Statistical Yearbook for Asia and the Pacific 2012
 
   
B. Health
 
B.1. Child health

The well-being of children in the Asian and Pacific region has improved. Child and infant mortality rates have decreased, and there has been a noticeable improvement in immunization coverage. However, there has been slower progress in reducing the neonatal mortality rate, underweight prevalence among children under 5 years of age, and the absolute number of children suffering from being underweight.

In the Asian and Pacific region, more children survive to their fifth birthday than at any other time in decades. Under-5 and infant mortality rates have fallen; however, neonatal mortality rates have lagged behind and the number of preventable child deaths remains unacceptably high.

The region halved the child mortality rate between 1990 and 2011 (from 81.5 per 1,000 live births in 1990 to 40.3 per 1,000 live births in 2011). Target 4.A of Millennium Development Goal 4 is to reduce the under-5 mortality rate by two thirds by 2015, and all Asian and Pacific subregions have considerably reduced this rate. However, only East and North- East Asia reduced the under-5 mortality rate by more than two thirds between 1990 and 2011, thanks to improvements in China and Mongolia. Bangladesh, the Lao People’s Democratic Republic, Maldives, Timor-Leste and Turkey have also successfully achieved the target. Conversely, slow progress in reducing the under-5 mortality rate has been witnessed in Afghanistan (101.1 per 1,000 live births), Pakistan (72.0 per 1,000 live births), Myanmar (62.4 per 1,000 live births) and India (61.3 per 1,000 live births), where under-5 mortality rates had not been reduced by even half between 1990 and 2011.

Progress can be attributed to improvements in areas that are directly or indirectly linked to the survival of children, including: (a) the availability of maternal, newborn and child health services; (b) family income and food availability, nutritional well-being and the health knowledge of mothers; (c) the level of immunization; (d) access to medical technology, safe drinking water and basic sanitation; and (e) the overall safety of the child’s environment. It is clear that a large proportion of the reduction in the under-5 mortality rate is due to improvements in vaccinepreventable diseases.

This progress is insufficient, however. Close to 3 million children under 5 years of age died in 2011 in the Asian and Pacific region, and more than three quarters of those deaths occurred in South and South-West Asia. The residual burden of pneumonia, diarrhoea, malaria and neonatal complications has to be overcome in order to make further progress in all countries.

Economic advancement has not necessarily translated into investments in human development. UNICEF indicates that there is no fixed relationship between the annual rate of reduction of the under-5 mortality rate and the annual rate of growth in per capita GDP1; however, it is clear that many nations that have achieved significant reductions in the under-5 mortality rate have also achieved significant reductions in fertility.2

A similar pattern in infant mortality rates can be observed. Progress has been considerable but insufficient. Only five countries in the region have been able to reduce their rates by more than two thirds in the past two decades, namely China, the Lao People’s Democratic Republic, Maldives, Singapore and Turkey. In 2011, the number of infant deaths estimated in the region was 2.36 million, which represents about 46 per cent of the total number of infant deaths worldwide.

The reduction in the under-5 mortality rate has largely occurred in older children (post-neonatal age, that is, beyond the first 28 days of life). The neonatal mortality rate has lagged behind due to high rates of prematurity, asphyxia and neonatal infections.3 There has been suboptimal progress in maternal health care, especially in the areas of skilled attendance at birth, birth spacing and the management of pregnancy and childbirth complications. As mortality among older children has declined, neonatal mortality has increased as a proportion of all under-5 deaths. In terms of neonatal mortality, six countries have rates above 25 deaths per 1,000 live births, namely Afghanistan (36.2), Pakistan (35.6), India (32.3), Myanmar (29.9), Nepal (27.0) and Bangladesh (26.4).

Figure B.1-1
Under-5 mortality rates, Asian and Pacific region and subregions

Figure B.1-1 Under-5 mortality rates, Asian and Pacific region and subregions

Figure B.1-2
Infant mortality rates, Asian and Pacific region and subregions

Figure B.1-2 Infant mortality rates, Asian and Pacific region and subregions

Immunization is a preventive measure for under-5 mortality. However, coverage in some countries in the region is not yet universal.

