tetanus toxoid and hepatitis B vaccines; and improve the
planning, and procurement of vaccine supply in at least five
In coordination with WHO, UNICEF and other partners,
USAID will continue reaching greater numbers of children with
basic child survival interventions, aimed at the major killers of
children, including immunizations and prevention and treatment of
diarrheal diseases, pneumonia and nutrition.
Additional efforts
will target increasing the use, quality and sustainability of
these interventions.
Sub Saharan Africa:
In the last ten years, under five mortality
rates in Africa have declined by more than 20% to 124.7 death per
1,000 live births.
Similarly, infant mortality has declined to
95 deaths per 1000 live births in 1996.
Continued investments in
health systems and key interventions to address infant and child
mortality are expected to result in continued declines in infant
and under five mortality.
In countries with severe levels of HIV
infection, however, major declines in child survival rates will
be unlikely and some increases unfortunately may occur.
Asia and the Near East:
On average, regional infant mortality
was 61 deaths per 1000 live births, and under five child
mortality rates have declined by 70% from 96.3 in 1987 to 59.8 in
In many countries, impressive improvements have been made
in reducing infant and child mortality, including Nepal, where
under five child mortality declined from 165 deaths per 1000 live
births in 1991 to 118 in 1996; the Philippines, where under five
mortality has been almost cut in half, and Morocco, where U5MR
declined from 216 in 1960 to 61 in 1992.
However, infant and
child mortality rates in many other countries in the region are
still disturbingly high.
Primary killers of children are
diarrheal disease, acute respiratory infections, and vaccine
preventable disease such as measles.
This region also has the
highest prevalence of child undernutrition, as well as high
prevalence of vitamin A deficiency; these facts make vitamin A
and other nutrition interventions key to achieving further
reductions in child mortality.
Continued investments in
addressing these and other related problems are expected to
result in at least a 7% decline in infant and under five
mortality rates in the region between 1997 and 1999.
Latin America and the Caribbean:
Average infant mortality and
under five mortality rates in Latin America have also continued
to decline; between 1987 and 1997 under five child mortality
declined dramatically from 77.4 deaths per 1,000 live births to
44 deaths per 1000 births.
Infant mortality has also declined
significantly; in 1996, the infant mortality rate was 40 deaths
per 1000 live births.
This decline is due to sustained progress
in building effective health systems that can deliver appropriate
services on a routine basis.
Vaccination coverage improved over
1995 levels across the region.
Among eight child survival
emphasis countries, 3 achieved 90% coverage of all program

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