82 The World Health Report 2005 PROGRESS AND SOME REVERSALS Neonatal mortality has not been measured for long enough to reach reliable conclu- sions on trends, but WHO estimates from 1995 to 2000 suggest that most countries in the Region of the Americas, and the South-East Asia, European and Western Pacific Regions have made some progress in reducing the mortality rate among newborns (see Figure 5.3). Improvements may have been less marked in the Eastern Mediter- rican Region may actually have experienced an increase in its neonatal mortality rate Consecutive household surveys from 34 developing countries show that most exper- ienced a decrease in neonatal mortality over recent decades. Much of the progress in survival has been made in the late neonatal period, with little improvement in the first week of life (8). This echoes the historical experience of many developed coun tries, where neonatal mortality (and particularly early neonatal mortality) did not begin to fall substantially until some years after a decline in post-neonatal and childhood mortality had been achieved (9) In many countries, neonatal mortality has fallen at a lower rate than either post-neonatal or early childhood mortality(10-12) Household surveys also suggest that there has been reversal and stagnation in ewborn mortality across sub-Saharan Africa since the beginning of the 1990s(see Figure 5.4). Indeed, the actual number of deaths has increased substantially in the African Region. In only five years, the dramatic drop in deaths in South-East Asia has meant that this region no longer has the highest neonatal mortality rate in the world this place has been taken by Africa, where almost 30% of newbon deaths now occur. Figure 5. 4 Neonatal mortality in African countries shows stagnation and some unusual reversals .... Benin g 0 1976 1981 200182 The World Health Report 2005 PROGRESS AND SOME REVERSALS Neonatal mortality has not been measured for long enough to reach reliable conclu￾sions on trends, but WHO estimates from 1995 to 2000 suggest that most countries in the Region of the Americas, and the South-East Asia, European and Western Pacific Regions have made some progress in reducing the mortality rate among newborns (see Figure 5.3). Improvements may have been less marked in the Eastern Mediter￾ranean Region (but regional averages mask variations between countries), and the Af￾rican Region may actually have experienced an increase in its neonatal mortality rate. Consecutive household surveys from 34 developing countries show that most exper￾ienced a decrease in neonatal mortality over recent decades. Much of the progress in survival has been made in the late neonatal period, with little improvement in the first week of life (8). This echoes the historical experience of many developed coun￾tries, where neonatal mortality (and particularly early neonatal mortality) did not begin to fall substantially until some years after a decline in post-neonatal and childhood mortality had been achieved (9). In many countries, neonatal mortality has fallen at a lower rate than either post-neonatal or early childhood mortality (10–12). Household surveys also suggest that there has been reversal and stagnation in newborn mortality across sub-Saharan Africa since the beginning of the 1990s (see Figure 5.4). Indeed, the actual number of deaths has increased substantially in the African Region. In only five years, the dramatic drop in deaths in South-East Asia has meant that this region no longer has the highest neonatal mortality rate in the world; this place has been taken by Africa, where almost 30% of newborn deaths now occur. Figure 5.4 Neonatal mortality in African countries shows stagnation and some unusual reversals Data source: (10). Neonatal deaths per 1000 live births Côte d'Ivoire Mali Benin Cameroon Uganda Kenya 0 10 20 30 40 50 60 70 1976 1981 1986 1991 1996 2001