Progress in child survival since the 1990 World Summit for Children

Child mortality is decreasing
Polio eradication is within sight
Micronutrient success
___Vitamin A deficiency
___Iodine deficiency
Diarrheal disease and oral rehydration therapy (ORT)

Polio eradication is within sight

Significant progress was made in eliminating polio during the 1990s, and now eradication of this terrible disease is within sight. In 1988 a global goal of eradicating polio by the year 2000 was set. Because of the vision, hard work and commitment of dozens of donor organizations, and national and local governments, the world is close to eliminating one of the most debilitating and deadly infectious diseases.

Long one of the most feared diseases, polio is a highly contagious viral infection that in severe cases can lead to respiratory failure, paralysis, and death. Prior to the development of a vaccine in 1955, polio paralyzed or killed more than a half million people every year. There is no cure for polio, and more than half of all cases of the disease are in children under age three. The only effective way to way to prevent and eliminate polio is through worldwide immunization.

As a result of the efforts of the World Health Organization, Rotary International, UNICEF and a host of other partners, reported cases of polio fell from an estimated 350,000 at the beginning of the 1990s to around 5,000 at the end of the decade. Through one of the largest international public health campaigns in history, two to three million children have been spared from the effects of polio.

Much of this progress comes from the success of well-coordinated National Immunization Days (NIDs). Organized through governments and communities around the world, NIDs are responsible for vaccinating almost two billion children in the last five years. In one week alone last year, more than 70 million children were immunized during a synchronized polio vaccination effort involving 17 West African nations.

North and South America have been officially certified as polio-free and Turkey remains as the only European nation reporting cases in the last year. The number of countries still affected by the disease has dropped from 125 to 20, the majority of which are now mainly concentrated in Central and Southern Asia, and West and Central Africa.

Complete elimination of the disease will require that every child has been fully immunized, and that every country remains free of any new cases for at least three years. Once this occurs and immunizations are no longer needed, the savings from polio eradication are estimated to be around US $1.5 billion per yearfunds that can be used to address other important public health priorities.

The worldwide effort to eradicate polio is at the critical final stages. With one last intensified commitment of resources and effort on the part of governments, donor organizations and individuals, polio could be wiped out by the year 2005, following small pox as the second disease to ever be eradicated.

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Micronutrient success

Some of the most important progress that has been achieved in child survival during the last decade has been in the area of micronutrient malnutrition, often called the hidden hunger. Years of intensive research have revealed the critical importance of micronutrients as not only fundamental building blocks for healthy development, but essential tools in combating infection and disease. Insufficient amounts of certain vitamins and minerals can permanently impair a child's intelligence and physical ability, limiting his capacity to function productively and achieve full potential. When whole populations are micronutrient deficient, as in many parts of the world, the social and economic development of entire nations can be negatively impacted.

The 1990 World Summit for Children identified micronutrients as an important part of the agenda to improve children's health by setting ambitious goals for the virtual elimination of vitamin A and iodine deficiency by the end of the decade.

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Vitamin A deficiency

For a child, deficiency in vitamin A, can mean the difference between life and death. Long known for its benefits to health and vision, vitamin A has also proven to be an absolutely critical element in the human body's ability to stave off disease and infection. In the developing world, more than 100 million children are vitamin A deficient resulting in as much as a quarter of all child deaths. Vitamin A deficiency (VAD) is the also the leading cause of preventable childhood blindness, afflicting an estimated half million children every year.

Over the past two decades, exhaustive research has been conducted on vitamin A and results show conclusively that vitamin A reduces the severity and mortality rates associated with diarrheal diseases, respiratory infections, and measles. Vitamin A supplementation alone can reduce overall child mortality by as much as 34percent in vulnerable populations. VAD is also common in women during pregnancy, often causing night blindness. Recent studies suggest that vitamin A, given in low-dose supplements during pregnancy, can reduce maternal mortality by up to 50 percent.

At only 2 to 3 cents per capsule, vitamin A supplementation is recognized as one of the most cost-effective and sustainable child survival interventions available. Even the total cost of delivering vitamin A capsules every six months to children aged six months to five years is only 50 cents per year.

Providing vitamin A through fortified foods is even more efficient and cost effective than supplementation. Fortification of staple foods like sugar, flour, margarine and rice represents one of the most promising long-term solutions to VAD in the developing world. Other methods of improving intake of vitamin A include increasing the support for dietary improvement programs that specifically encourage foods rich in beta-carotene and exclusive breastfeeding programs.

Iodine deficiency

Iodine deficiency is one of the most serious and damaging conditions that affects children. The lack of iodine in a child's diet can lead to iodine deficiency disorder (IDD) and result in severe physical and mental disabilities that can last his or her entire life.

IDD can be prevented with just one teaspoon of iodine over a person's entire lifetime. Lack of iodine can lead to goitre (visible swelling of the thyroid gland) or cretinism (severe physical and mental developmental disorder resulting from the thyroid's inability to produce the hormone thyroxine). The world's leading cause of preventable retardation, IDD is particularly damaging during pregnancy when insufficient iodine consumption on the part of the mother can severely retard fetal brain development. In regions where iodine deficiency is prevalent, the average intelligence quotient (IQ) of entire populations can be as much as 13 points lower. The social and economic implications of IDD can be detrimental to entire nations, due to the diminished physical and mental capacities of individuals coupled with the high costs of treating such severe physical and mental disabilities.

Diarrheal disease and oral rehydration therapy (ORT)

In 1979, diarrhea was the leading cause of child mortality, accounting for an estimated 4.6 million deaths annually. That year, public health workers introduced Oral Rehydration Therapy (ORT) as a way to combat this devastating child survival challenge. This simple treatment formula became the cornerstone of a worldwide public health campaign to reduce infant and child mortality from diarrheal diseases. Originally consisting of prepackaged, dissolvable oral rehydration salts (ORS), ORT has evolved to include increased home fluid therapy, (usually breastfeeding and homemade electrolyte solutions), and expanded feeding. ORT has been called the most significant medical advance of the twentieth century, and is responsible for reducing child mortality by more than two-thirds.

The successful reduction in diarrheal disease mortality was achieved over the last two decades through carefully developed strategies and the implementation of comprehensive global programs delivered through numerous organizations. These programs trained thousands of health workers to effectively apply social marketing and public education techniques, promoted exclusive breastfeeding and developed local capacity to produce oral rehydration salts.