CHAPTER ONE

INTRODUCTION

1.1 Background

Child mortality, also known as under – five mortality refers to the deaths of infants and children under the age of five. Globally, child mortality continues to fall and the total number of under five deaths decreased to 8.1million per year in 2009 from 12.4 million per year in 1990 (UNICEF report, 2010).

The highest child mortality rates are still in sub-Saharan Africa where one in eight children dies before their fifth birthday nearly twenty  times the average for developed regions (1 in 67). Southern Asia has the second highest rate with about one in fourteen children dying before reaching five. Sub-Saharan Africa have achieved only around a thirty percent reduction in under five mortality, less than half that required to reach MDG4. (IGME report 2011).

Six conditions account for about 70% of all child deaths: acute lower respiratory infections, mostly pneumonia (18%), diarrhea (18%), malaria (9%), Measles (1%), HIV/AIDS (2%) and neonatal conditions mainly pre-term birth, birth asphyxia and infections (37%)

Pneumonia is a form of acute respiratory infection that affects the lungs and is the leading cause of death in children worldwide. Pneumonia can be caused by bacteria, viruses or fungi. Streptococcus pneumonia is the most common cause of bacterial pneumonia in children whilst Haemophilus influenza type b is the second most common cause of bacterial pneumonia. Respiratory synctial virus is the most common cause of viral cause of pneumonia. It can be prevented by immunization, adequate nutrition and by addressing environmental factors. Pneumonia can be treated with antibiotics.

Pneumonia is frequently an associated cause of mortality in children with other underlying conditions. Co-morbid conditions especially malnutrition, measles or HIV increase the severity and risk mortality from pneumonia (Black et al., 2003.,Zar, 2004; Duke et al., 2003.)There are multiple risk factors identified to increase the risk of pneumonia in children under five. These have been grouped into demographic (gender and age), nutritional (low birth weight, malnutrition, inadequate breastfeeding, vitamin and micronutrient deficiencies, environmental (crowding, air pollution, smoking), lack of immunization, attendance to day-care centres and socio-demographic factors such as large family size, short birth interval, low income, low level of parental education, poor housing and in-appropriate child care practices.

Pneumonia accounts for approximately 1.9million deaths globally in children under five each year (Black et al., 2003; Campbell, 1995; Malholland, 1999; Williams et al., 2002). The WHO estimates that there are more than 150 million cases of pneumonia each year in children under five.  It is the leading cause of death in children worldwide, killing 1.6 million children yearly and this accounts for 19% of all deaths of children under five years old worldwide. According to Paediatric Association of Nigeria (PAG, 2010), pneumonia has been rated as one of the leading cause of under-five mortality and morbidity in Nigeria, with twenty two percent of children under five dying from it.

Childhood pneumonia has been identified as a major “forgotten killer of children” by UNICEF and WHO. 

Fig. 1.1: Causes of Under-five child deaths in low income countries

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