In Eastern and Southern Africa (ESA), the official primary net enrollment rate stands at 87 percent for both boys girls.
However, there are wide variations between countries, ranging from 39 percent for boys and 34 percent for girls in Eritrea to 99 percent for boys and 100 percent for girls in Madagascar.
For secondary education, rates are significantly lower. The regional averages for enrolment are 32 and 28 percent, respectively, for boys and girls, and an even smaller proportion actually attends school (26 percent of boys and 24 percent of girls).
In Eastern and Southern Africa (ESA), under-nutrition is a major underlying cause of the persistently high child mortality, contributing to more than a third of all deaths among children under five years of age.
9.3 million children under five, or 15 percent of all children that age group are underweight, while 24 million, or 39 percent suffer from stunted growth.
Severe acute malnutrition (SAM) is the most advanced stage of malnutrition and the most threatening one to a child’s life. Studies have shown that mortality among children with severe acute malnutrition is five to 20 times higher than for well-nourished children.
Without adequate treatment, between 30 to 50 percent of children with severe acute malnutrition will die.
Throughout ESA, children living in rural or from the poorest households are more susceptible to malnutrition. In Eritrea, for example, the prevalence of malnutrition for children under five years is 40 percent in rural areas, and 23 percent in urban areas; while in Somalia the figure is 42 percent for children from the poorest 20 percent of the population, and 14 percent for the richest 20 percent.
According to a recent study published by the Lancet, exclusive breastfeeding is one of the single most effective interventions to combat child mortality. There is also evidence to suggest that early breastfeeding within the first hour of life can significantly reduce neonatal mortality.
Appropriate complementary feeding (timely introduction, safe and adequate amounts) with continued breastfeeding for up to two years is critical for children’s optimal growth and development.
Three countries in the region – South Africa, Somalia, and Angola – have breastfeeding rates of less than 20 percent.
Vitamin A supplementation can help strengthen children’s immune system and reduce child mortality by 23 percent.
At the regional level, vitamin A supplementation (VAS) coverage is 80 percent.
Apart from brain damage, iodine deficiency can cause learning disabilities and stunting, and significantly increases the risk for pregnant women of stillbirth and miscarriage. Salt iodization has proven to be most effective in reducing the risk of iodine deficiency.
While only accounting for 23 percent of the world’s annual births, half of all under-five deaths occur in Eastern and Southern Africa (ESA).
Of the 20 countries with the highest under-five mortality rate, all are in Sub-Saharan Africa, including four in Eastern and Southern Africa: Angola, Burundi, Somalia and South Sudan.
In ESAR, 1 in 6 children died before its fifth birthday in 1990; in 2011, this dropped to 1 in 12. And under-five mortality has declined by 48 percent from 166 per 1,000 live births in 1990, to 84 per 1,000 live births in 2011.
However, high levels of fertility and birth rates coupled with high levels of child mortality in the region have led to a rather gradual decrease in the absolute number of child deaths from 1.66 million in 1990 to 1.18 million in 2011.
Among the top 10 high-mortality countries that have achieved the sharpest annual rate of reduction over the past two decades, eight are from ESA – Rwanda, Zimbabwe, South Africa, Lesotho, Kenya, Namibia, Swaziland and Tanzania.
Overall, there is not enough progress being made in the region to meet the Millennium Development Goal (MDG 4) of reducing child mortality by two thirds between 1990 and 2015.
Around 43 percent of all deaths among children under five occur in the first month of life. The leading causes of young children dying are pneumonia, preterm birth complications, diarrhea, complications during birth and malaria.
Globally, more than a third of under-five deaths are attributable to under-nutrition.
Only six of the 21 countries in the region, Botswana, Malawi, Namibia, South Afria, Swaziland, and Uganda are on track to meet the related target under MDG 7 of reducing the proportion of the population without access to safe water by half between 1990 and 2015.
Geographical disparities are vast, with 87 percent of people in urban neighborhoods having access to improved drinking water sources compared to 59 percent of the population in rural areas.
Only three countries, Angola, Botswana, and South Africa, are on track to meet the MDG target of reducing the proportion of people without sanitation by half.
Open defecation – the unhealthiest sanitation practice of all – is still commonplace in some countries. In Ethiopia, Namibia and Mozambique, for example, the proportion of people who practice open defecation stands at 46, 52 and 41 percent,
In the whole of sub-Saharan Africa it is particularly the poor who lack access to sanitation. The lowest income quintile is 16 times more likely to practice open defecation than the highest.
