The U.N. children's fund says infant morality around the world has dropped nearly 30 percent during the past two decades. But that improvement in child survival is far smaller in West and Central Africa where growing populations are straining health services.
The new U.N. estimates on deaths of children under five shows an 18-percent decline in West and Central Africa since 1990. It is good news, but only to a point as the rate of that decline does not appear to be accelerating, and health officials fear that larger populations mean the actual number of infants dying in the region may be growing.
"The decline is there. It is not as much as other regions in the world. It reflects high population and high fertility," said Martin Dawes, the chief of communications for UNICEF in West and Central Africa.
Dawes says many governments are working hard to improve infant mortality in West and Central Africa, but the survival rate is not as good as UNICEF had hoped. That is partly a result of the strain that growing populations are putting on national health care systems, especially in rural areas where infant mortality increases when access to primary medical care is limited.
"Certainly their rates of survival increase when a sick child is near someone who can identify what is wrong and deal with it," added Dawes. "Around the world, pneumonia and diarrhea are the biggest killers of children. In this region, it is still malaria."
Insecticide-treated bed nets have helped improve survival for children under five as have immunization campaigns, dietary supplements, and programs to encourage mothers to breastfeed their babies for at least one year.
Forty percent of the world's under-five deaths occur in just three countries - India, Nigeria, and the Democratic Republic of Congo. Nigeria alone accounts for 12 percent of the world's infant mortality.
Dawes says that is partly a function of large population.
"High population will always cause these figures to be challenging - just the sheer numbers of children at risk, the sheer number of children malnourished, the sheer number of children out of school," said Dawes.
In the Democratic Republic of Congo, it is also a result of years of conflict.
"When you have situations of conflict or civil strife it is much harder to get out these quick interventions, such as the treated bed nets for malaria," Dawes continued. "It is much harder for the population to get to health centers, if health centers even exist. And it is of course harder to run vaccination campaigns."
Dawes says mortality rates for children under five are a leading indicator of what is going on within the health services of a country and the general health of the population.
"Child mortality is at the center of many countries' development stories. This is accepted," added Dawes. "The question now is a matter of resources and getting out information to people and getting out the right supplies such as treated nets, and ensuring that there is vaccination amongst the majority of the population."
The new analysis of infant mortality is based on a range of demographic information collected by UNICEF, the World Health Organization, the World Bank, and the U.N. Population Division.
Compared to 1990, the new report says 10,000 fewer children are dying each day around the world. But UNICEF says it is still unacceptable that each year, more than eight million children die before their fifth birthday.