Special report:Where and why children face the greatest danger of dying in Afrika

By Edward Qorro
Tanzania is among countries where children aged under-five face the greatest risk of death despite ongoing efforts to improve child welfare. Most of those countries are located in sub-Saharan Africa, according to a report released recently by an international NGO Save the Children, titled the State of World’s Mothers 2011.

Others facing the same situation are located in conflict and post-conflict zones, such as Afghanistan and Somalia.

The risk factor is based on under-five mortality estimates calculated by the United Nations Children’s Fund (Unesco) in collaboration with other development agencies.

Mortality rankings show that in 2009, an average of 108 under-five deaths for every 1000 live births were reported in Tanzania, as compared to 118 deaths in 2006 and 116 deaths in 2007.

And according to the United Nations Development Programme (Undp) office in Tanzania, most child deaths in the country are due to malaria, pneumonia, diarrhoea, malnutrition and complications of low birth weight as well as HIV and Aids.

Some studies also associate short birth intervals, teenage pregnancies and previous child deaths with increased risk of child and mother’s death.

“Malnutrition is the underlying factor in more than 50 per cent of child deaths. So is neonatal deaths accounting for 50 per cent of infant mortality. Census data and those from surveillance sites suggest a decline in both infant and under-five mortality rate. Under-five mortality decreased from 191 per thousand live births in 1990 to 133 in 2005 and further to 81 in 2010 in the Mainland and from 202 in 1990 to 101 in 2005 in Zanzibar,” Undp says on its official website.

Although the figures represent some improvement in child welfare, the country still ranks among those where the prospect for life among small children is still uncertain.

In comparison, the industrialised Western countries have the lowest under-five mortality rates, with Nordic states led by Sweden at the bottom of the risk ladder.

Only three deaths for every 1000 live births were reported in Sweden in 2009, as compared to the average of 129 deaths in sub-Saharan Africa. The figures as the most recent estimates by Unesco.

Under-five mortality is used as a principle indicator of human and economic development of a country. In East Africa, Kenya ranked favourably in 2009 at 39 with 84 deaths per 1000 live births, followed by Tanzania (ranked 27) and Rwanda at number 25 with 111 deaths per 1000 live births.

According to Unicef, globally there has been a significant long-term decline in under- five deaths. In 1970, for example, 16.3 million people were dying every year, as compared to 8.1 million reported in 2009.

“In the last 20 years, the number of children under five dying every day from preventable causes has been cut by one third, from 34,000 in 1990 to around 22,000 in 2009,” noted Unicef in the State of World’s Children 2011.


For its part, Save the Children has called for more investments in maternal and health care in the developing countries, noting: “Millions of children are alive today because of past investments in lifesaving programmes.
But our work is not done. Each day, 22,000
children still perish, mostly from preventable
or treatable causes.”

The causes include malnutrition and hunger, which continue to affect millions of children in the developing countries, especially sub-Saharan Africa.

Currently about 11 million people are facing starvation in the famine-stricken Horn of Africa and some parts of East Africa, most of them women and children.

Save the Children is urging developed countries, led by the United States to increase support on programmes for improving maternal and child welfare in the developing nations.

“The United States spent about $667 billion
on defence last year, but only $17 billion on
humanitarian and poverty-focused development assistance. How much more could we have accomplished if we had invested a lot more – and much earlier – in things like hospitals and schools and midwives and medicine
for the women and children of Afghanistan

and other developing countries?” writes in the report Colonel (rt) John Agoglia, who served as Director of the Counterinsurgency Training
Center-Afghanistan in Kabul.

He argues that human suffering caused by hunger and malnutrition leads to conditions of despair and political instability, which in turn are a threat to global peace. “When communities have little hope for the future, they have little hope for peace.”

The report notes that the gap in availability of maternal and child health services is “dramatic” between countries at the top and those at the bottom of the ranking, such as Afghanistan and Norway.

“Skilled health personnel are present at virtually
every birth in Norway, while only 14 percent
of births are attended in Afghanistan,” it notes. “A typical Norwegian woman has 18 years of formal
education and will live to be 83 years old; 82
percent are using some modern method of
contraception, and only 1 in 175 will lose a
child before his or her fifth birthday.

“At the opposite end of the spectrum, in Afghanistan, a typical woman has fewer than five years of education and will not live to be 45. Less than 16 percent of women are using modern contraception, and 1 child in 5 dies before reaching age 5. At this rate, every mother in Afghanistan is likely to suffer the loss of a child.”

