greater delays in care –seeking or poorer quality of care. Gender-based discrimination in health care affecting girls is reported mainly from South Asia and China, with sporadic reports from Africa and South America. WHO stressed that vaccines are available for some of the most deadly childhood diseases, such as measles, polio, diphtheria, tetanus, and pertussis, pneumonia to Haemophilus influenza type B and Streptococcus pneumonia and diarrhoea due to rotavirus. Vaccination rates are similar between boys and girls. Use of pneumococcal conjugate and rotavirus vaccines is lagging, especially in middle-income countries without donor support. Vaccination against both these diseases has the potential to substantially reduce deaths of children aged less than 5 years, because pneumonia and diarrhoea are the leading causes of death in this age group.

 

Globally, countries with a low under-5 mortality rate have high male female ratio of 31; 32, partly because congenital diseases predominate when mortality is low. Countries with a high under-5 mortality rate have low male female mortality ratios. Both high under-5 mortality rate and low male female ratios are associated with low socioeconomic status and gender inequality. Progress in reducing the under-5 in the male female since 2000 was accompanied by an increase in the M/F mortality ratio from 1.06 in 2000 to 1.11 in 2017, indicating that the decline in the female under-5 mortality rate was faster than that for males. Reductions in the under-5 mortality rate are accompanied not only by higher M/F ratios but also by reduction in fertility. Smaller families reduce the chances of a couple having a child of any givens sex. In societies with a preference for male children, reductions in the under-5 mortality rate have been accompanied by another type of female disadvantage- that is, a disadvantage in nasality- through selective abortion of female foetuses.  Increases in the M/F sex ratio at birth have been seen in parts of East Asia, South Asia and the South Caucuses. Male female ratios at birth have been seen to be higher if a couple’s previous children have been female; also, multiparous women are more likely to have prenatal knowledge of the sex of their foetus, resulting in sex selection and more male births than in premiparous women.

 

A number of actions can be envisaged to address female disadvantage in populations with an atypically high female under-5 mortality rate, including policies to discourage sex-selective abortions, financial incentives to have female children, and policies that address the marginalized status of women or the provision of social protection in old age. The development of policies that will improve child health morbidity and mortality, and more qualitative research that can reveal the harmful gender norms and expectations that result in discriminatory treatment of boys and girls. Female disadvantage is of widespread concern and must be tackled. In addition, the WHO added that the specific needs of boys should be addressed. ‘’boys experience higher rates of mortality than girls in most of the world, and as the under-5 mortality rate falls globally, the M/F mortality ratio is increasing. In countries that have achieved large reductions in the under-5 mortality rate, additional actions may need to be taken to improve health outcomes for boys, to ensure continued progress towards SDG Target 3.2.

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