World health report

Executive summary

Infant, child and adolescent health

Since 1960, infant mortality has fallen from 130 to 60 per 1000 live births and child mortality has fallen from 180 to 80 per 1000 live births. Immunization against six vaccine-preventable diseases (diphtheria, pertussis, tetanus, measles, tuberculosis and poliomyelitis), undertaken with intensive support from WHO, UNICEF and the international community, has saved millions of children annually from death and disability. By 1995, the goal of 80% coverage for these vaccines (except tetanus toxoid) had been achieved globally, but 25 countries (19 in Africa) still reported coverage below 50% for all six vaccines. Comprehensive plans of action were developed in six African countries, but major efforts are urgently needed to cover the remaining 19 countries.

Since the goal of global eradication of poliomyelitis was set in 1988, reported cases of the disease have declined by about 85%.

For the past four years global measles immunization coverage has remained at about 80%; since immunization began, the number of cases has declined by 70% and the number of deaths by 83%. The disease is targeted for elimination in the Americas by the year 2000, and in other regions, many countries are pursuing innovative immunization strategies.

Substantial progress has been made globally in the elimination of neonatal tetanus, particularly in the Americas and South-East Asia. More than 700 000 deaths are now being prevented annually through routine immunization of women with tetanus toxoid, and through improved hygienic birth practices. In 1980, 76 countries reported less than one neonatal tetanus death per 1000 live births annually; by 1995 the number of countries had increased to 122.

Every year diarrhoea, pneumonia, measles, malaria or malnutrition - or a combination of them - kill more than eight million children. Three out of every four children brought for health care suffer from at least one of these conditions. Child health programmes need to address the sick child as a whole rather than single diseases. WHO and UNICEF therefore jointly developed an approach for the integrated management of the sick child, which gives due attention to both prevention and treatment of childhood disease. The WHO/UNICEF course Management of childhood illness enables health workers in outpatient clinics and health centres to manage infant and childhood illnesses effectively in an integrated fashion. The course is based on treatment guidelines developed by WHO and covering the most common potentially fatal conditions.

WHO provides normative information on monitoring, prevention and management of major crippling forms of malnutrition, with emphasis on protein-energy malnutrition, micronutrient malnutrition such as iodine deficiency disorders, vitamin A deficiency, and nutritional anaemia. The Organization also gives support to countries in dealing with infant and young child nutrition in emergency situations.

Recent research has confirmed strong links between health, school attendance and educational attainment. WHO's global school health initiative is concerned with the various hazards to which the world's school-age children and adolescents - more than 1000 million, almost 700 million of whom are of primary school age (6-11 years) - are exposed, such as injuries, sexually transmitted diseases and substance abuse.