Every year, nearly 11 million children worldwide die before their fifth birthday, most from preventable causes such as diarrhea, pneumonia, neonatal problems and malaria. Malnutrition is a major factor in more than half those deaths, researchers estimate.
In a series of articles this week in The Lancet medical journal, experts say inexpensive lifesaving measures — such as breast feeding, insecticide-treated bed nets, flu shots, antibiotics, newborn resuscitation and clean childbirth — are not reaching the mothers and children who need them most.
Scaling up those interventions to a level that would save 6 million lives a year would cost about $7.5 billion annually, the experts say.
In the 1980s, the world made great progress in reducing unnecessary child deaths through a UNICEF campaign called the child survival revolution. But the momentum was lost in the 1990s.
"We have dropped the ball," said one of the experts, Cesar Victora, professor of epidemiology at the Federal University of Pelotas in Brazil. "Child survival has fallen off the international agenda ... we need now a second revolution to finish this job."
The number of deaths among children under 5 fell from 117 per 1,000 live births in 1980 to 93 per 1,000 in 1990. Today, the death rate is still declining but not as fast — in 2000, it was 83 per 1,000 live births.
Experts stressed two main reasons why progress appears to have stalled.
One is the realization in the 1990s that HIV/AIDS was decimating populations in Africa, which shifted the world's attention and resources toward fighting specific diseases, such as AIDS, malaria and tuberculosis.
"I'm not saying that it was wrong, but child health lost out in that," said Hans Troedsson, director of child and adolescent health and development at the World Health Organization.
The experts noted that the total number of child deaths each year is greater than those due to HIV, malaria and tuberculosis combined.
The other major factor was complacency, experts say.
"We were doing really well," Troedsson said. "There was a kind of attitude that the job was more or less finished. That kind of perception meant that a lot of investments and commitments to keep the steam in child survival was actually lost."
Other experts said the death of former UNICEF leader Jim Grant, who spearheaded the child survival revolution of the 1980s, left a void in global leadership as UNICEF's focus later shifted toward children's rights and education.
The U.N. children's agency said it still spends most of its money on child survival programs and many of its newer strategies addressing children's rights and education translate in the long-term to better child survival.
"The easy gains have been made," said UNICEF spokeswoman Marjorie Newman-Williams. "We have now plateaued because the strategies we have to put in place are more difficult."
Whereas earlier strategies were focused on delivering vaccines and medicines to clinics, future progress does not necessarily depend on that, she said. The benefits of that approach have been mostly mined, she said.
Many of the actions that will reduce the deaths now are those that have to be taken into the home, such as breast-feeding, bed nets and proper infant nutrition after weaning.
"Those three heavily depend on women's time, women's knowledge and availability," Newman-Williams said. "And to reduce neonatal mortality, you have to focus on women's health. This is not a child health intervention."
By Emma Ross