Death rates in children younger than 5 are dropping in many countries at a surprisingly fast pace, according to a new report based on data from 187 countries from 1970 to 2010.
Worldwide, 7.7 million children are expected to die this year — still an enormous number, but a vast improvement over the 1990 figure of 11.9 million.
On average, death rates have dropped by about 2 percent a year from 1990 to 2010, and in many regions, even some of the poorest in Africa, the declines have started to accelerate, according to the report, published online today by the Lancet, a British medical journal. Some parts of Latin America, north Africa and the Middle East have had declines as steep as 6 percent a year.
Other reports in recent years have found similar trends, but the new article, based on more detailed information and what its authors say are improved statistical methods, paints the most optimistic picture yet. Health experts say the figures mean that global efforts to save children's lives have started working, better and faster than expected.
Vaccines, AIDS medicines, vitamin A supplements, better treatment of diarrhea and pneumonia, insecticide-treated bed nets to prevent malaria and more education for women are among the factors that have helped lower death rates, said Dr. Christopher J.L. Murray, an author of the report and the director of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. He said the improvements in Africa were especially encouraging.
The United Nations has set a goal of reducing death rates in children younger than 5 by two-thirds from 1990 to 2015, but not many countries seem to be on track to reach it.
A third of all deaths in children occur in south Asia, and half in sub-Saharan Africa. Newborns account for 41 percent of those who die. The lowest death rates, per 1,000 births, are in Singapore (2.5) and Iceland (2.6); the highest are in Equatorial Guinea (180.1) and Chad (168.7).
In rich countries, some of the worst rates are in the United States (6.7) and Britain (5.3).
Dr. Mickey Chopra, the chief of health for UNICEF, said countries with governments that had "fully supported child survival and primary care" had improved quickly, and he cited Malawi, Ethiopia, Tanzania and Rwanda.
In addition, he said, Botswana had scaled up treatment for HIV and for preventing mother-to-child transmission, and was seeing child mortality rates decline as a result. Zambia also had significant declines, he said, because 75 percent of families had received bed nets to prevent malaria.
Twenty years ago, the United States ranked 29th. It now ranks 42nd globally, behind much of Europe as well as the United Arab Emirates, Cuba and Chile.
Singapore cut its rate by two-thirds between 1990 and 2010. Serbia and Malaysia, which were ranked behind the United States in 1990, cut their rates by nearly 70 percent and now are ranked higher. The United States saw a 42 percent decline in child mortality, a pace that is on par with Kazakhstan, Sierra Leone and Angola.
"There are an awful lot of people who think we have the best medical system in the world," Murray said. "The data is so contrary to that."
Information from the Los Angeles Times was used in this report.