Comparing the situation in Sweden and Somalia, the report reads: “While nearly every Swedish child – girl and boy alike– enjoys good health and education, children in Somalia face a more than 1 in 6 risk of dying before age 5. Thirty-six percent of Somali children are malnourished and 70 percent lack access to safe water. One in 3 primary-school aged children in Somalia is enrolled in school, and within that meagre enrolment, boys outnumber girls almost 2 to 1.”

Although the situation in Tanzania is comparatively better than Somalia, the country still suffers from high under-five mortality rates, and is in league with some post-conflict states.

Every year, about 154,000 children die in Tanzania from preventable and treatable illnesses before reaching their fifth birthday and more than a quarter of these children are reported as dying within the first 28 days.


It is feared that “the high presence of anaemia among pregnant women would lead to low birth weight and stillbirths and a significant 20 per cent of new HIV infections which are due to mother to child transmission.”

However, Tanzania has made some strides in child health care, as a half of the births are said to be delivered by a health professional, half of them done in a health facility.

Dr Joy Lawn, the Director Global Evidence and Policy for Save the Children's Saving Newborn Lives program, says that the increasing coverage and quality of care at birth would accelerate Tanzania’s progress to MDG5 and also MDG 4 (newborn deaths account for over 30% of deaths in children under five) and also stillbirth reduction.

The MDG 4 targets reducing by two-thirds the mortality death of children under five by 2015, while MDG5 aims to reduce by three quarters the maternal mortality ratios.

Globally, however, there is some progress towards health-related MDGs. The World Health Organisation (WHO) says fewer children are dying, and the annual global deaths of children under five years of age fell to 8.1 million in 2009 from 12.4 million in 1990.

According to WHO, there is also indication that fewer children are underweight, with the percentage of underweight children under five years old estimated to have dropped from 25% in 1990 to 16% in 2010.

“More women get skilled help during childbirth. The proportion of births attended by a skilled health worker has increased globally, however, in the WHO Africa and South-East Asia regions fewer than 50% of all births were attended,” is stated.

A further decline in under-five mortality is expected as “fewer people are contracting HIV. New HIV infections have declined by 17% globally from 2001–2009,” says WHO, noting also that, among other things, “more people have safe drinking-water, but not enough have toilets. The world is on track to achieve the MDG target on access to safe drinking-water but more needs to be done to achieve the sanitation target.”

Nevertheless, Save the Children points out that the situation in Tanzania and other sub-Saharan African countries still requires move investment in child welfare programmes in order to achieve the MDG targets.


“Investment is needed in more midwives, improving facilities and considering novel approaches like maternity waiting homes, voucher schemes, emergency transport schemes and partnering with Traditional Birth Attendants to bring women to hospitals for birth,” says Dr Lawn, noting adding that such investments would bring a triple return by saving the lives of mothers, newborns and stillbirths.

And according to a situation analysis recommendations, the government and decision makers are required to ensure that every district hospital in the country has the necessary equipment for childbirth and a neonatal unit to care for small and sick babies.

A recommendation has also been made for “integrating services such as emergency obstetric care services with newborn care, especially resuscitation as well as improving supervision, pay, and mentorship and career opportunities for health workers.”

The government is in addition advised to consider offering incentives to families to encourage earlier care seeking during pregnancy, and to introduce flexible clinic hours and facilitate referral services, in addition to ensuring that every birth and death is well recorded.


According to Save the Children, working on children’s and maternal wellbeing and allocation of maximum available resources to achieve it, is a legal obligation which requires the state’s adequate response and action.

Earlier this year, the government pledged its commitment to reducing deaths of children under the age of five, focusing on improving maternal healthcare.

The minister of Health and Social Welfare, Dr Haji Mponda, says the move is necessary for Tanzania to realise targets four and five of the Millennium Development Goals (MDGs) by 2015.

“Our focus will be on reducing maternal and child deaths, by ensuring that we improve the health sector,” he said.
The minister also stressed the importance of ensuring that health services reach the grassroots where adequate health services are unheard of.

For her part, Ms Tonny Ndunguru, the executive director of Chemichemi, a non -governmental organisation based in Mwanza advocating for reduction of maternal deaths, has urged the government to extend it health services to places where maternal deaths are more rampant, particularly in rural areas.

“Maternity health services are lacking in most rural areas in the country; the government has to ensure that such areas are also catered for,” she said.

She cited transport bottlenecks, few skilled midwives and poor infrastructure as among the setbacks in extending health services towards the realisation of the MDGs targets by 2015.

“Most women walk long distances to get maternal healthcare, at some point they deliver on their way to the hospital…such setbacks cause more deaths of women and their children,” she observed.

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