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Young child survival and development

While only accounting for 23 percent of the world’s annual births, half of all under-five deaths occur in Eastern and Southern Africa (ESA).

Of the 20 countries with the highest under-five mortality rate, all are in Sub-Saharan Africa, including four in Eastern and Southern Africa: Angola, Burundi, Somalia and South Sudan.

In ESAR, 1 in 6 children died before their fifth birthday in 1990; in 2011, this had dropped to 1 in 12. And under-five mortality has declined by 48 percent from 166 per 1,000 live births in 1990, to 84 per 1,000 live births in 2011.

However, high levels of fertility and birth rates coupled with high levels of child mortality in the region have led to a rather gradual decrease in the absolute number of child deaths from 1.66 million in 1990 to 1.18 million in 2011.

Among the top 10 high-mortality countries that have achieved the sharpest annual rate of reduction over the past two decades, eight are from ESA – Rwanda, Zimbabwe, South Africa, Lesotho, Kenya, Namibia, Swaziland and Tanzania.

Overall, there is not enough progress being made in the region to meet the Millennium Development Goal (MDG 4) of reducing child mortality by two thirds between 1990 and 2015. 

Around 43 percent of all deaths among children under five occur in the first month of life. The leading causes of young children dying are pneumonia, preterm birth complications, diarrohea, complications during birth and malaria.

Globally, more than a third of under-five deaths are attributable to under-nutrition.

Water, sanitation and hygiene

Only six of the 21 countries in the region, Botswana, Malawi, Namibia, South Afria, Swaziland, and Uganda are on track to meet the related target under MDG 7 of reducing the proportion of the population without access to safe water by half between 1990 and 2015.

Geographical disparities are vast, with 87 percent of people in urban neighborhoods having access to improved drinking water sources compared to 59 percent of the population in rural areas.

Only three countries, Angola, Botswana, and South Africa, are on track to meet the MDG target of reducing the proportion of people without sanitation by half.

Open defecation – the unhealthiest sanitation practice of all – is still commonplace in some countries. In Ethiopia, Namibia and Mozambique, for example, the proportion of people who practice open defecation stands at 46, 52 and 41 percent,

In the whole of sub-Saharan Africa it is particularly the poor who lack access to sanitation. The lowest income quintile is 16 times more likely to practice open defecation than the highest.