In many African countries, one child in five dies before they are 5 years old compared to one in 150 in the UK.^1,2 Eleven million children under 5 die each year, 40% of them in Sub-Saharan Africa (SSA).¹ Factors that affect children’s health can be looked at in terms of issues that are proximal to the child (domestic or around the home), such as household income, and issues distal from the child (national or international factors), such as a country’s ability to provide free health care.

The link between poor child health and poverty is well established, and more than 99% of the deaths in children <5 years occur in a setting of poverty.³ Nutrition is highly correlated with income⁴ and the leading cause of morbidity and mortality in Africa is malnutrition.⁵ More than 50% of all childhood deaths can be attributed to being underweight.¹ The estimated contribution that under-nutrition makes to the individual causes of deaths is 50% in measles related deaths, 60% in pneumonia, 65% in malaria, and 70% in diarrhoea.⁶ Since malnutrition and poverty play such a major role in child health, it is appropriate that we, as children’s advocates, should be involved in the debate about issues that lead to poverty. Thus while directly supporting projects overseas, we can also advocate for economic justice, which arguably will have a much greater effect on children’s health.

FACTORS CAUSING THE GREATEST BURDEN OF DISEASE

The causes of mortality in African children follow four main patterns. (table 1). An individual country’s profile of disease largely depends on the impact of malaria and AIDS.¹

The multiple exposures multiple effects (MEME) model (see http://www.who.int/ceh/indicators/indiconcept/en/) …