A study in the Lancet published today found that many simple measures, from encouraging breastfeeding to providing rehydration fluids for babies with diarrhoea, are affordable for the 42 countries with the highest proportion of child deaths, with help from the rich world.

A series by public health experts in the Lancet in 2003 found that 6 million of these deaths could have been prevented. Today's paper, by Robert Black of the Johns Hopkins Bloomberg School of Public Health in Maryland and colleagues, costs the proposals for saving those 6 million lives a year. The total bill comes to $5.1bn a year, a fraction of what is currently spent on HIV/Aids.

Jennifer Bryce, one of the report's authors, said: "$5bn is about 6% of expenditures for tobacco products in the US for 2003. For public health decision makers, the $5bn needed to save 6 million child lives annually might be compared with the estimates of $12bn-$20bn committed annually to the fight against HIV/Aids.
"These examples suggest that $5bn is affordable and reflects a choice being made by policy makers and donors - a choice that allows 6 million children to die each year, over 16,000 each day."

One of the main millennium development goals, set out in 2000 to be achieved by 2015 and the subject of a major UN conference in September, is to cut child mortality from its 1990 level by two-thirds.

The Lancet group in 2003 identified 23 interventions that were proven to save lives. They included access to clean water and sanitation and insecticide-impregnated bed nets to protect young children from malarial mosquitoes in the night. Vitamin A for newborns, and tetanus and measles vaccinations were also on the list.

Barbara McPake of the London School of Hygiene & Tropical Medicine said that financial constraints were not the only problem.

Sub-Saharan Africa has a major healthcare staffing crisis because many nurses, doctors and midwives are themselves falling ill from HIV, while others are leaving for better prospects in countries such as the UK.

"But it is unquestionably a shameful indictment of our global society that, when known effective interventions have been developed and could be financed at a cost of this order, millions of children are denied them."