Immunization can save children’s lives and prevent serious diseases that can cause permanent problems. Full immunization includes coverage against measles, polio, hepatitis B, diphtheria, pertussis and tetanus. These last three, called DPT, are administered together at three different times. The final dose of DPT, called DPT3, is considered an important milestone in a child’s life as DPT3 is used as a proxy indicator for a fully immunized child. In general, in 2011, countries in the Asian and Pacific region had a DPT3 coverage of 80 per cent or above, with the exception of the Lao People’s Democratic Republic (78 per cent), Timor-Leste (67 per cent) and Papua New Guinea (61 per cent). In some countries, DPT3 coverage was lower in 2011 than it was in 1990; examples include India (100 per cent to 85 per cent), Indonesia (88 per cent to 83 per cent) and the Philippines (88 per cent to 80 per cent).

Figure B.1-3
Rate of immunization against measles, Asia and the Pacific

Figure B.1-3 Rate of immunization against measles, Asia and the PacificMeasles is a very contagious disease, and high immunization coverage rates are needed to prevent outbreaks. Immunization for this disease is also used as a proxy indicator of a fully immunized child because it is usually given at the age of 9 months, by which time all other antigens have been provided. In the Asian and Pacific region, almost 87 per cent of children 1 year of age or younger are immunized against measles. However, this aggregate masks differences between subregions. East and North-East Asia (98.7 per cent), and North and Central Asia (96.7 per cent) have close to a 100 per cent immunization rate. South and South-West Asia has the lowest rate (78.5 per cent), followed by the Pacific (81.7 per cent). Countries where the immunization rate against measles is below 80 per cent are Afghanistan, Azerbaijan, India, the Lao People’s Democratic Republic, Papua New Guinea, the Philippines, Samoa, Solomon Islands, Timor-Leste and Vanuatu. The trend in Brunei Darussalam, Palau, Papua New Guinea, the Philippines, Samoa and Vanuatu is worrisome because immunization against measles has dropped since 1990. In several other countries, however, efforts continue to strengthen routine services in order to ensure consistently high coverage.

About 77 million children under 5 years of age in developing countries in the region are at risk of suffering due to being underweight.

Insufficient or inappropriate dietary intake can be very dangerous for children and can lead to permanent physical problems, such as stunting and low immunity (thereby increasing their vulnerability to infectious diseases and death) and intellectual problems, which will affect their development and performance for the rest of their lives. It is estimated that about 77 million children under 5 years of age are underweight in developing countries in Asia and the Pacific and are therefore at risk.

Although the prevalence of underweight children under 5 years of age in the region has generally been decreasing in the past two decades, this progress has been occurring at a slow pace. Impressive reductions were observed in the Democratic People’s Republic of Korea (from 55.5 per cent in 1998 to 18.8 in 2009) and Viet Nam (36.9 per cent in 1993 to 11.7 per cent in 2011), among others. Bangladesh was able to reduce the rate from 61.5 per cent in 1990 to 36.4 per cent in 2011.

According to the most recent data available, Bangladesh (36.4 per cent in 2011), India (43.5 per cent in 2006) and Timor-Leste (45.3 per cent in 2010) still have very high underweight prevalence rates. In the case of Timor-Leste, the trend is alarming as prevalence increased from 40.6 per cent in 2002 to 45.3 per cent in 2010.

It is important to keep in mind that estimates of the prevalence of underweight children under 5 years of age are not produced regularly for most countries and in many cases estimates are not very recent. Estimates of this indicator are produced from data collected from such surveys as demographic and health surveys and multiple indicator cluster surveys. Interpretation should therefore be considered with caution.

Box B.1-1
Preterm births

Babies born alive before 37 completed weeks of pregnancy are called “preterm births.” These babies are at a higher risk of suffering breathing difficulties, having feeding problems, having lower immunity to infections and having problems maintaining their body temperature. In 2011, almost 15 million babies were born preterm worldwide, which represents more than 1 in 10 babies. A total of 60 per cent of the world’s preterm births are found in only 10 countries, 6 of which are in the Asian and Pacific region: Bangladesh; China; India; Indonesia; Pakistan; and the Philippines.

