Measles vaccine, like the one given to this Indonesian child in 2006, has helped to reduce child mortality, UNICEF says. (AP Photo/Dita Alangkara)

The rate at which children under five are dying continued to fall in 2008, but 99 per cent of these child deaths still occur in poor countries, according to a paper released on Thursday.

Based on estimated mortality rates, the number of child deaths declined to an estimated 8.8 million last year from 12.5 million in 1990, when the Millennium Development Goals to reduce world poverty were set, UNICEF said.

"Compared to 1990, 10,000 fewer children are dying every day," said UNICEF's executive director Ann Veneman said in a statement. "While progress is being made, it is unacceptable that each year 8.8 million children die before their fifth birthday.”

Public health experts credited the decline to greater use of measles vaccinations, insecticide-treated bednets to prevent malaria and vitamin A supplementation.

The UN's millennium development goal 4 or MDG 4 calls for a two-thirds reduction in the mortality rate among children under the age of five years between 1990 and 2015.

Call to accelerate progress

"The rate of decline in under-five mortality is still grossly insufficient to obtain the MDG goal by 2015 particularly in sub-Saharan Africa and South Asia," Danzhen You at UNICEF in New York and his colleagues wrote in a commentary in The Lancet medical journal.

"It is alarming that among the 67 countries with high mortality rates (40 per 1,000 or more), only 10 are on track to meet MDG 4. These findings call for a more concerted effort to accelerate progress."

Other findings:

• Together, Africa (51 per cent) and Asia (42 per cent) represented 93 per cent of the deaths globally.
• The best performing region was Latin America and the Caribbean, which has reduced under-five mortality by 56 per cent between 1990 and 2008. Central and eastern Europe is also on track to meet MDG4.
• One in seven children in sub-Saharan Africa die before their fifth birthday; in a sub-region of this region — West and Central Africa — this was even higher, at one in six children.
• Half of the deaths in 2008 occurred in five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan, and China. India and Nigeria together account for nearly one-third of the total number of under-five deaths worldwide (21 per cent and 12 per cent, respectively).
• The best performers in terms of average annual rate of reduction among countries with under-five mortality of 40 or higher included Nepal, Bangladesh, Eritrea, Lao, Mongolia, Bolivia, and Malawi which have all consistently achieved annual rates of reduction of under-five mortality of 4.5 per cent or higher.

The authors noted that since the data generally focused on mortality in the preceding three to five years that improvements in vaccination programs, efforts to fight HIV and an increase in insecticide-treated bednets might not be fully reflected yet.

"There is evidence therefore to believe that the acceleration in child survival might already be well under way," the UNICEF commentators wrote.

They suggested redoubling efforts on pneumoccocal pneumonia and rotaviral diarrhea vaccination, since the diseases are two of the top causes of under-five mortality.