By Amanda Gardner
HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

FRIDAY, June 27 (HealthDayNews) -- The information is no less devastating for being familiar: More than 10 million children under the age of 5 die every year worldwide, and 6 million of those deaths needn't happen.

Those sobering statistics have prompted a call to action by one of the world's leading medical journals to find ways to prevent these deaths. Over the next month, The Lancet will be publishing a series of five articles devoted to the issue of child survival.

"The enormity of this child death rate is staggering," says Dr. Cliff O'Callahan, a member of the pediatric faculty at the Middlesex Family Practice Residency Program in Connecticut who also serves on the American Academy of Pediatrics' committee on international child health.. "What is also staggering is that so many of these children are dying from phenomenally simple things that we know how to cure, and it does not need a doctor or a nurse to do that."

The first article in the series, which appears in the June 28 issue, outlines the hard facts of child mortality: where it occurs, what causes it, and who are the main victims.

Forty-two countries account for 90 percent of all the deaths of children under the age of 5. But only six countries -- India, Nigeria, China, Pakistan, Democratic Republic of Congo, and Ethiopia -- account for 50 percent of those deaths. In addition, 40 percent of child deaths occur in sub-Saharan Africa; 35 percent in South Asia. Of the total deaths, 40 percent occur in babies who have not reached the age of 1 month.

What's more, most of the causes of childhood death include diarrhea, malaria, pneumonia, measles, HIV/AIDS and neonatal causes. Unsafe drinking water and lack of breast-feeding are two more common culprits.

"The vast majority of child deaths are far distant from the northern countries. It's not an immediate problem to us," says O'Callahan, who set up a rural health system in Guatemala that has trained at least 200 health promoters, serves 70 villages, and cares for thousands of people. "To think of an entire state's population being wiped out every year. We tend to step back from it."

"It's sobering," he adds. "The challenge is for many of us to look at this in a different light, to be challenged visually and mentally with some of the obvious once again."

"The series is principally a call to leadership on the issue of child mortality," adds Alfred Ironside, a spokesman for UNICEF in New York City. "The kind of leadership that's needed is the consistent, committed leadership of heads of state and national governments. The Lancet series is intended to tighten our focus on the remaining challenges and to spur some more of that commitment from national governments and heads of state."

The second article, which appears in the July 5 issue, discusses how measures such as breast-feeding, insecticide-treated bed nets, measles vaccination, and rehydration therapy could reduce the mortality rate.

These strategies form much of UNICEF's current focus.

"From UNICEF's perspective, the major challenge is moving child survival from the health center into the home," Ironside says. "It's no longer the vaccine-preventable disease where most progress can be made. Now, most progress can be made through greater use of breast-feeding globally, through the use of oral rehydration salts to treat diarrhea in the home, and the use of insecticide-treated bed nets in malaria areas."

Part of the answer, O'Callahan adds, involves going into individual communities and training local health-care workers. An illiterate person can help diagnose pneumonia, for instance, by drawing a line on a thermometer and measuring the sick person's breathing rate. Diarrhea can be treated with rehydration fluid. Although HIV/AIDS is a tougher issue, it is possible to slow the transmission rate from a pregnant woman to her child with antiviral drugs.

The third paper deals with the changes in health-care infrastructure that will be needed. The fourth paper address inequalities in access to health care. The final article is really a call to action, figuring how to translate all this information into progress.

Here, O'Callahan says, the focus needs to get more localized -- not regions, but countries and even parts of countries.

Health-care workers from developed countries such as the United States who want to help out in poorer regions also need to focus their efforts. "The challenge for any one of us working in international health is to concentrate on an area where we might know something," O'Callahan says. "Getting into our little niche. That's the only way we can deal with the enormity of it."

More information

Visit UNICEF for a detailed summary of State of the World's Children 2003 or the World Health Organization for more on child health.

SOURCES: Alfred Ironside, spokesman, UNICEF, New York City; Cliff M. O'Callahan, M.D., Ph.D., pediatric faculty, Middlesex Family Practice Residency Program, Middlesex, Conn., and assistant professor of pediatrics, University of Connecticut School of Medicine, Farmington, and member, committee on international child health, American Academy of Pediatrics; June 28, 2003, The Lancet

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