In 2011, more than half of global preterm births were observed in Asia and the Pacific. The countries in the region with the highest preterm birth rates in 2010 were Pakistan (16 per 100 live births), Indonesia (15 per 100 live births), the Philippines (15 per 100 live births), Bangladesh (14 per 100 live births) and Nepal (14 per 100 live births).

Prematurity is the leading cause of death in newborns (babies in the first four weeks of life) and the secondleading cause of death after pneumonia in children under 5 years of age. Over 75 per cent of deaths from preterm birth complications can be prevented with costeffective care and without the availability of neonatal intensive care. Simple and affordable solutions, such as antenatal corticosteroids for preterm labour, antibiotics for the preterm premature rupture of membranes, and the kangaroo mother care technique, can save many lives.

Preterm birth rates in the top 10 countries in the Asian and Pacific region, 2010

Preterm birth rates in the top 10 countries in the Asian and Pacific region, 2010

Source: Hannah Blencowe and others, “National, regional and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications”, Lancet, vol. 379, No. 9832 (June 2012), pp. 2162-2172.
 

Box B.1-2
Disparities in child health indicators

Disparities in child health indicators can be observed not only across the Asian and Pacific region and between countries, but also at the subnational level. One of the major drivers of disparities in child health indicators at the subnational level is household wealth. For example, the percentage of children receiving diarrhoea treatment with oral rehydration salts (according to the most recent data from 2007 to 2012) shows gaps in coverage according to household wealth and rural or urban residence, as presented in table 1. In the majority of the cases presented, the gaps between the poorest 20 per cent and the richest 20 per cent are wider than the gaps between urban and rural residence. Similar results are observed in other child health indicators, such as underweight prevalence, as presented in table 2.

Table 1. Children receiving diarrhoea treatment with oral rehydration salts, 2007-2012 (Percentage)
Country
Poorest 20 per cent
Richest 20 per cent
Urban
Rural
Bangladesh
81
82
84
76
Cambodia
32
34
33
34
Myanmar
52
75
72
56
India
19
43
33
24
Pakistan
41
44
44
40
Philippines
37
55
58
36

Source: United Nations Children's Fund, The State of the World's Children: Children with Disabilities ( New York , 2013). Note: Data are from the most recent year available during the period 2007-2012, with the exception of 2005-2006 data from India.

Table 2. Underweight prevalence in children under 5 years of age, 2007-2011 (Percentage)
Country
Poorest 20 per cent
Richest 20 per cent
Urban
Rural
Bangladesh
50
21
28
39
Cambodia
35
16
19
30
India
57
20
33
46
Myanmar
33
14
19
24
Source: United Nations Children’s Fund, The State of the World’s Children: Children with Disabilities (New York, 2013).
Note: Data are from the most recent year available during the period 2007-2011, with the exception of 2005-2006 data from India.

Further reading

United Nations Children’s Fund. Committing to Child Survival: A Promise Renewed – Progress Report 2012. New York, 2012.

–––––––. Immunization Summary: A Statistical Reference Containing Data through 2011.

New York: United Nations Children’s Fund and World Health Organization, 2012. –––––––. The State of the World’s Children: Children with Disabilities. New York, 2013.

World Health Organization and United Nations Children’s Fund. Ending Preventable Child Deaths from Pneumonia and Diarrhoea by 2025: The Integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD). 2013.

Technical notes
Live birth defined

A live birth is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life – such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles – whether or not the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered a live birth.

Mortality rate: neonatal, infant, under-5 (deaths per 1,000 live births)
The mortality rate is the probability (expressed as a rate per 1,000 live births) of a child born in a specified year dying in the first month of life in the case of neonatal mortality; before reaching the age of 1 year in the case of infant mortality; or before reaching the age of 5 years in the case of under-5 mortality. These calculations are, strictly speaking, not rates (that is, the number of deaths divided by the number of population at risk during a certain period of time) but a probability of death derived from a life table and expressed as a rate per 1,000 live births. A life table is a statistical representation of the probability of a person surviving for each additional year of life; that is, the probability of surviving one more year, then based on the survival of one additional year, the probability of an additional year. Aggregate calculations: Millennium Development Goal aggregation and imputation methods; weighted averages using live births or the number of children under 5 (WPP2012) as weight.

