UNITED NATIONS — In Sierra Leone, one in four children dies before age 5. In Iraq, one in 10 does not make it to a fifth birthday. Across the globe, poor care for newborns, malnutrition, malaria, diarrhea and measles snuff out lives of the very young, according to a U.N. report released Friday.
The United Nations Children's Fund reported "alarmingly slow progress on reducing child deaths" — one in 12 children worldwide does not live to age 5, with half of all those deaths occurring in sub-Saharan Africa.
"It is incredible that in an age of technological and medical marvels, child survival is so tenuous in so many places, especially for the poor and marginalized," UNICEF director Carol Bellamy said.
"The world has the tools to improve child survival, if only it would use them. Vaccines, micronutrient supplements and insecticide-treated mosquito nets don't cost much and would save millions of children."
Child mortality refers to the number of children who die before their fifth birthdays and is measured per 1,000 live births. In 2002, industrialized countries had seven deaths per 1,000 births, while the poorest nations had 158.
The UNICEF study is a report card on whether countries are fulfilling a goal adopted by world leaders at the U.N. Millennium Summit in 2000. The goal calls for child mortality to be reduced by two-thirds by 2015.
The United States had eight child deaths per 1,000 in 2002, down from 10 in 1990. But it also will have to make significant strides to reach its target of three by 2015.
In more than a third of the countries in sub-Saharan Africa, child mortality rates have increased or stagnated, the report said.
But Iraq, which was defeated in the two Gulf Wars and was under U.N. sanctions for over a decade, lost the most ground of any nation. It was the only country in the Middle East and North Africa where the child mortality rate increased from 1990 to 2002. One in 10 Iraqi children under 5 died in 2002. That was up from the 1990 rate of one in 20.
The 10 countries with the highest death rates for children under 5 since 2002 were Sierra Leone with 284 per 1,000 births, Niger 265, Angola 260, Afghanistan 257, Liberia 235, Somalia 225, Mali 222, Guinea-Bissau 211, Burkina Faso 202 and Congo 205.
Despite Afghanistan's tumultuous path in the last decade, it slightly reduced the number of deaths of the very young: from 260 per 1,000 in 1990 to 257 in 2002. It still has a long way to go to reach the 2015 goal of 85 per 1,000 births.
Its rate also was far higher than other Asian countries. Pakistan had 107, India 93 and Sri Lanka the fewest number in Asia with 19 per 1,000, the study reported.
HIV/AIDS was a major obstacle.
Botswana, Zimbabwe and Swaziland — with high rates of HIV and AIDS — had the second-, third- and fourth-largest increases in under-5 deaths. Their rates of increase respectively were 37, 25 and 39 percent.
Poor care for newborns is the most prominent cause of child deaths, while malaria accounts for more deaths than HIV/AIDS, the study said.
Malnutrition contributed to more than half of the deaths, while acute respiratory infections and diarrhea are at the root of approximately one-third, and measles still accounts for about 5 percent.
UNICEF said 90 nations, including 53 developing nations, are on track to meet the millennium goal of a two-thirds reduction in deaths of the young, while 98 developing countries are stagnating or going backward.
"No government should be allowed to let another 10 years pass with so little progress," Bellamy said. "Leaders have agreed to goals and they must be held accountable."
Despite the almost certainty that all countries will not meet the goal, the study said the overall figure of one in 12 deaths globally is a vast improvement over the one-in-five mortality rate of the 1960s.
Russia with a relatively low rate of 21 made no advances in the decade, while Turkey halved its rate, going from 78 in 1990 to 42 in 2002, the report said.
Sweden had the lowest rate of the industrialized countries with only three under-5 deaths per 1,000 births, while Norway, Denmark, and Iceland all were at four.
Japan, Finland, Netherlands, Austria, Germany, Luxembourg, Greece, Czech Republic, Malta and Monaco were at six.
Canada's rate was seven, down from nine but still far from its 2015 target of three, the study found.