Children gather at the school compound during their break at Undugu school in Nairobi, Kenya. Photo: AP Photo/Sayyid Azim

Two days later, Alice was unconscious. Her frantic mother rushed to the hospital with the child in her arms, but it was too late: Alice had died of malaria.

Alice is one of more than 10 million children around the world who die before their fifth birthday every year, according to a report by UNICEF.

The report, “The State of Africa’s Children 2008,” was launched on May 28 at the Fourth Tokyo International Conference on African Development in Japan. It looks at the successes and failures of governments regarding the health and survival of the children of Africa and is complementary to a broader UNICEF report on the health of the world’s children.

The facts are shocking. Although Africa accounts for only 22 percent of births globally, half of the 10 million child deaths annually occur on the continent. Africa is the only continent that has seen rising numbers of deaths among children under five-years-old since the 1970s.

Many of these children die of preventable and curable diseases. Malaria is the cause of 18 percent of deaths among children under five in Africa, according to the report. Diarrheal diseases and pneumonia—both illnesses that thrive in poor communities where sanitation is severely compromised, and where residents are often undernourished and exposed to pollution—account for a further 40 percent of child deaths. Another major killer is AIDS.

At the launch of the report in Tokyo, Ann M. Veneman, the chief executive director of UNICEF, said limited gains have been made in sub-Saharan Africa: Overall, the mortality figures have declined by 14 percent between 1990 and 2006.

These gains can be attributed to dramatically expanded immunization programs, the increased use of insecticide-treated bed nets and the provision of vitamin A supplements to children. Other interventions in Africa include programs emphasizing exclusive breast-feeding practices for up to six months and the prescription of anti-retroviral medication to prevent the mother-to-child transmission of HIV.

In Ghana, all pregnant women are now covered by an intervention program that includes iron and folic acid supplementation and preventative treatment for malaria. All children between six months and five years of age are vaccinated against childhood diseases such as measles and polio.

In Malawi, the government has rolled out immunization programs as well as micronutrient supplementation—small amounts of vital minerals such as iron, cobalt, chromium and copper. The government is also building wells to improve access to clean water for people living in remote towns and villages.

According to the report, five countries in North Africa have made huge strides in decreasing child mortality rates. In Algeria, Egypt, Libya, Morocco and Tunisia, the figures came down by at least 45 percent between 1990 and 2006. These relatively wealthy countries are on target to meet millennium development goal No. 4: to reduce by two-thirds the child mortality rate among children under five.

But sub-Saharan Africa is unlikely to achieve any of the health-related millennium development goals by 2015; the continent lags behind on progress toward eradicating extreme poverty and hunger, improving maternal health, and halting and reversing the spread of HIV. One in every six children in sub-Saharan Africa will still die before his or her fifth birthday. The region is described by UNICEF as the most difficult place in the world for a child to survive.

In South Africa, 250,000 children under 15 are HIV-positive. They make up a huge proportion of the estimated 400,000 children under 15 who have been infected with HIV in Africa. Despite the expanded provision of anti-retroviral drugs, 64,000 more children contract the virus in South Africa each year. Across the southern African region, deaths of children under five have risen by 17 percent between 1990 and 2006; these deaths are mostly attributed to HIV/AIDS.

In West and Central Africa, there were more people without access to clean drinking water in 2004 than in 1990. Unsafe drinking water can cause diarrhea, dysentery and other water-borne diseases. Women and children who have to go out to find water for household needs are at particular risk of becoming victims of marauding gangs when they fetch water; cases of abduction and rape of women and children who fetch water are well-documented in the Sudan, for example.

The UNICEF report calls for intervention packages that include vaccines for children, pre- and post-natal care for pregnant women, exclusive breastfeeding for at least six months and the establishment of more—and more accessible—health care centers.