Infant and under-5 mortality (thousand deaths)
The number of infant and under-5 deaths is estimated for only economic, regional and subregional groupings. Aggregate calculations: The number of infants or children under 5 years of age for each economic, regional or subregional grouping multiplied by their respective mortality rate.

Children under 5 underweight (percentage of children under 5 years, thousands)
The percentage of children aged 0-59 months whose weight for age is less than two standard deviations below the median weight for age of the international reference population. The international reference population, often referred to as the NCHS/WHO reference population, was formulated by the National Center for Health Statistics as a reference for the United States of America and later adopted by the World Health Organization (WHO). Aggregate calculations: Millennium Development Goal aggregation and imputation methods; weighted averages using children 0-59 months (WPP2012) as weight (percentage of children under 5 years); the total number of children under 5 years of age for each economic, regional or subregional grouping multiplied by the aggregate percentage of underweight children (thousands).

Children under 5 stunted (percentage of children under 5 years, thousands)
The percentage of children aged 0-59 months whose height for age is less than two standard deviations below the median height for age of the international reference population according to the 2006 WHO Child Growth Standards. Aggregate calculations: Millennium Development Goal aggregation and imputation methods; weighted averages using children 0-59 months (WPP2012) as weight (percentage of children under 5 years); the total number of children under 5 years of age for each economic, regional or subregional grouping multiplied by the aggregate percentage of stunted children (thousands).

Children under 5 wasted (percentage of children under 5 years, thousands)
The percentage of children aged 0-59 months whose weight for height is less than two standard deviations below the median weight for height of the international reference population according to the 2006 WHO Child Growth Standards. Aggregate calculations: Millennium Development Goal aggregation and imputation methods; weighted averages using children 0-59 months (WPP2012) as weight (percentage of children under 5 years); the total number of children under 5 years of age for each economic, regional or subregional grouping multiplied by the aggregate percentage of wasted children (thousands).

Children under 1 year immunized against measles (percentage of children under 1)
Children under 1 year of age who have received at least one dose of a measles vaccine. Note that it is generally recommended for children to be immunized against measles at the age of 9 months. Aggregate calculations: Millennium Development Goal aggregation and imputation methods (poorest and richest quintiles are not aggregated); weighted averages using children aged 1 year (WPP2012) as weight.

Children under 1 year not immunized against measles (thousands)
Children under 1 year of age who have not received at least one dose of a measles vaccine (estimated only for economic, regional and subregional groupings). Aggregate calculations: The number of children under 1 year of age for each economic, regional or subregional grouping multiplied by the percentage of children not immunized against measles (1 minus the percentage of children immunized against measles).

DPT3 immunization rate for children 1 year of age (percentage of 1-year-olds)
The percentage of children 1 year of age who have received three doses of the combined diphtheria, pertussis and tetanus toxoid vaccine in a given year. Aggregate calculations: Weighted averages using children 1 year of age (WPP2012) as weight. Missing data are not imputed.

Source

Source of data on stunted and wasted children: UNICEF, WHO, World Bank, UNICEFWHO- World Bank Joint Child Malnutrition Estimates, 2011 revision (completed July 2012). Data obtained: 5 August 2013.

Source of data on neonatal mortality: Interagency Group for Child Mortality Estimation (database available from www.childmortality. org/). Data obtained: 10 April 2013.

Source of data on DPT3 immunization, immunized against measles: WHO Global Health Observatory Database, World Health Statistics. Data are collected from countries by WHO and UNICEF. Data are reported to WHO and UNICEF by national authorities. Missing country values are estimated using linear interpolation (for middle gaps) and carrying the previous year’s data forward (for end gaps). Data obtained: 7 August 2013.

Source of other child health data: Millennium Indicators Database. UNICEF is the primary data custodian. Country-level data are generally obtained from national household surveys, including demographic and health surveys, multiple indicator cluster surveys and national nutrition surveys. Data obtained: 2 August 2013.

____________________

1 United Nations Children’s Fund, The State of the World’s Children: Children with Disabilities (New York, 2013).
2Ibid., p. 95.
3 Joy E. Lawn and others, “3.6 million neonatal deaths: what is progressing and what is not?”, Seminars in Perinatology, vol. 34, No. 6 (December 2010), pp. 371-386.
 
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