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State of the world’s children and progress towards the Alma Ata Declaration
  1. B O Olusanya1,2,
  2. J K Renner3,
  3. A A Okolo4
  1. 1
    Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London, UK
  2. 2
    Institute of Child Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
  3. 3
    Department of Paediatrics, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Idiaraba, Surulere, Lagos, Nigeria
  4. 4
    Institute of Child Health, College of Medical Sciences, University of Benin, Benin City, Nigeria
  1. Bolajoko O Olusanya, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, 30 Guilford Street, London WC1N 1EH, UK; b.olusanya{at}

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In an earlier report,1 one of us drew attention to the plight of the many survivors of child mortality in the developing world and the lack of relevant data on developmental disabilities in the yearly report by UNICEF on the state of the world’s children within the context of “health” as envisioned in the Alma Ata Declaration of 1978.2 It is gratifying to note for the first time that UNICEF in its latest report3 has introduced data on 2–9-year-old children with seizure, cognitive, motor, visual or hearing disabilities. Although the data are sparse and based on parental accounts of a child’s physical and mental development and functioning, it is nonetheless an important start towards addressing the needs of these children and improving the global database for developmental disabilities.

The addition of data on child discipline, whether psychological or physical punishment, also must be commended because of its close association with childhood disabilities. For instance, children with disabilities generally experience maltreatment more than children without disabilities.4 Those with communication problems, in particular, have a greater preponderance of first incidents from birth to 5 years than any other group of disabled children as their parents are more likely to resort to physical discipline often out of frustration and stress.4

Undoubtedly, more work is required on the epidemiology and to provide cost-effective interventions for disabilities in the first crucial years of life in the light of growing evidence associating countries such as Nigeria and India that account for the highest rates of neonatal, infant and child mortality with the highest proportion of developmentally disadvantaged children worldwide.5 It is therefore hoped that the renewed emphasis on under 5 mortality rate as “an indispensable measure of child health” or a “barometer of child well-being” will in due course give way to a measure that better reflects the vital but poorly understood links between child survival, disability and well-being in the developing world.

As financial and human resources are mobilised towards a two-thirds reduction in child mortality by 2015, we must not fail to acknowledge the need to ensure that no child is disadvantaged physically, mentally or socially. Health authorities at various levels in each country should be encouraged to build on these new initiatives by UNICEF as a fitting tribute to the Alma Ata Declaration as we celebrate its 30th anniversary this September (2008).



  • Competing interests: None.