The number of children under 5 years who died in 1993 - more than 12.2 million - equals the entire populations of Norway and Sweden combined. Of such deaths in the developing world, the great majority could have been avoided if those countries enjoyed the same health and social conditions as the world's most developed nations. The gap between the developed and the developing world in terms of infant and child survival is one of the starkest examples of health inequity.
The estimated global figure for mortality among children under 5 years in 1993 was 87 per 1 000 live births, an encouraging fall from rates of 215 during the period 1950-1955 and of 115 in 1980. Yet in parts of the developed world only 6 out of 1 000 liveborns die before reaching age 5, whereas in 16 of the least developed countries the rate is over 200 per 1 000, and in one country it is 320 per 1 000. Infant mortality - deaths of children under 1 year - varies from 4.8 per 1 000 live births to 161 - a 33-fold difference. The gap in infant mortality between developed and developing world narrowed by 50% during the years 1960-1993, from 113 to 54 per 1 000 live births. But at the same time the gap widened between least developed and developing countries.
Malnutrition contributes substantially to childhood disease and death but often goes unrecognized as such. In 1990 more than 30% of the world's children under 5 years were underweight for their age. As many as 43% of children in the developing world - 230 million - have low height for their age. Micronutrient malnutrition is estimated to affect at least 2 billion people of all ages, but children are particularly vulnerable. As a result of iodine deficiency - a public health problem in 118 countries - at least 30 000 babies are stillborn each year and over 120 000 are born mentally retarded, physically stunted, deaf-mute or paralysed. A quarter of all children under age 5 in developing countries are at risk of vitamin A deficiency.
There have been improvements in child health, and 1993 saw the number of children dying from vaccine-preventable diseases reduced by 1.3 million compared to 1985 - equal to the population of Trinidad and Tobago. Nevertheless, around 2.4 million children under 5 years are still dying every year from such diseases, particularly measles, neonatal tetanus, tuberculosis, pertussis, poliomyelitis and diphtheria. There are also worrying signs that recent immunization gains are being eroded or even reversed by economic and social conditions.
Every year in the developing world acute respiratory infections, particularly pneumonia, kill more than 4 million children under 5 years - one death every 8 seconds - and are a leading cause of disability. They account for 30-50% of visits by children to health facilities everywhere. Significant reductions in mortality could be achieved by treating the underlying bacterial infections with low-cost antibiotics for a few days.
Diarrhoeal diseases, resulting from unsafe water and poor sanitation coupled with poor food-handling practices, are responsible for a further 3 million deaths a year among children under age 5 in the developing world - one every 10 seconds - and are a graphic example of the deadly synergy of poverty and lack of knowledge. Worldwide there are an estimated 1.8 billion episodes of childhood diarrhoea annually. Many of the deaths from diarrhoea could be prevented by using oral rehydration salts, which cost just US $0.07 on average.