Nine out of ten deaths are occurring in sub-Saharan Africa and South Asia where poverty levels are high.

According to a report released today (FRIDAY) by the United Nations Children’€™s Fund (Unicef), pneumonia and diarrhoea are the leading killers of children under five years despite the fact that there are a number of cost effective interventions to curb these illnesses.

Far fewer children are dying today than 20 years ago ‘€“ In 1990, 12-million child deaths were recorded, compared to 7.6-million in 2010.

The reduction is mainly due to the rapid expansion of public health and nutrition interventions such as immunisation, breastfeeding and safe drinking water.

However, the use of low-cost, curative interventions against pneumonia and diarrhoea remains low, particularly among the most vulnerable communities.

In South Africa, the under-five mortality rate was 57 per 1 000 live births in 2010, translating to around 58 000 children dying in that one year.

A Medical Research Council (MRC) review of vital registration data from various sources reveals that in 2007, the majority of registered child deaths in South Africa were infants (76%), with 22% of these deaths occurring in the first month of life.

Of the 61 335 under-five deaths registered in 2007, diarrhoea accounted for 21% of deaths and lower respiratory infections for 16%.

South African public health experts agree that the country needs to focus on pneumonia and diarrhoea.

Dr Tanya Doherty and Professor David Sanders of the University of Western Cape point out that, with the decreased mother-to-child HIV transmission (3.5% transmission from HIV positive women at tests carried out at 4 to 8 weeks in 2010), the contribution of HIV to child mortality is decreasing.

‘€œHowever even amongst deaths due to HIV, the terminal events leading to death are usually diarrhoea or pneumonia-related. South Africa has one of the lowest rates of exclusive breastfeeding in the world (1.5% amongst children four to six months) yet high coverage of exclusive breastfeeding could result in the largest reduction in under-five mortality due to these diseases,’€ say Doherty and Sanders.

They add that community health workers need to manage cases of diarrhoea (supplying oral rehydration solution) and pneumonia (antibiotics).

‘€œCommunity treatment for pneumonia is currently being implemented in 18 sub-Saharan African countries. This could be added to the scope of the outreach teams being scaled up across South Africa and would have a substantial impact on reducing deaths from these illnesses,’€ they say.

The Unicef report says that deaths due to pneumonia and diarrhoea were largely preventable through optimal breastfeeding practices and adequate nutrition, vaccinations, hand washing with soap, safe drinking water and basic sanitation, among other measures.

In the next three years, more than two million child deaths due to pneumonia and diarrhoea could be averted across the 75 countries with the highest mortality burden if national coverage of key pneumonia and diarrhoea interventions were raised to the level in the richest 20 per cent of households in each country.

New vaccines against major causes of pneumonia and diarrhoea are available but the most vulnerable children are not being reached.

Exclusive breastfeeding during the first six months of life is one of the most cost effective child survival interventions and greatly reduces the risk of a young infant dying due to pneumonia or diarrhoea. Fewer than 40 per cent of children under six months of age in developing countries are exclusively breastfed.

Nearly 90 per cent of deaths due to diarrhoea worldwide have been attributed to unsafe water, inadequate sanitation and poor hygiene.

Despite attaining the Millennium Development Goal of an improved drinking water source, 783-million people do not have access to this supply, while 2.5-billion do not use an improved sanitation facility ‘€“ mostly in the poorest and rural households.

Hand washing with water and soap is among the most cost-effective health interventions to reduce the incidence of both childhood pneumonia and diarrhoea.

Timely recognition of key pneumonia symptoms by caregivers followed by seeking care and antibiotic treatment for bacterial pneumonia is lifesaving. Despite an increase in careseeking for children, appropriate careseeking for suspected pneumonia remains low with less than a third of children with suspected pneumonia receiving antibiotics.

Children with diarrhoea are risk of dying due to dehydration – and early and appropriate fluid replacement is the main intervention to prevent death.

Yet few children with diarrhoea in developing countries receive appropriate treatment with oral rehydration therapy and continued feeding. Even fewer receive solutions made of oral rehydration salts with no real progress on this front in the past decade.

Statistics from South Africa indicate that less than half (40%) of children access oral rehydration therapy, with only 32% in the rural areas.

Poor nutritional status is an important underlying risk that often interacts with infections. Malaria may interact with other illnesses to increase susceptibility or severity of either disease while HIV places a child at high risk of pneumonia or diarrhoea.