Mitsutaka Udagawa writes:

The number of children under 5 years who died in 1993 amounted to more than 12.2 million. Of such deaths in the developing world, the great majority could have been avoided if those countries enjoyed the same health and social conditions as the world's most developed nations, according to the World Health Organization. The gap between the developed and the developing world in terms of infant and child survival is one of the starkest examples of health inequity. The estimated global figure for mortality among children under 5 years in 1993 was 87 per 1 000 live births, an encouraging fall from rates of 215 during the period 1950-1955 and of 115 in 1980. Yet in parts of the developed world only 6 out of 1 000 die before reaching age 5, whereas in 16 of the least developed countries the rate is over 200 per 1000.

Infant mortality - deaths of children under 1 year - varies from 4.8 per 1000 live births to 161 - a 33-fold difference. The gap in infant mortality between developed and developing world is reported by WHO as having narrowed by 50% during the years 1960-1993, from 113 to 54 per 1 000 live births. But at the same time the gap widened between least developed and developing countries.

The first problem in many developing countries is malnutrition. Malnutrition contributes substantially to childhood disease and death but often goes unrecognized as such. More than 200 million children are undernourished. And as a result of iodine deficiency at least 30000 babies are stillborn each year and over 120000 are born mentally retarded, physically stunted, deaf-mute or paralysed. Iodine deficiency is a public health problem in 118 countries. A quarter of all children under age 5 in developing countries are at risk of vitamin A deficiency.

There have been improvements in child health, and 1993 saw the number of children dying from vaccine-preventable diseases reduced by 1.3 million. Nevertheless, around 2.4 million children under 5 years are still dying every year from such diseases, particularly measles (measles kills about 1.2 million children a year), malaria (malaria kills about 1 million children a year), neonatal tetanus, (More than half a million babies die each year from neonatal tetanus.), tuberculosis, pertussis, poliomyelitis and diphtheria. Recently It is more and more serious that the fear of HIV is bigger. It is estimated that by the year 2000, over 5 million children will be infected by HIV and another 5-10 million orphaned by the HIV/AIDS pandemic. Every year in the developing world acute respiratory infections, particularly pneumonia, kill more than 4 million children under 5 years and are a leading cause of disability. They account for 30-50% of visits by children to health facilities everywhere. Significant reductions in mortality could be achieved by treating the underlying bacterial infections with low-cost antibiotics for a few days.Diarrhoeal diseases, resulting from unsafe water and poor sanitation coupled with poor food-handling practices, are responsible for a further 3 million deaths a year among children under age 5 in the developing world and are a graphic example of the deadly synergy of poverty and lack of knowledge. Worldwide there are an estimated 1.8 billion episodes of childhood diarrhoea annually. Many of the deaths from diarrhoea could be prevented by using oral rehydration salts, which cost just US $0.07 on average.

What can we do about these problem? First with regard to malnutrition we can support the developing world with food. And regarding death from measles, malaria, neonatal tetanus, tuberculosis, pertussis, poliomyelitis and diphtheria, we can support the developed world by giving money to buy medicine, vaccines, medical equipment and low-cost antibiotics. And we can and should send teams of doctors to help. But is good to support the developing world by the way of food, medicine and equipment? Certainly yes, because these things can help keep the child from death caused by malnutrition and many diseases.

Although we will be spending much money, this way itself can not solve the fundamental problem. Money alone can not solve the growth problems of the developing world forever. And we in the developed world will have to support these people for a long time in the future, because they can not make a living by themselves, and they don't have enough medical knowledge. I was heard that, even though we have paid money to developing world people to buy machines for agriculture, nobody could use these machine because they lacked special training to operate them.

Then what can we do about these problems now? I think we in the developed world must give assistance in skills for growing more nutritious food, providing better education to use machines which in turn can help these people have their own food and education. Education gives us hope and the right road to culture. And we Japanese medical students can help give them education for curing many diseases common in the developing world. So a majority of deaths in the developing world can be avoided with the right kind of joint efforts. To help developing nations more, we must improve medical science. For example, HIV is serious now and there is still no cure. So the people who are infected HIV will eventually die. Against the other disease we must improve medicine, too. We must make cheaper, more useful and effective medicines. Lastly, what would be the biggest improvement for these people and us? The biggest problem facing all of us is rising birth rates. That is more and more a global problem. I repeat once. This is an area that needs much more research, and maybe we Japanese can help here as well.

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