Fifty percent of the deaths in children occur in six countries -- India, Nigeria, China, Pakistan, Democratic Republic of Congo and Ethiopia. The illnesses they die from range from diarrhoea, pneumonia and malnutrition to malaria and HIV/AIDS which can be prevented or treated.

"We could save six million child lives every year just by doing what we already know how to do if people would put their heart and money into it. It is not a question of technical know-how," Dr Jennifer Bryce of the World Health Organisation (WHO) told a news conference.

But although doctors have the means to prevent the deaths, they are not being incorporated into public health policies.

In the latest issue of The Lancet medical journal, Bryce and other child health experts urge the United Nations, governments, development agencies and scientists to focus on child health and survival.

"We see child survival as the most pressing moral and political issue of our time," Lancet editor Richard Horton said.

SIMPLE INTERVENTIONS, INEXPENSIVE TREATMENT

Nearly all of the deaths of young children occur in poor countries but interventions such as promoting breast feeding, improving nutrition, insecticides to prevent malaria, vaccinations against infections and improvements in water and sanitation could prevent the illnesses.

And those that do occur can be treated with anti-malarial medicines, antibiotics and therapies for diarrhoea.

"Most of these interventions are not reaching half of the children who need them," said Dr Cesar Victora, an epidemiologist at Federal University of Pelotas in Brazil.

The Commission for Macroeconomic and Health estimates that to increase interventions by 2007, $7.5 billion a year would be needed, less than the amount wealthy countries spend on pet food annually.

"The initial impetus on child survival that was present in the 1980s just discontinued in the 1990s," Victora added.

The U.N. Children's Fund, UNICEF, said it agreed with the findings but said it is simplistic to suggest that an approach that worked in the 1980s would have a similar success.

"There are much more complex challenges we are facing now, including AIDS and conflict," Alfred Ironisde, a UNICEF spokesman, told Reuters.

Weak healthcare systems in poor countries and disproportionate spending on the health needs of the rich are compounding the health problems of the world's poorest children.

"The key issue is we need political will. We need political will at international level," Victora said. "We need political will by donors from rich countries and we need political will within developing countries which are not prioritising the survival of their own children."

Key facts and figures about child survival rates

LONDON, June 27 (Reuters) - Six million children who die each year in poor countries could be saved every year but interventions and treatments are not reaching them.

Following are key facts and figures about childhood deaths.

- Six countries, India, Nigeria, China, Pakistan, Democratic Republic of Congo and Ethiopia, account for 50 percent of deaths under the age of five.

- More than 99 percent of childhood deaths occur in poor countries.

- Diarrhoea, pneumonia and neonatal problems in the first month of life are the biggest killers of children. Undernourishment is the basic cause of over half of child deaths.

- Breastfeeding exclusively for six months and mixed feeding up to a year could prevent 13 percent of childhood deaths.

- Insecticide-treated materials to prevent malaria could reduce deaths in young children by seven percent and complementary feeding by six percent.

- Cleaner water and better sanitation and hygiene could also reduce child mortality.

- Interventions to prevent childhood deaths reach only about half of the children who would benefit from them.

- Fifteen percent fewer children would die each year if youngsters with diarrhoea were treated. Antibiotics for pneumonia, sepsis and dysentery could cut deaths by a further 15 percent, according to health experts.

- Poor children are more likely to be exposed to and have a lower resistance to illnesses. They are less likely to have access to health facilities and life-saving drugs.

- Weak healthcare systems due to staff turnover, high training costs and low accessibility contribute to the problem.

- Governments often spend more money on healthcare for the rich than the poor.

Studies: Child Deaths Avoidable
Measures Could Help Poor Nations

By David Brown
Washington Post Staff Writer
Friday, June 27, 2003; Page A12

About 6 million of the 10 million children in poor countries who die each year before their fifth birthday could be saved by low-tech preventive measures or a few cheap and proven medical treatments, according to a series of new studies.

More than 10 percent of the deaths could be prevented if women in poor countries fed their infants breast milk and nothing else for six months. About 7 percent of deaths could be prevented if children in malaria-prone regions slept under insecticide-treated mosquito nets. Zinc supplements given weekly could save about 500,000 children now dying of diarrhea and pneumonia. Inexpensive generic antibiotics could save an additional 600,000, the research predicted.

