Child health


et0173In 2013, an estimated 6.3 million children under five died, 2.9 million of them in the WHO African Region. This is equivalent to five children under 5 years of age dying every minute. Two thirds of these deaths can be attributed to preventable causes. A third of all these deaths are in the neonatal period.

Pneumonia, diarrhoea, malaria and HIV are the main causes of death in infants and young children. In the African Region, about 473 000 children die from pneumonia, 300 000 from diarrhoea, and a further 443 000 from malaria every year. In 2012, 230 000 new HIV infections were recorded among children under 5 years of age.

Undernutrition is associated with more than one third of the global disease burden for children under 5. Sub-Saharan Africa has one of the highest prevalence of low birth weight ranging from 7-42%. Only 37% of children in sub-Saharan Africa are exclusively breastfed for the first 6 months of life, and complementary foods are inadequate and inappropriate. Maternal nutrition increases the risk of death of the mother at birth and may be associated with about 20% of maternal deaths.

Pneumonia is the single biggest killer of children worldwide, accounting for nearly one in seven deaths among young children, with an estimated over 950 000 deaths annually. Most of the deaths occur in resource-constrained countries, with 50% in sub-Saharan Africa.

There were 528 000 deaths from malaria in 2013, and about 78% of these were in children under 5 years of age.

Child health intreventions

Key interventions that contribute to child survival are:

  • preventing and managing diarrhoea and pneumonia;
  • child survival strategies;
  • political commitment at the national and international level;
  • and immunization.

Ensuring adequate nutrition

Exclusive breastfeeding for the first 6 months of life, with timely introduction of nutritionally adequate and safe complementary foods while breastfeeding continues for the first 2 years of life and beyond, effectively improves infant survival.

Early initiation and exclusive breastfeeding promotion and support is associated with a 45% reduction in all-cause and infection-related neonatal mortality, while about 12% of deaths of children aged under 2 years are attributed to suboptimal breastfeeding.

Focusing nutrition interventions on the first 1000 days of a child’s life (and working to ensure that women are well nourished in the 3 months before conception) prevents irreversible harm such as growth retardation and intellectual impairment. Effective interventions include micronutrient supplementation, targeted fortification and food supplementation, management of severe and moderate acute malnutrition, and improving the nutrition of lactating women.

Preventing and managing diarrhoea and pneumonia

Use of vaccines against Streptococcus pneumonia and Haemophilus influenzae type b, the two most common bacterial causes of childhood pneumonia, and against rotavirus, the most common cause of childhood deaths from diarrhoea, substantially reduces the disease burden and deaths caused by these infectious agents.

Use of simple, standardized guidelines for the identification and treatment of pneumonia, diarrhoea and malaria in the community, at health facilities such as those for integrated management of childhood illness (IMCI), substantially reduces child deaths.

Child survival strategies

The implementation of national child survival strategies in the Region has guided country priorities for improving child survival. These include:

  • the IMCI strategy;
  • integrated community case management (iCCM) for pneumonia, diarrhoea and malaria, and improving antibiotic treatment for suspected cases of pneumonia in children less than 5 years of age;
  • vaccination against common vaccine-preventable diseases;
  • use of long-lasting ITNs.


Immunization has had an impressive effect on reduction of child deaths and disability in the Region, particularly that for measles and polio. Three decades ago, routine childhood immunization was almost non-existent in Africa. There is now much greater public awareness of the benefits of vaccines; a competent workforce has been built up to procure, transport, store and administer these vaccines; and data are being collected and disseminated rapidly and efficiently, revealing progress achieved and pitfalls encountered.
Immunization also serves as a means to deliver other life-saving interventions, such as vitamin A supplementation, distribution of ITNs for protection against malaria, and deworming medicine distribution for treating intestinal worms.

Routine vaccination of children has been established in all countries of the Region, but coverage levels vary widely.

Related links:

Integrated Management of Childhood Illness (IMCI)

Caring for newborns and children in the community: Caring for the sick child