Tanzania marks Africa's Children Day today with one of the highest child and maternal mortality rates in the world.

The country, like many other sub- Sahara African countries, is still one of the most difficult places in the world for a child to survive up to the age of five.

Acording to the United Nations Children's Education Fund (Unicef), Tanzania records 578 deaths per 100,000 live births.

Also one in every 6 children does not reach its fifth birthday in the country, just like in other countries in the region, Unicef deputy country representative Hasmik Egian said in an interview with The Citizen recently.

She said although latest figures represented a 14 per cent reduction, the rate remained by far the highest of under-five mortality in the world.

Attributed to the high rate were several health care problems such as shortages of trained community health workers, inadequate coordination of diverse stakeholders and insufficient funding.

Tanzania faces a number of health challenges, and despite this, the Government's national budget allocation for the health sector still falls short of the Abuja target of 15 per cent. The sector is currently getting 10 per cent.

The per capita recurrent government budget allocation to health increased from Sh5,332 million in 2005/6 to Sh7,819 million in 2006/7, an increase of 47 per cent.

Other problems facing the sector are irregular supplies of drugs and equipment, poor support and supervision of health workers, entrenched traditional childcare practices, and the low economic and social status of women.

Most of the under-five deaths in the country are caused by neonatal problems, which cause 27 per cent of the total under-five deaths. Malaria is responsible for 23 per cent of the deaths, while the other 21 per cent results from pneumonia.

Diarrhoea causes 17 per cent of the deaths, HIV/Aids 9 %, injuries 2 % and measles 1 %.

According to Unicef's 2008 Africa's Children Report, approximately half of all infant deaths in the country occur in the week after birth.

The Report says amid such high figures, is concern about the declining routine immunisation coverage in the country.

Immunisation coverage gradually declined from 90 per cent in 2005 to 87 per cent in 2006 and 83 per cent in 2007.

On maternal deaths rate, Unicef says Tanzania still has one of the highest in the world.

According to the agency's Count down to 2015 Report, 34 per cent of maternal deaths in the country is caused by haemorrhage.

Sepsis, a condition caused by toxic micro-organisms in the bloodstream; and HIV/Aids cause 16 per cent of the deaths.

Hypertensive disorders contribute to at least 9 per cent of the maternal deaths while anaemia, obstructed labour and abortion, all claim 4 per cent of the maternal mortality in the country.

"Reducing maternal and neonatal deaths remains a major challenge for Tanzania," said Ms Hasmik Egian, who added that there was urgent need for "a massive scale-up of key interventions delivered in effective packages across a continuum of maternal, newborn and child care."

In addition to having the highest regional rate of child mortality, sub-Saharan Africa is the furthest behind on most of the health-related Millennium Development Goals, particularly MDG 4 and also MDG 5, which seeks to reduce maternal mortality by three quarters between 1990 and 2015.

Sub-Saharan Africa faces an immense and unprecedented challenge to meet Millennium Development Goal 4 on time, notes the report on Countdown to 2015.

It says achieving the MDG 4 would require reducing the number of child deaths between 2007 and 2015 at more than 10 times the rate recorded between 1990 and 2006.

The report also says if current trends persist, 2.8 million children under five in sub- Saharan Africa will die in the MDG target year of 2015 whose lives could have been saved in that year alone if MDG 4 had been met.

According to latest figures published in the World Health Organisation's World Health (WHO) statistics 2007, neonatal deaths account for more than one quarter of deaths in Saharan Africa.

The WHO also says pneumonia, which is responsible for more than one fifth of child deaths in the region, is one of the major killers.

Sub Saharan Africa countries still lag on the other health-related MDGs such as progress towards eradicating extreme poverty and hunger.

The region is still far behind in reversing the spread of HIV/Aids. It has also made little progress towards ensuring environmental sustainability.

Sub-Saharan Africa, according to the report needs to undergo a radical transformation aimed at strengthening health systems through community partnerships, establishing continuums of care across time and location, and developing health systems for outcomes.