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Targets by 2015:

To reduce child mortality by two-thirds, from 93 children of every 1,000 dying before age five in 1990 to 31 of every 1,000 in 2015.

Child survival lies at the heart of everything UNICEF does.

About 29,000 children under the age of five  21 each minute  die every day, mainly from preventable causes.

More than 70 per cent of almost 11 million child deaths every year are attributable to six causes: diarrhoea, malaria, neonatal infection, pneumonia, preterm delivery, or lack of oxygen at birth.

These deaths occur mainly in the developing world. An Ethiopian child is 30 times more likely to die by his or her fifth birthday than a child in Western Europe. Among deaths in children, South-central Asia has the highest number of neonatal deaths, while sub-Saharan Africa has the highest rates. Two-thirds of deaths occur in just 10 countries.

And the majority are preventable. Some of the deaths occur from illnesses like measles, malaria or tetanus. Others result indirectly from marginalization, conflict and HIV/AIDS. Malnutrition and the lack of safe water and sanitation contribute to half of all these childrens deaths.

But disease isnt inevitable, nor do children with these diseases need to die. Research and experience show that six million of the almost 11 million children who die each year could be saved by low-tech, evidence-based, cost-effective measures such as vaccines, antibiotics, micronutrient supplementation, insecticide-treated bed nets and improved family care and breastfeeding practices.

These measures are the basis for UNICEFs actions to help children survive, carried through with hundreds of allies and via offices in the field  and well-travelled staff  all over the world.

UNICEF responds by:

Providing high-impact health and nutrition interventions. In partnership with governments, WHO and others, UNICEF aims to scale up proven, high-impact, cost-effective health and nutrition interventions to reduce the number of neonatal and young child deaths from preventable and easily treatable causes.

UNICEF is the worlds largest purchaser of vaccines, procuring more than 40 per cent of all vaccines used in the developing world. While global immunization rates have risen from less than 20 per cent in the 1970s to about 74 per cent in 2002, millions of children must still be reached. UNICEF negotiates favourable prices and forecasts vaccines requirements to ensure sustainable supplies. Targets include increasing immunization coverage to at least 90 per cent at the national level and 80 per cent in all districts, with particular focus on reaching population groups with low coverage levels, and the final eradication of polio.

When delivering vaccines UNICEF adds micronutrient supplements to offset malnutrition, another critical factor in child survival. Supplements of vitamin A taken every four to six months can reduce child mortality from all causes by as much as 23 per cent, measles deaths by 50 per cent and deaths from diarrhoea by 33 per cent.

Another target in this area is increasing the rate of children sleeping under mosquito nets to at least 60 per cent in

malaria-endemic areas. Malaria is responsible for 10 per cent of all under-five deaths in developing countries.

According to the World Health Organization (WHO), poor neonatal conditions are the most prominent cause of young deaths. Four million babies per year die in the first week of life. In response, UNICEF advocates for and promotes programmes to increase rates of exclusive breastfeeding. The strongest foundation of baby health is nutrition, and the best food for newborns is breast milk. Breastfeeding protects babies from diarrhoea and acute respiratory infections, stimulates their immune systems and improves response to vaccinations, and contains many hundreds of health-enhancing molecules, enzymes, proteins and hormones.

A mothers health is also critical to newborns, particularly in light of new research that suggests a sound neonatal environment is an important predictor of future health. Together with the WHO and United Nations Population Fund (UNFPA), UNICEF advocates and lends technical and financial support to comprehensive community health programs for expectant women. This would ideally include providing micronutrient supplements, vaccines, anti-malarial drugs and insecticide-treated bed nets.

Improving family care practices. About 80 per cent of health care in developing countries occurs in the home  and the majority of children who die do so at home, without being seen by a health worker. Meanwhile, proper infant feeding and breast feeding are still not practiced by many families. As many as 40 per cent of child deaths could be prevented with improved family and community care  not high-tech health equipment, but access to solid knowledge, support and basic supplies.

Working with governments, health providers and communities in the field, UNICEF helps families learn essential skills and basic health knowledge, particularly in the care of newborns. This includes best practices in breastfeeding and complementary feeding, hygiene and safe faeces disposal.

UNICEF also works for better integration among systems that deliver basic supplies and health services to the poorest families. Health and outreach workers are enabled to support better parenting, the care of mothers, infant feeding, care-seeking practices among families and communities in favour of disease prevention, and optimal management of childhood illness.

These include treatment for diarrhoea, including the use of oral re-hydration salts, and for acute respiratory infections such as pneumonia.

Increasing access to improved water and sanitation. UNICEF helps develop systems to control water-borne diseases like Guinea worm and cholera that undermine child survival and development, reduce productivity and raise health-care costs. Struggles to find water and hygiene resources also primarily increase burdens on girls and women.

Working closely with governments, UNICEF also helps strengthen policies and budgets and support technical capacities in programmes for hygiene promotion, sanitation, cost-effective water supply options and water quality, particularly for poor rural and urban families. These activities also aim toward fulfilling Millennium Goals 4 and 7.

UNICEF also helps develop partnerships that pool competencies and resources, particularly in its role as advocate, facilitator and coordinator in emergencies.

Responding rapidly to emergencies. UNICEF is also one of the first aid organizations on the scene following the outbreak of a crisis, helping to establish monitoring systems, organize partnerships and provide vaccinations and vitamin A supplementation. UNICEF also helps fund and build fresh water and sanitation facilities, helping stem the spread of water-borne diseases.

By providing supplies, personnel and assistance with facilities and sanitation, UNICEF also helps get children Back to School, which supports a number of Goals. As well as being registered and accounted for, and supervised by adults, children can also access health care, food and sanitation resources at a school.

Progress

In its sixty years of existence, UNICEF has seen a fifty per cent reduction in under-five mortality between 1960 and 2002. Weve seen that vitamin A supplementation can save over a quarter million lives a year; oral rehydration therapy can prevent 1 million deaths, and immunization programmes can protect the lives of nearly 4 million children.

But progress in meeting this Millennium Goal is the most off track of any. In 2002, 7 of every 1,000 children in industrialized countries died before they were five. In South Asia, 97 of 1,000 children died before they were five. And in sub-Saharan Africa, that number is 174 of every 1,000 children.

Ninety countries, 53 of them from developing nations, should be able to meet the 2015 Goal of reducing child mortality by two-thirds, if they maintain their current annual reduction rate. But 91 developing countries lag far behind. Many have seen mortality rates rise since 1990, countries from sub-Saharan Africa as well as Iraq and former members of the Soviet Union.

The number of children orphaned and made vulnerable by HIV/AIDS is projected to reach 25 million by the end of the decade, 18 million of them in sub-Saharan Africa. This, along with only modest progress fighting malaria, means the threats facing child survival are as grave as ever.