London School of Hygiene & Tropical Medicine

Child survival experts have challenged the world to wake up to an unprecedented opportunity to save the lives of 30 million under fives over the next decade, at an international conference in London, Tracking Progress in Child Survival: Countdown to 2015, 13-14 December 2005. They are calling for donors and governments to equal the major commitments on prevention and simple treatments for children as have already been made to HIV/AIDS, malaria and immunization.

At the conference delegates will hear details of a landmark report - Tracking Progress: Tracking Intervention Coverage - which, for the first time, pulls together the latest data on the implementation of 20 simple interventions in 60 countries where 94% child deaths under five occur. 10.5 million children die each year from largely preventable causes. The report is the first of a two yearly update on the progress made towards achieving the Millennium Development Goal for Child Survival (MDG4), which aims to reduce the mortality rate for children under five by two thirds between 1990 and 2015.

The key findings of the new report show that seven of these 60 priorities countries are on track to meet the millennium target, including Bangladesh, Brazil, Egypt, Indonesia, Mexico, Nepal and Philippines. However, 17 countries will only meet the millennium target if they attain a massive annual rate reduction of at least 10 per 1000 live births. The conference will hear that achieving this will take an investment of US $ 7 billion in the coming decade.

"Child mortality is one of the world's most urgent crises - and one of the most preventable," says Ann M. Veneman, Executive Director of UNICEF. "By seizing the opportunity to reach the Millennium Development Goal, we could save more than 30 million young lives in the decade ahead, ten million through immunization alone". The report was produced by a group of Child Survival experts, including the Bellagio Study Group, UNICEF and the World Health Organization.

"Let's not forget: the health and survival of mothers is intimately linked to the survival of their children," said Dr LEE Jong-Wook, Director-General of the World Health Organization. "Progress in increasing child survival is stalling significantly because of the high numbers of newborns who die within their first 24 hours and first month. We have to keep the focus on this vital relationship. When we think about life-saving interventions, the child's mother is a crucial component "

However, Tracking Progress shows progress is by no means universal: only seven of the 60 countries are on target to meet MDG4. Children living in nations where child deaths are highest are still getting less than half the minimum healthcare services they need to survive and thrive and, at current speed, the world will not reach MDG4 until 30 years after the deadline - and some parts of Africa will not get there until 2115, one hundred yards off target.

"The bad news is that not one country is reaching children with all the affordable life-saving interventions that are available," says Jennifer Bryce, a member of the Bellagio Group on Child Survival and one of the report's authors. "The good news is that most of these 60 countries are reaching many of their children with at least some interventions - so we can see exactly what needs to be done, and where."

What is vital now, says Bryce, is that these interventions are adopted universally, across other countries. These interventions include exclusive breastfeeding, vaccination, access to safe drinking water and sanitation services, the use of insecticide-treated nets for preventing malaria, delivery attendants when babies are born (to ensure newborn health), prevention of mother-to-child transmission of HIV, oral rehydration therapy (ORT), and treatments for malaria and pneumonia.

Some successes have been seen already: malaria currently causes almost one in five child deaths in Africa. But with a rising global supply of insecticide-treated bednets and improved distribution in a growing number of countries, illness rates look set to drop. Pneumonia is the world's biggest killer of children. But countries such as Nepal, Senegal and Pakistan are showing great success in using well-trained community workers to identify and treat pneumonia.

Promising trends are also emerging where home-based healthcare is supported by local health systems and national policies. Exclusive breastfeeding, for example, can increase a child's chance of survival six fold - and in Ghana, rates have increased by 77% since 1998 thanks to baby-friendly hospitals, community outreach and legislative backing for breastfeeding.

Maternal health is seen as key to saving children's lives, in particular the four million newborns who die in the first month of life, and three million stillborn babies. As a result, the next Tracking Progress report will expand to include critical numbers on maternal mortality and health interventions. "The Countdown 2015 is not a one-off event--it will not go away," says Dr. Francisco Songane, former Minister of Health in Mozambique and new director of new global Partnership for Maternal, Newborn & Child Health. "This tracking mechanism is important to monitor progress in improving maternal, newborn and child health and keeping us all accountable for our commitments and contributions."