World health report

Executive summary

Infants and small children

WHO has participated in the achievement of outstanding improvements in child health during the last 50 years. Progress has been made in eliminating neonatal tetanus through maternal immunization and promoting breast-feeding and baby-friendly hospitals. WHO has shown that perinatal and neonatal deaths can be reduced by 30%, by using an essential set of interventions for the mother during pregnancy and delivery and for the newborn child after birth.

WHO's efforts to reduce child mortality have evolved from single-disease programmes in the 1970s to the current strategy of integrated management of childhood illness. WHO has promoted the wide use of oral rehydration therapy (ORT) to reduce mortality from acute diarrhoea and associated malnutrition. In the late 1980s it was shown that acute respiratory infections, mainly pneumonia, were the major killers of children aged under 5. Simplified standard case management became the basis of WHO's efforts to reduce pneumonia mortality. The programmes for control of diarrhoeal diseases and for acute respiratory infections were merged in 1990. By then it was clear that most childhood deaths were caused by a small number of conditions: diarrhoea, pneumonia, measles, malaria and malnutrition. In 1992, WHO and UNICEF worked out clinical guidelines that integrated all five conditions. The resulting strategy is called integrated management of childhood illness.

In 1992, the World Declaration and Plan of Action for Nutrition was adopted, including nine goals for the year 2000 and nine action-oriented strategies for improving nutrition. By 1997, over 160 countries had received technical and/or financial support from WHO for developing and implementing their national food and nutrition policies and plans. The WHO global database on malnutrition and child growth now covers over 90% of the world's under-5 children, and its databank on breast-feeding covers 65 countries. The baby-friendly hospital initiative is being implemented in over 170 countries.

WHO's Expanded Programme on Immunization was launched in 1974 and by 1995, 80% of the world's children had been immunized against diphtheria, tetanus, whooping cough, poliomyelitis, measles and tuberculosis, compared to less than 5% in 1974. Following the successful eradication of smallpox, poliomyelitis has become the second disease targeted for global eradication. Virtually all endemic countries in the world have now begun to implement the WHO-recommended strategies to eradicate polio. By 1996, estimated measles morbidity and mortality worldwide had fallen by 78% and 88%, respectively compared to the prevaccine era.