Because of the findings, a group of public health experts is calling on poor and rich nations, private donors and international organizations to take up the flagging cause of "child survival" and implement those interventions and a short list of others.

"These children are not dying from exotic or difficult-to-treat diseases. This is a really needless tragedy," said Michael McCarthy, North American editor of the Lancet, the European medical journal that is publishing five articles on the subject today.

"The child survival revolution of the 1980s was abandoned before the job was done. . . . A second revolution can complete this unfinished agenda," said Robert E. Black, a physician at the Bloomberg School of Public Health at Johns Hopkins University.

"Our failures are that we have not been able to scale up the interventions that we know are effective," said Hans Troedsson, head of child and adolescent health at the World Health Organization in Geneva. The three men announced the initiative at a news conference in Washington.

Childhood mortality fell steeply in the 1970s as living standards rose in the developing world, clean water became more available, the "green revolution" in agriculture improved crop yields and diet, and the number of vaccines for childhood diseases increased. From 1960 to 1990, the number of child deaths fell 2.5 percent a year on average, with the most progress occurring in the late 1980s.

In the 1990s, however, the decline in early childhood mortality slowed to about 1.1 percent a year. That was partly the inevitable result of progress -- there were fewer dying children to save. But it also reflected a changed focus by numerous organizations, including some U.N. agencies, away from populations in need, such as women and children, and toward specific diseases such as AIDS, tuberculosis and malaria.

Since then, some gains in child health have reversed. For example, fewer children in sub-Saharan Africa and South Asia receive the diphtheria-pertussis-tetanus vaccination today than in 1995, one of the Lancet papers reported. The number of African children immunized against measles -- which can be fatal in the undernourished -- fell from 62 percent in 1990 to 50 percent in 1999.

There is now nearly a thirtyfold difference in child mortality between the world's industrialized countries and the globe's poorest region, sub-Saharan Africa -- six deaths vs. 175 deaths among every 1,000 infants. In 1990, the difference was twentyfold. AIDS accounts for much of this widening gap.

"We all dropped the ball," Troedsson said.

The initiative began after several people at WHO and in a group of outside consultants saw evidence of the reversal. About 20 experts from numerous organizations and universities met in Bellagio, Italy, in February to analyze the data.

Of the 10.8 million child deaths worldwide each year, about 90 percent -- 9.7 million -- occur in 42 countries. Six nations account for half of the deaths -- India, Nigeria, China, Pakistan, Democratic Republic of Congo and Ethiopia.

The total amount now being spent on the preventive strategies and treatments in the developing world is unknown. The Lancet authors, however, estimated that $1 billion a year more will be needed for vaccinations, $4 billion to treat childhood illnesses and $2.5 billion to prevent and treat malaria in all age groups. (Most fatal malaria occurs in children.)

"North Americans and Europeans spend about $17 billion a year on pet food. This is an investment that we think we should be able to make," Black said.

There is wide variation in how widely available the interventions are in the 42 countries where nearly all the deaths occur.

Although about 90 percent of mothers nurse their infants for more than six months, only about 40 percent rely on breast milk alone in the first six months. Studies have shown that when mothers supplement breast feeding with other liquids, many mixed with contaminated water, a baby's risk of dying of diarrhea or pneumonia doubles.

Only 20 percent of children with diarrhea receive oral rehydration therapy, a sugar and salt mixture stirred into water. Nearly 1.5 million lives could be saved each year if that treatment became universal, the authors predicted. Only about 2 percent of children in malaria-infested areas sleep under insecticide-treated nets. Virtually no children receive zinc supplements.

The group stressed that child deaths will decrease only if the hardest-hit countries make that a priority. Although outside organizations can train and equip health care workers, for example, they cannot easily recruit them or supervise them, or reduce the high worker turnover that has doomed some previous campaigns.

Several speakers noted that poverty worsens health, and that spending money on improving health helps economies grow.

"Investment in child survival is important and necessary for sustainable development," said Flavia Bustreo, a public health specialist at the World Bank.