MDG 4: Reduce Child Mortality

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1 143 MDG 4: Reduce Child Mortality The target for Millennium Development Goal (MDG) 4 is to reduce the mortality rate of children under 5 years old (under-5 mortality) by two-thirds between 1990 and Related indicators are the infant mortality rate and the proportion of children under 1 year of age immunized against measles. The target for infant mortality (dying before reaching the age of 1 year) is also to reduce the rate by two-thirds between 1990 and 2015 that is, attain a 2015 rate that is one-third of the 1990 infant mortality rate. To reduce measles-related deaths, another target is to increase the percentage of children under 1 year of age who have been immunized or have received at least one dose of vaccine against measles. Immunization against measles is administered through two doses of a vaccine. The recommended coverage of the first dose of measles-containing vaccine (MCV1) is at least 90% at the national level. Millennium Development Goals Snapshots Developing Asia has made substantial progress in reducing under-5 mortality by more than half from 90 deaths per 1,000 live births in 1990 to 36 in 2015, but the region is still behind the MDG target to reduce under-5 mortality by two-thirds of the 1990 rate. Deaths of children under the age of 1 year have also reduced substantially with the infant mortality rates reduced by more than half from 66 to 29 deaths per 1,000 live births between 1990 and Measles vaccination increased significantly with 84% of the children in developing Asia receiving at least one dosage of measles vaccination in 2013 as against 73% in Progress Developing Asia has reduced under-5 mortality from 90 deaths per 1,000 live births in 1990 to 36 in Despite this impressive performance, it is still short of the MDG target to reduce under-5 mortality by two-thirds of the 1990 rate. This translates into reduction from an estimated 7.4 million child deaths in 1990 to almost 2.5 million deaths in 2015 or reduction of more than 13,000 deaths every day. The has achieved the highest rate of reduction at 91% (Figure 4.1). Other economies that have met the MDG target reduction on under-5 mortality include,,,, the,,,, the,,, the People s Republic of China (PRC),, and. As of 2015 (or latest year), all economies in the Asia and Pacific region have under-5 mortality rates of less than 100 deaths per 1,000 live births (Figure 4.2), with the highest rates in (91), (81), and the Lao People s Democratic Republic (67). The under-5 mortality rates are lowest, at 10 deaths or below per thousand, in (10), the (8), the Republic of Korea (3),

2 144 Key Indicators for Asia and the Pacific 2015 Figure 4.1: Infant Mortality Rate and Under-5 Mortality Rate, Percent Reduction between 1990 and 2015 (%) PRC Australia Japan New Zealand Infant Mortality Rate = Target Under-5 Mortality Rate = Federated States of Micronesia, = Lao People's Democratic Republic, PRC = People's Republic of China. (7), the (9), (3), and Sri Lanka (10) and in developed economies of Australia (4), Japan (3), and New Zealand (6). Box 4.1 shows the progress toward achieving the MDG target of reducing under-5 mortality to a rate of two-thirds of the 1990 baseline rates by In 2015, 15 economies are expected to achieve the target. If past trends since 1990 continue, then 13 economies are expected to meet the target between 2016 and 2030 and 15 economies will achieve the target only after However, among these economies,, the Republic of Korea,,,,, Sri Lanka, and have relatively low baselines or current child mortality rates below 20. Major causes of under-5 deaths are preventable causes such as pneumonia, diarrhea, and malaria (United Nations 2015, The Millennium Development Goals Report). Developing Asia has reduced by more than half its infant mortality (dying before reaching the age of 1 year) from 66 per 1,000 live births in 1990 to 29 in Figure 4.1 shows the percentage reductions in infant mortality and under-5 mortality between 1990 and 2015 for economies with available data for both indicators. All economies show significant progress in reducing infant mortality rates and in general, economies with high percentage reductions in under-5 mortality rates have also high percentage reductions in infant mortality rates. The percentage reductions in infant mortality rates are, however, lower than those for under-5 mortality (Figure 4.1), which implies that many of the under-5 deaths occur before the children reach their first birthday. A significant number of deaths take place in the neonatal period, i.e., the first 28 days of life (0 27 days), caused by preterm birth complications, complications during labor and delivery and sepsis. (United Nations 2015, The Millennium Development Goals Report). Much more attention should thus be given to the neonatal period, the most critical period for the survival of children.

3 Goal 4: Reduce Child Mortality 145 Figure 4.2: Under-5 Mortality Rate (per 1,000 live births), 1990 and 2015 PRC Australia Japan New Zealand = Federated States of Micronesia, = Lao People's Democratic Republic, PRC = People's Republic of China. Box 4.1: Progress Toward the Target for Under-5 Mortality Rate Achievers/on track China, People s Rep. of Off track - slow Expected to meet target between 2016 and 2020 Expected to meet target between 2021 and 2030 Expected to meet target after 2030 Micronesia, Fed. States of = Lao People s Democratic Republic. Source: Tabla 4.1. Box 4.2 shows the progress of developing economies in attaining the MDG target of reducing infant mortality rate by two-thirds between 1990 and Eleven economies are expected to achieve the MDG target for infant mortality by Another fourteen developing economies in the Asia and Pacific region are expected to meet the target on infant mortality between 2016 and 2030, and 20 economies are expected to meet the MDG target after Among these economies, however, ; the ; the Republic of Korea; ; ; ; ; Taipei,China; ; and already have either low baseline or current infant mortality rates of 15 or lower (Figure 4.3). Measles vaccination of 1-year-old children has increased significantly in the region from 74% in 1990 to 84% in This vaccination rate is at par with the global average (84%) in 2013, which likely has prevented more children from deaths (Table 4.1). Measles is a highly contagious viral respiratory infection that can lead to serious complications, and Millennium Development Goals

