“This trend is a positive one. Millions of lives have been saved,” said Anthony Lake, UNICEF Executive Director. “And we can do still better. Most of these deaths can be prevented, using simple steps that many countries have already put in place – what we need is a greater sense of urgency.”

The leading causes of death among children aged less than five years include pneumonia, prematurity, birth asphyxia, diarrhoea and malaria. Globally, about 45% of under-five deaths are linked to undernutrition.

About half of under-five deaths occur in only five countries: China, Democratic Republic of the Congo, India, Nigeria, and Pakistan. India (22%) and Nigeria (13%) together account for more than one-third of all deaths of children under the age of five.

Newborn children are at particularly high risk

“Care for mother and baby in the first 24 hours of any child’s life is critical for the health and wellbeing of both,” says Dr Margaret Chan, Director-General at WHO. “Up to half of all newborn deaths occur within the first day.”

The lives of most of these babies could be saved if they had access to some basic health-care services. These include skilled care during and after childbirth; inexpensive medicines such as antibiotics; and practices such as skin-to-skin contact between mothers and their newborn babies and exclusive breastfeeding for the first six months of life.

While the global average annual rate of reduction in under-five mortality accelerated from 1.2% a year for the period 1990–1995 to 3.9% for 2005–2012, it remains insufficient to reach Millennium Development Goal 4 which aims to reduce the under-five mortality rate by two-thirds between 1990 and 2015.

“Continued investments by countries to strengthen health systems are essential to ensure that all mothers and children can get the affordable, quality care they need to live healthy, productive lives,” said Keith Hansen, Acting Vice President of Human Development at the World Bank Group.

Sub-Saharan Africa, in particular, faces significant challenges as the region with the highest child mortality rates in the world. With a rate of 98 deaths per 1000 live births, a child born in sub-Saharan Africa faces more than 16 times the risk of dying before his or her fifth birthday than a child born in a high-income country.

However, sub-Saharan Africa has shown remarkable acceleration in its progress, with the annual rate of reduction in deaths increasing from 0.8% in 1990–1995 to 4.1% in 2005–2012. This is the result of sound government policies, prioritized investments and actions to address the key causes of child mortality and reach even the most difficult to reach populations.

The broad based Maternal and Neonatal Tetanus Elimination Initiative, in which various United Nations agencies participate, said that since 1999, over 118 million women of child-bearing age have been vaccinated against tetanus in 52 countries.

Many of these women received their tetanus vaccine as part of a campaign which included other life- saving interventions for children – such as immunization against measles, Vitamin A supplements, de-worming tablets and information on umbilical cord care.

Tetanus kills one newborn baby every nine minutes and almost all of these babies are born in poor families living in the most disadvantaged areas and communities. The disease is transmitted when children are born in unhygienic conditions, and non-sterile materials are used to cut the umbilical cord, or are applied to the umbilical bump. At that point, the mother’s life is also in danger.

Tetanus is easily preventable with a vaccine administered to the mother. With at least three protective doses that cost about $2, the mother and her future newborns are protected for five years.

In a news release, the Initiative said that despite the progress half the 59 priority countries, some 28 other have still not reached the elimination goal. The main challenges to eliminate the disease are a lack of access to communities because of insecurity, cultural barriers, competing priorities, and inadequate funding.

The countries that have eliminated maternal and neonatal tetanus are: Bangladesh, Benin, Burkina Faso, Burundi, Cameroon, China, Comoros, Congo, Cote d’Ivoire, Egypt, Eritrea, Ghana, Guinea Bissau, Iraq, Liberia, Malawi, Mozambique, Myanmar, Namibia, Nepal, Rwanda, Senegal, South Africa, Tanzania, Timor Leste, Turkey, Togo, Uganda, Vietnam, Zimbabwe and Zambia.

Shortly after the Initiative was launched in 1999, it was estimated that over 200,000 deaths of newborns were caused by tetanus every year. By 2010, this number dropped to an estimate 58,000.

The Initiative is an international private-public partnership that includes national governments, the UN Children’s Fund (UNICEF), World Health Organization (WHO), UN Population Fund (UNFPA), the GAVI Alliance, USAID/Immunization Basics, Centres for Disease Control and Prevention, Save the Children, and the Bill & Melinda Gates Foundation, among others.