Eight MDGs were adopted by international leaders at the Millennium Summit of the UN in New York four years ago. In addition to seeking a decrease in child mortality, the goals focus on reducing poverty, achieving universal primary education and halting the spread of AIDS, amongst other matters.

Progress in achieving the MDGs is calculated by comparing the latest statistics on child mortality and the like to figures gathered in 1990 – the so-called "baseline year" for the MDGs.

In order to reduce child mortality by two-thirds by 2015, countries need to record an annual decrease in child deaths of 4.4 percent. (The term "child mortality" refers to the number of children who die before reaching the age of five.)

But according to ‘Progress for Children’, child mortality has either remained the same or become worse in 18 countries of sub-Saharan Africa.

Six of the ten countries that have performed worst in reducing child deaths are located in this region. These are Botswana (where mortality has increased by 5.3 percent annually from 1990 to 2002), Zimbabwe, Swaziland, Kenya, Cameroon and the Ivory Coast (which recorded a 1.1 percent increase).

This means that while only seven out of every 1,000 children who survived birth in developed countries died before age five in 2002, 174 of every 1,000 children in sub-Saharan Africa did not reach their fifth birthday.

Of the ten countries with the highest mortality rates in 2002, nine were located in Africa – with Sierra Leone registering the greatest number of child deaths globally.

For every 1,000 children born in this West African nation, 284 will die prematurely. Next on the list is Niger (with 265 deaths), Angola, Liberia, Somalia, Mali, Guinea-Bissau, Burkina Faso and the Democratic Republic of Congo (205 deaths).

‘Progress for Children’ notes that "poor perinatal conditions are still the main cause of infants’ dying in the region (sub-Saharan Africa)". These include a lack of persons with the appropriate skills or qualifications to assist women in deliveries.

Thereafter, respiratory infections, diarrhoea and diseases such as malaria and measles claim the greatest number of lives, with malnutrition contributing to child mortality. The report further notes that HIV/AIDS accounts for eight percent of child deaths in sub-Saharan Africa – "more than double the global average."

Botswana, Zimbabwe and Swaziland – which recorded the second, third and fourth biggest increases in child mortality – also have the highest HIV prevalence rates in the world. In Swaziland, prevalence is put at 39 percent. Botswana has 37 percent prevalence, while that in Zimbabwe is put at 25 percent.

While children may not die from AIDS-related diseases, the survival chances of those who lose parents to the pandemic is also greatly compromised.

UNICEF says that of the 13.4 million children orphaned by AIDS, 11 million live in sub-Saharan Africa. While the region contains just over 10 percent of the global population, two-thirds of all HIV-positive persons live in the area – this according to the Joint UN Programme on HIV/AIDS.

"The looming crisis of AIDS is going to make it a daunting task for sub-Saharan Africa to meet the target of reducing child mortality within the required period," said Per Engebak, regional director for UNICEF in Eastern and Southern Africa. He was speaking to journalists Wednesday ahead of the launch of ‘Progress for Children’.

Khin Sandi Lwin, UNICEF’s representative in Namibia, noted that convincing people to get themselves tested for AIDS would play a key role in reducing the effects of the pandemic on children.

"Advocating for people to know their status means mothers get tested when they are pregnant and if positive their unborn babies will be put on medication to prevent them from getting the virus," she said.

Lwin added that Namibia’s experience had proved the merits of this approach – even though the initial response to calls for pregnant women to get tested was dispiriting.

"At first the response was low because women did not come up to know their status," she said. "But after awareness creation and educating populations on the benefits of this service, now many of them are coming up – even with their spouses. As a result, child mortality caused by HIV/AIDS has (been) reduced tremendously."

Namibia instituted its programme to prevent mother-to-child transmission of HIV two years ago.

As the increase in child mortality in the Ivory Coast shows, civil conflict can also take a toll on children. The country has experienced intermittent strife since President Henri Konan Bedie was toppled in a military coup led by Robert Guei in 1999.

In light of these various trends, says the UNICEF report, efforts to reduce child mortality should be greatly stepped up in sub-Saharan Africa. If it is to meet its MDG commitments, the region will have to start reducing child deaths by 8.2 percent annually, "almost double the rate originally required."

However, in her introduction to ‘Progress for Children’, UNICEF Executive Director Carol Bellamy notes that the world already has the tools to reduce child mortality at its disposal: "cost effective measures such as vaccines, antibiotics, micronutrient supplementation, insecticide-treated mosquito nets and improved breastfeeding practices."

In regions other than sub-Saharan Africa, the picture for children is less bleak.

The nine South Asian countries have succeeded in cutting down on their child mortality rates, says the report, although only Bangladesh and Bhutan are scheduled to meet the MDG on child deaths.

In East Asia and the Pacific region, Cambodia has recorded an increase in child mortality. While this is an isolated case, UNICEF notes that reduction of child deaths "averaged just 2.8 percent" in these regions between 1980 and 2000 – down from almost five percent in the 1960s and 1970s.

The countries of Central Asia and Central Europe present a mixed picture. While a number of states (Armenia, Lithuania and Turkey, to name a few) are on target to meet the child mortality MDG, the Russian Federation "has barely made any advances on reducing child mortality over the past decade."

The view is equally disparate as far as the Middle East and North Africa are concerned.

"Almost two thirds of the 21 countries in the region…were on schedule to meet MDG4 as of 2002", says the report. However, the country which has experienced the greatest increase in child mortality globally, Iraq, is also located in this area. (The state recorded a 7.6 percent increase in mortality between 1990 and 2002).

The UNICEF report is mostly satisfied with the performance of industrialised countries, although it notes there is "room for improvement" in Hungary, Poland and Slovakia where mortality rates are "conspicuously higher than the region’s average."

Latin America and the Caribbean are singled out for particular praise. These regions were "able to maintain a steady pace of reduction during the 1990s, posting an annual reduction rate of 4 per cent over the course of the decade."

"No other region managed to maintain an average annual reduction rate of 3 per cent or above in that period," adds the report.

UNICEF says that it considers child mortality rates the "basic measure of a country’s advancement.”