4 146 Key Indicators for Asia and the Pacific 2015 Box 4.2: Progress Toward Achieving the Infant Mortality Rate Target Achievers/on track Hong Kong, China China, People s Rep. of Off track - slow Expected to meet target between 2016 and 2020 Expected to meet target between 2021 and 2030 Expected to meet target after 2030 Taipei,China Micronesia, Fed. States of = Lao People s Democratic Republic. Source: Tabla 4.1. Figure 4.3: Infant Mortality Rate of Selected Economies, 1990 and 2015 or Latest Year Taipei,China = Federated States of Micronesia or latest year even death. Though the disease can occur at any age, measles mainly affects children under 5 years, especially those undernourished or with poor immune systems. Figure 4.4 presents the proportion of 1-yearold children immunized against measles in 1990 or earliest year and 2013 across developing economies. By 2013, more than half (23 out of 43) of developing economies in the Asia and Pacific region with data have at least 95% of their 1-year-old children immunized against measles, with another eight developing economies having measles vaccination rates between 90% and 94%. (52%) has the least proportion of 1-year-old children immunized against measles. Other developing economies with at most 75% of their 1-year-old children immunized against measles are (75%), (74%), the (70%), (61%), Papua New Guinea (70%), and (70%). The largest percentage point increases in immunization coverage of over 50 percentage points in the MDG period are seen in the economies that started from a low baselines (of less than 35% coverage) in 1990:,,, and the Lao People s Democratic Republic. Of concern is the decline in the immunization rates in the Pacific economy of by 14 percentage points from 66% in 1990 to 52% in Data issues and comparability In more developed economies, data on mortality are usually taken from vital statistics produced from complete and fully functional civil registration systems. However, most developing economies in Asia and the Pacific lack fully functioning civil registration systems; thus, alternative and lessefficient data sources such as census and household surveys have become primary sources of data in many developing economies, posing severe challenges to accurate measurement of these critical indicators of primary health care systems. These household surveys may not be conducted each year, so that

5 Goal 4: Reduce Child Mortality 147 Figure 4.4: Proportion of 1-Year Old Children Immunized Against Measles, 1990 or Earliest Year and 2013 (%) PRC Australia Japan New Zealand econometric estimation techniques may be used to produce a consistent time series. Mortality statistics, thus, vary widely in quality. Data on immunization may be provided directly from administrative records of health workers and health stations or clinics providing inoculations or, more commonly in Asia and the Pacific, the information is collected from households in demographic and health surveys. As with mortality data, estimation techniques are used to convert partial data into comprehensive estimates. The post-2015 agenda While there has been a substantial reduction in the deaths of children due to preventable causes, there will be a need for more concerted action by governments, the development community, and other stakeholders, including the provision of requisite resources to further reduce child deaths, especially neonatal deaths to the levels of the developed economies of the world. Higher investments for prenatal and antenatal child and maternal care; labor and delivery care interventions; promoting breastfeeding; and providing women and their children with adequate nutrition, safe drinking water, and good sanitation are required in the post world to significantly reduce infant and under-5 mortality. There is also a requisite need to improve the lack of basic data regarding births, deaths, and causes of deaths from civil registration systems in many developing economies that hampers effective progress monitoring and policymaking. These systems need to be strengthened as reliable sources for vital statistics. Millennium Development Goals 1990 or earliest year 2013 = Federated States of Micronesia, = Lao People's Democratic Republic, PRC = People's Republic of China.

6 148 Key Indicators for Asia and the Pacific 2015 Goal 4 Targets and Indicators Table 4.1: Target 4.A Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate Regional Member 4.1 Under-5 Mortality Rate (per 1,000 live births) 4.2 Infant Mortality Rate (per 1,000 live births) 4.3 Proportion of 1-Year-Old Children Immunized against Measles (%) Developing Member Economies Central and West Asia a (1992) (1992) (1992) (1992) (1992) (1992) (1992) (1992) East Asia a China, People's Rep. of Hong Kong, China (2014) Taipei,China (2013)... South Asia a Southeast Asia a The Pacific a Micronesia, Fed. States of (1997) (2002) Developed Member Economies a Australia Japan New Zealand DEVELOPING MEMBER ECONOMIES a REGIONAL MEMBERS a WORLD = data not available at cutoff date, = Lao People s Democratic Republic. a Aggregates are derived for reporting economies only. Sources: United Nations. Millennium Development Goals Indicators Database. (accessed 6 July 2015); Asian Development Bank estimates.

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