The average number of children around the world who die before they reach their fifth birthdays dropped substantially in the past decade, according to the principal annual report of the United Nations Children's Fund.

Worldwide from 1990 to 2001, the mortality rate for children under five years old fell by 11 deaths per 1,000 live births, from 93 to 82.

"We use the under-5 mortality rate as kind of a bellwether because it really does say a lot about nutrition, education, vaccination and even access to clean water," Dave Agnew, president and CEO of Unicef Canada, said after the report's release yesterday.

What this means is that the health safeguards being set up worldwide are working, Mr. Agnew said.

"Smallpox is gone. We're on the cusp of ridding the world of polio, measles, whooping cough and so on," he said. "This is a historic gain in the history of the world in terms of providing a healthier environment to raise our children."

In many countries, the drop in the child mortality rate is far above the average, Mr. Agnew said. For example, Albania's rate fell by 33 per cent; Greece's fell by 55 per cent and Malaysia's by 62 per cent.

But there is bad news, too. Sierra Leone, which in 1990 had the worst survival rate for children under 5, dropped marginally to 316 deaths per 1,000 live births, from 323. Niger, Angola, Afghanistan and Liberia were not far behind.

In Iraq, subject to economic sanctions for most of the past decade, the mortality rate rose to 133 per 1,000 live births, from 50.

Canada's rate improved slightly, falling to seven from nine, but its base line was low in 1990, Mr. Agnew said. Canada's rate is tied with that of the United Kingdom and marginally ahead of the rate in the United States.

But Canada trails countries such as Cyprus, Malta, Singapore and the Scandinavian nations. Sweden has reduced its death rate for children under five years old to three per 1,000 live births.

"That says we shouldn't be sanguine," Mr. Agnew said. "If the Nordic countries can have a rate that's half of ours, why can't we?"

Jack Holland, chairman of pediatrics at McMaster University, said yesterday that it is not certain why Sweden's rate is better than Canada's. "It's certainly much easier to administer health care over a much smaller country than it is over a country like Canada."

Canada's aboriginal population has less satisfactory outcomes in almost every health category than does the rest of the population, which may contribute to our poorer record, he said.

While the report generally is positive, there is devastating news regarding AIDS and HIV infection, Mr. Agnew said.

Those countries where the life expectancies of children are very low tend to be those taking the brunt of the AIDS pandemic, he said. "We've got 6,000 kids a day across the planet being infected with HIV. We've got more than 10 million orphans in Africa because of HIV-AIDS. And the impact is felt is so many ways."

The world must focus the fight against disease on the AIDS epidemic, Mr. Agnew said.

The successes in other areas show that "when we have a new challenge like this, we've just got to redouble our efforts."

Under-five mortality

A report ranked countries and territories in descending order of their estimated 2001 under-five mortality rates*, a critical indicator of the overall well-being of children. The list compares rates for 2001 with those for 1990 by selected countries:

'01

rank..Country..............'90.....'01

..1...Sierra Leone.........323.....316

  2   Niger                320     265


  3   Angola               260     260


  4   Afghanistan          260     257


  5   Liberia              235     235


  6   Mali                 254     231


  7   Somalia              225     225


  8   Guinea-Bissau        253     211


  9   Congo, Dem. Rep      205     205


 10   Zambia               192     202


 25   Cameroon             139     155


 33   Iraq                  50     133


 40   Kenya                 97     122


 98   Albania               45      30


130   Libya                 42      19


158   Malaysia              21       8


161   Canada                 9       7


178   Greece                11       5


193   Sweden                 6       3

-*Rates are probablity of dying between birth and exactly five years of age expressed per 1,000 live births.

SOURCE: UNICEF