In 2005, 10 million children under the age of five died across the world; over 4 million of these deaths occurred in Asia and the Pacific.

Although the under-five mortality rate (58 per 1,000 live births) is considerably lower than in Africa (153 per 1,000 live births), the absolute number of children dying before their fifth birthday in Asia and the Pacific is comparable to that of Africa. Among all developing regions, the Latin American and Caribbean region has the lowest child mortality rate.

From 1990 to 2005, the Asian and the Pacific region managed to reduce the under-five mortality rate considerably, from 90 children per 1,000 live births to 58. During the same period, Latin America and the Caribbean experienced an even faster reduction, but in Africa there was a more modest reduction, from 172 to 153.

Figure 4.1 Index of change in the child mortality rates for selected groups of Asian and Pacific countries/areas, 1990-2005

Within the ESCAP region, under-five mortality was reduced most rapidly in the ASEAN region, where the rate dropped from 77 child deaths per 1,000 live births to 40, a reduction of nearly half. However, despite the overall progress in ASEAN countries, Cambodia, the Lao People's Democratic Republic and Myanmar are still among the 20 countries with the highest under-five mortality rates in the Asian and Pacific region.

The rate of under-five mortality in the SAARC region has also fallen, albeit at a slower pace. From 129 deaths per 1,000 live births in 1990, it came down to 82 in 2005, but, as children constitute a large population group in the SAARC countries, this means that, every year, more than 3 million children still die before reaching their fifth birthday.

Among the landlocked developing countries of the Asian and Pacific region, there has been only a marginal reduction in the under-five mortality rate, which currently stands at 134 deaths per 1,000 live births. Armenia is the only country in this group that is not among the 20 countries with the highest under-five mortality rates in the Asian and Pacific region, but the most worrying case is that of Afghanistan, where the under-five mortality rate has barely moved. With 257 child deaths per 1,000 live births, Afghanistan has the fourth highest under-five mortality rate in the world, after Sierra Leone, the Niger and Angola.

According to WHO, most child deaths occur in the first year of life. Of the 58 under-five deaths per 1,000 live births in Asia and the Pacific that occurred in 2005, 44 were among infants (see figure 4.3). In the Central Asian subregion, the under-five mortality rate is 72 deaths per 1,000 live births, and 60 of those - a staggering 83 per cent - are infant deaths.

As in the case of under-five mortality, the South-East Asian subregion reduced infant mortality at the fastest pace within the Asian and Pacific region. The SAARC region, however, reduced infant mortality between 1990 and 2005 at a much faster pace than under-five mortality. Bangladesh and Nepal almost halved their infant mortality rates between 1990 and 2005. Bhutan and India also made significant progress during this period.

Overall, the Asian and Pacific region has reduced infant mortality at a faster pace than under-five mortality, and this may be related to two of the main interventions that, according to WHO, reduce child deaths: reducing malnutrition and increasing immunization coverage.

The main cause of infant and child mortality is malnourishment. According to some estimates from WHO, over 50 per cent of all under-five deaths are caused by malnutrition. The prevalence of moderately or severely underweight children is a direct indicator for monitoring nutritional status among children under 5 years of age.

Although there is insufficient data to calculate subregional estimates for Asia and the Pacific, UNICEF estimates suggest that South Asia has the highest percentage of underweight children in the world. According to WHO, half of the world's 150 million malnourished children live in this subregion.

Figure 4.2 Under-five mortality rates in Asia and the Pacific, 1990 and 2005

Figure 4.3 Infant mortality rates in Asia and the Pacific, 1990 and 2005

The prevalence of children underweight is close to half in Bangladesh, India and Nepal. Afghanistan and Pakistan, at close to 40 per cent, also have high rates of underweight children (see table 4.1).

As the available data is insufficient to establish trends, there is no clear sign of progress on this indicator in most countries. Among the few countries for which it is possible to track progress is Bangladesh, which has reduced the proportion of underweight children from nearly two thirds to less than one half.

One of the better-performing countries, Malaysia reduced the proportion of underweight children from 23 per cent in 1993 to 11 per cent in 2003. China and Turkey also more than halved the number of underweight children during a similar period, from 19 to 8 per cent and from 10 to 4 per cent, respectively.

ASEAN countries such as the Philippines and Viet Nam, despite having made progress in reducing poverty, have yet to experience equal progress in reducing child malnourishment. In the Lao People's Democratic Republic and Cambodia, over 40 per cent of all children under 5 years of age are underweight. The prevalence of underweight children in Cambodia increased from 40 per cent to 45 per cent between 1994 and 2000.

Measles, an easily preventable disease, is still responsible for 4 per cent of all infant and child deaths in the world. Although three quarters of all one-year-old children in the Asian and Pacific region had been immunized by 2005, wide disparities remain among subregions.

Central Asia has a measles immunization rate of 97 per cent, which is even higher than the 90 per cent of North America and Europe. In ASEAN countries, four out of five one-year-olds are vaccinated, but immunization rates are as low as 66 per cent in small island developing States and 64 per cent in SAARC countries, which is lower than the 66 per cent achieved in Africa.

Income differentials are important determinants of immunization. High-income countries in the region have an immunization rate close to 100 per cent, while middle- and low-income countries manage to achieve 85 and 66 per cent, respectively.

Figure 4.4 Prevalence of moderately or severely underweight children in Asia and the Pacific, 1990 and 2004

Out of the 10 countries with the lowest immunization rates in the Asian and Pacific region, 7 are small island developing States. This poor performance is partly due to their geographical circumstances, but there are other countries not in the category of small island developing States that also perform poorly in this area. At just 41 per cent, the Lao People's Democratic Republic has the lowest measles immunization rate in Asia and the Pacific; only a few African countries, such as Chad and Somalia, are further behind. Afghanistan and India round out the list of Asian and Pacific countries with the 10 lowest immunization rates.

Disparities in immunization rates among different income groups within countries can be substantial. While Cambodia, for instance, has an immunization rate close to the ASEAN average, 80 per cent of children living in households in the upper income quintile are immunized, as opposed to only half of those living in households in the lowest income quintile.

This is also the case for SAARC countries. In Bangladesh and Nepal, for example, over 80 per cent of children living in households belonging to the upper income quintile are immunized, compared with less than 61 per cent of those living in low-income households.

Only Central Asian countries, such as Armenia and Turkmenistan, have no significant disparities in immunization rates between high and low income quintiles.

Figure 4.5 The 10 Asian and Pacific countries with the lowest measles immunization rates for one-year-old children, 1990 and 2005

Figure 4.6 Measles immunization rates for one-year-old children in the richest and poorest income quintiles of selected Asian and Pacific countries/areas (latest year between 1991 and 2004)