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Physical and mental health for young children
Physical and mental health for young children

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1.2 Progress and patterns in low- and middle- income countries

Worldwide childhood mortality (death) rates have reduced in recent decades. The 50-year mortality trends tell us that in 1955, mortality was highest in the 1–4 year age group, but that since that time death rates in children aged 1–4 years have fallen by between 85 and 93 per cent (Viner et al., 2011; p. 1162).

Although there has been substantial progress in reducing childhood deaths across the world, some middle- and low-income countries continue to have childhood death and illness rates at alarming levels (WHO, n.d.). Eighty per cent of under-fives’ deaths in 2020 took place in Sub-Saharan Africa and Southern Asia, even though they only accounted for 53 per cent of live births. The leading causes of death for young children remain as infectious diseases (pneumonia, diarrhoea and malaria), pre-birth and birth complications, and congenital abnormalities (WHO, n.d.). Lack of access to healthcare, poor sanitation and hygiene facilities, unclean water and insufficient food as well as limited education and information all contribute to the risk of death in children (Rau, 2015).


Malnutrition contributes to poor health experiences and outcomes for young children. It is concentrated in low- and lower-middle-income countries with 1 in 3 children suffering from stunted growth. It can occur at any age but has the most devastating effect on the youngest children.

Malnutrition makes children more vulnerable to severe diseases. Chronic malnutrition or stunting—when children are too short for their age because they have not been adequately nourished, received inadequate care and/or live in unhygienic environments—can leave a devastating and permanent impact on a child’s physical and cognitive capabilities.

(Save the Children, 2022)

Undernourishment of pregnant and breastfeeding mothers also adds to the risk of malnutrition and birth complications for babies up to age two years, the first 1000 days.


In countries with prolonged conflicts, babies and young children are at the greatest risk of stunted growth due to malnutrition and to death before the age of five years. At least 240 million children live in countries affected by conflict [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] . Children in countries such as South Sudan, Syria and Yemen, which have been experiencing conflict for a considerable time, are subject to acute malnutrition and lack access to health care and education (Save the Children, 2022).

Activity 2 Different perspectives

Timing: 10 minutes

Read the testimony below from Claire Nicoll, who works for the Humanitarian Operations Team at Save the Children and worked in Yemen in 2019. Consider what the feelings of Rayah (the mother) and Claire (Humanitarian worker, Save the Children) must have been in this situation.

Today, we visited a health facility in rural Hajjah, northern Yemen. … I met 18-month-old Leila and her mother Rayah, and their story is one that I know will stay with me. Leila is suffering from Severe Acute Malnutrition – the deadliest form of extreme hunger that can easily claim the lives of young children. In Yemen, it often does.

When Rayah took Leila’s shirt off to be examined, I struggled to keep my expression neutral. I was shocked at how painfully thin she was.

‘What would you do – take one child to the hospital or feed the others?’

This is the question that Rayah asked when telling me about how the brutal four-year conflict has impacted her life. It shows the impossible choices many mothers in Yemen face every day. She didn’t take Leila to the health facility earlier, when recovery would be guaranteed, as the transport costs would have left her with no money to feed her other children.

Rayah has already lost two children, one from hunger and the other from cancer. She told me in a matter-of-fact tone that cancer was easier to bear, as the death was faster, and she felt less responsible.

I had no answer to her question.

(Save the Children, 2022)