Every year, about 10.6 million children die before their fifth birthday, mostly from preventable causes such as diarrhea, measles, pneumonia, neonatal problems and malaria.
The United Nations has committed to lowering the number of deaths among small children by two thirds by 2015, from the 1990 level.
But experts said Tuesday that, in the worst-affected nations, children were still getting less than half the minimum health care services they needed to survive and thrive. At the current rate, they said, the world would not reach the U.N.'s target until 30 years after the deadline, and some parts of Africa would not get there until 2115 — 100 years off target.
Only seven countries are on track to meet the U.N. child survival goal — Bangladesh, Brazil, Egypt, Indonesia, Mexico, Nepal and Philippines — according to a report published at the start of an international conference in London aimed at tracking the progress in reducing child deaths in 60 of the poorest countries.
Another 17 countries were close to meeting the target, needing to reduce child deaths by 1 percent a year until 2015, the report said.
Getting all 60 countries to meet the child survival target, which is part of the U.N.'s Millennium Development Goals, would cost about US$7 billion over the next 10 years, said Kul Gautam, deputy executive director of the U.N. children's agency, UNICEF.
"The amount of money needed for child survival is the equivalent of one day's worth of farm subsidies in the industrialized countries," Gautam said Tuesday, coinciding with the opening in Hong Kong of World Trade Organization talks. "Yes it is a lot of money, but you have to put it in some perspective."
The report — titled "Tracking progress in child survival" — was produced by a group of child survival experts, UNICEF and the World Health Organization. It is the first of a series of updates to be published every two years.
"The bad news is that not one country is reaching children with all the affordable lifesaving interventions that are available," said Jennifer Bryce, one of the reports authors. "The good news is that most of these 60 countries are reaching many of their children with at least some interventions," and could provide information on what needed to be improved.
The interventions include getting women to exclusively breast feed their babies, rather than using water-soluble formulas, providing vaccinations, establishing access to safe drinking water and improving sanitation. Additionally, people were being provided with insecticide-treated nets for preventing malaria, oral rehydration therapy for diarrhea and treatments for malaria and pneumonia.
Countries also need to add delivery attendants when babies are born to improve their chances of surviving, and could provide drugs to HIV-positive pregnant women to reduce chances of transmitting the virus that causes AIDS to their babies.
"In 2003, it was very clear that something had gone badly wrong, that the child had dropped off the global agenda for health," said Dr. Richard Horton, editor of The Lancet medical journal, which has published much research on child survival in the developing world.
"In two years, a great deal has changed," he said, noting greater commitment by governments to fighting preventable diseases.
"But there is still too much complacency. There is genuine accountability, but nevertheless there are still broken promises," he said.
Progress noted in the report included programs to tackle pneumonia, the world's biggest killer of children. Countries such as Nepal, Senegal and Pakistan have shown great success in using well-trained community workers to identify and treat pneumonia, the report said.
In Ghana, breast-feeding rates have increased by 77 percent since 1998, thanks to baby-friendly hospitals, community outreach and legislative backing. Exclusive breast feeding for at least six months can increase a child's chance of survival six fold.
Bryce said future versions of the report card, and the conferences that go with them, would help keep countries focused on the task.
"If the numbers don't go up, we will ask why. If the numbers do go up, we will go there and learn why it's been successful," she said.