The New York Times - September 13, 2007
Donald G. McNeil Jr.

This public health triumph has arisen, Unicef officials said, partly from campaigns against measles, malaria and bottle-feeding, and partly from improvements in the economies of most of the world outside Africa.

The estimated drop, to 9.7 million deaths of children under 5, "is a historic moment," said Ann M. Veneman, Unicef's executive director, noting that it shows progress toward the United Nations Millennium Development Goal of cutting the rate of infant mortality in 1990 by two-thirds by 2015. "But there is no room for complacency. Most of these deaths are preventable, and the solutions are tried and tested."

Interestingly, Unicef officials said, the new estimate comes from household surveys done in 2005 or earlier, so they barely reflect the huge influx of money that has poured into third world health in the last few years from the Global Fund to Fight AIDS, Tuberculosis and Malaria; the Gates Foundation; and the Bush administration's twin programs to fight AIDS and malaria. For that reason, the next five-year survey should show even greater improvement, they said.

"We feel we're at a tipping point now," said Dr. Peter Salama, Unicef's chief medical officer. "In a few years' time, it will all translate into a very exciting drop."

The most important advances, Unicef said, included these:

-- Measles deaths have dropped 60 percent since 1999, thanks to vaccination drives.

-- More women are breast-feeding rather than mixing formula or cereal with dirty water.

-- More babies are sleeping under mosquito nets.

-- More are getting Vitamin A drops.

In 1960, about 20 million children died annually, but the drop since then has been steeper than 50 percent because the world population has grown. If babies were still dying at 1960 rates, 25 million would die this year.

There are still wide disparities. The highest rates of child mortality are found in West and Central Africa, where more than 150 of every 1,000 children born will die before age 5. In the wealthy countries of North America, Western Europe and Japan, the average is about six.

The most rapid progress has been made in Latin America and the Caribbean, in Central and Eastern Europe, and in East Asia and the Pacific.

Despite the improvement, two sets of countries have worsened, Unicef said: those in southern Africa that have been hit hardest by AIDS, and those that have been at war recently, like Congo and Sierra Leone.

The improving economies of India and China have helped pull world figures upward. More girls are getting education and jobs, they marry later and they have fewer children, more of whom survive.

Also, because malnutrition is an underlying factor in 53 percent of all child deaths, anything that feeds children - whether that means large-scale aid during famines or simply better seeds and fertilizer - reduces deaths.

Among countries that made particularly rapid progress since 2000 are the Dominican Republic, Vietnam and Morocco, which all cut child deaths by more than one-third.

Madagascar cut its deaths by 41 percent despite going to the brink of civil war in 2002, and Sao Tome and Principe managed to cut its deaths by 48 percent.

Domingos Ferreira, a minister counselor at Sao Tome and Principe's mission to the United Nations, was pleasantly surprised to learn that his country - two islands in the crook of West Africa - had bested the world.

He guessed that credit was due to a national antimalaria campaign that had drained swamps, sprayed houses and provided mosquito nets. "Malaria used to be the first source of killing in our lives," he said. "And now I hear that the hospital beds on Principe are empty for the first time."

In Madagascar, Dr. Salama said, the difference was Vitamin A drops, which drastically reduce the chances that a child will die of measles, diarrhea or malaria.

In general, Ms. Veneman said, the countries that did best concentrated on extending simple measures to rural areas, and focusing on inexpensive prevention rather than expensive care.

Ethiopia, many of whose doctors and nurses emigrate, trained 30,000 community health workers for tasks like weighing babies, advising on breast-feeding, giving shots, testing for malaria and handing out mosquito nets.

Success, Ms. Veneman said, "is not just linked to money, it's linked to setting priorities."

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