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The UK has one of the highest rates of death for children under five in Western Europe, according to new research published in The Lancet.

In 2013, the mortality rate for under-fives in the UK was 4.9 deaths per 1,000 - more than double the rate of 2.4 per 1,000 in Iceland, the country with the lowest rate.

Poverty and smoking in pregnancy are two of many factors cited by experts.

The analysis by US experts shows the UK rate is still low by global standards.

These latest figures put us rock bottom of the Western European league table Dr Ingrid Wolfe,, Royal College of Paediatrics and Child Health

The analysis of data on 188 countries was carried out by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle, USA.

It showed that the UK had worse rates than nearly every other western European nation for early neonatal deaths - between zero and six days, post-neonatal deaths (death between 29 and 364 days), and for childhood deaths (death between one and four years).

The UK's rate is comparable with Serbia and Poland.

Austria, Belgium, Cyprus, Greece, Ireland, Israel, the Netherlands and Switzerland all had rates between 4 and 4.6 deaths per 1,000 children aged under five,

'Significant advances'

Image copyright SCIENCE PHOTO LIBRARY Image caption Smoking in pregnancy explains some of the high rate

However figures for the rest of Europe are higher.

In Central Europe, the average mortality rate was 6.7 deaths per 1,000 births while for Eastern Europe it stood at 9.7 deaths per 1,000 births.

The country with the highest child death rate in the world in 2013 was Guinea-Bissau, at more than 150 deaths per 1,000 while the lowest was Singapore, at about two deaths per 1,000.

Dr Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME), the lead author of the study, said: "We were surprised by these findings because the UK has made so many significant advances in public health over the years.

"The higher-than-expected child death rates in the UK are a reminder to all of us that, even as we are seeing child mortality decline worldwide, countries need to examine what they are doing to make sure more children grow into adulthood."

Across the world, child deaths rates have been falling since 1990.

But in the UK the rate has slowed, and the decline in 2000-2013 was half that seen between 1990 and 2000.

Poverty gap

Dr Ingrid Wolfe of the Royal College of Paediatrics and Child Health, which itself recently analysed the UK's child mortality rate, said: "We've known for some time that the UK has high child mortality rates compared to some of the best performing countries in Europe - but these latest figures put us rock bottom of the Western European league table even compared to the European average, let alone the top performing countries.

A national strategy to reduce infant mortality by at least 20% in the next decade must be a priority Andy Cole, Bliss

"Over a third of all child deaths in the UK are in under-fives, so we need to think seriously about how we can prevent these.

"Many are due to risky behaviours during pregnancy for example smoking, which is more common among women who are socially disadvantaged so already at higher risk."

She added: "Crucially, risk of child death disproportionately affects poorer families. So the focus has to be on reducing the growing gap between rich and poor.

"Britain is one of the most unequal societies in Western Europe - and it's no coincidence that our child mortality rate is also the worst."

Andy Cole, chief executive of premature baby charity Bliss, said, "It remains an appalling reality that babies and children in the UK still have a significantly greater chance of dying than those in Western Europe.

"There are a combination of reasons for this including the need to support expectant mothers to make healthy choices, such as stopping smoking and drinking alcohol.

"There is also a substantial gap before we reach safe staffing levels in all neonatal and maternity services throughout the UK, plus there needs to be much better identification and referral of those women at greater risk of preterm birth or complex pregnancies.

"A national strategy to reduce infant mortality by at least 20% in the next decade must be a priority for government."

A Department of Health spokesperson said: "Deaths in infants, children and young people are falling, but we recognise that more needs to be done.

"That is why we are investing more in services and training, particularly ensuring that that GPs have stronger skills to care for children and young people with long term conditions in the community."