The United Nations says nearly 20-percent of the children born in sub-Saharan Africa die before their fifth birthday. The U.N. Children's Agency has released its Progress for Children report tracking child mortality rates around the world, and the findings for the African continent are particularly bleak.
Forty-two percent of all children in the world who die before they are five-years old are in sub-Saharan Africa.
In 18 countries south of the Sahara, the under-five mortality rate has either stayed the same or worsened since 1990.
These are the stark findings of the U.N. Children's Agency, UNICEF, in its Progress for Children report.
The report is intended to measure the progress of countries and regions around the world in reducing by two-thirds the number of children who die before age five by 2015.
The report says infections and diseases are the main killers of children under five in sub-Saharan Africa.
HIV/AIDS is responsible for eight-percent of all under-five deaths, which is more than double the global average.
The director of UNICEF's Eastern and Southern Africa office, Per Engebak, says the situation is particularly bad in southern Africa, where three countries record the world's highest national HIV prevalence rates. "The pandemic of HIV/AIDS is contributing to currently 59-percent of the mortality under five in Botswana. It contributes to 33-percent of the mortality under five in Zimbabwe. And we have an even graver concern in the country that has the highest infection rate now, and that is Swaziland," he says.
UNICEF's representative in Namibia, Khin-Sandi Lwin, says about 22-percent of pregnant women in the country are HIV-positive, which means more and more children under five are also HIV-positive.
She says the situation is made worse when families - and even health-care workers - are unable to care for their children because of the infection. "Mothers and other care givers are ill or dying. You have more malnutrition, early child care to seek health care is going down. So, even though Namibia is one of those better-off countries, we see that, over time, that system is already starting to collapse, including the care capacity of the health services, with nurses and other care givers getting ill, getting absent from work," she says.
HIV/AIDS is not the only danger to children. Malaria, upper respiratory infections, and what UNICEF director Mr. Engebak calls perfectly preventable diseases such as diarrhea are also major killers of African children.
Adding fuel to the fire are the high levels of absolute poverty throughout the continent, which means many people are unable to have access to clean water, enough nutritious food, basic health care, and medicines to prevent or cure diseases.
For example, UNICEF's representative in Ethiopia, Bjorn Ljungqvist, says that about half of Ethiopia's people live on less than one dollar a day. The cost of malaria drugs, meanwhile, has skyrocketed because the malaria parasite has developed resistance to the traditional cheaper drugs. "Malaria drugs now, the ACTs, they cost like $2 for a treatment, whereas before they were 10 cents, so it is a dramatic difference for people on the ground. That is why it is so important that when it comes to these key factors for children, we really look into affordability," he says.
Interestingly, says UNICEF, countries in sub-Saharan Africa that have higher incomes do not necessarily have lower child mortality rates.
For instance, HIV/AIDS has a tendency to reverse any gains made in reducing the number of child deaths, no matter what the income level.
But more important than the national income level are income disparities within countries. The report says children born into the poorest 20-percent of Africa's population are 1.7 times more likely to die before the age of five than those born in the wealthiest 20-percent.
A key strategy to reducing child mortality rates, say the UNICEF officials, is to address the factors that cause or contribute to child mortality.
UNICEF's representative in Zambia, Stella Goings, says the continent's children face a number of risks of dying, so that even if one cause of death is removed, children can still succumb to something else.
Ms. Goings says to reduce child mortality, measures such as immunization, improvements in sanitation, school feeding programs, and others must be implemented simultaneously to reduce the risks to children. "Malaria - leading killer of children in Zambia. But in the last two years, we have gotten 50-percent of our children sleeping under insecticide-treated bed nets. We have gone from having 32 percent of our households with access to clean water to 49.8 percent of our households with access to clean water. That means fewer children are dying from diarrheal disease," she says.
Ms. Goings and the other UNICEF officials urge sub-Saharan African governments and international donors to do what it takes to reduce the number of deaths for children under-five years old. They say efforts in sub-Saharan Africa must redouble for the continent to reach the fourth Millenium Development Goal.