Overall, the under-five child mortality rate fell by 12.85 per cent for Africa as a whole between 1992 and 2007, while an annual rate of decline of 8 per cent is needed if the goal is to be attained on time. Child survival presents a real challenge for the region. But this broad trend however, conceals variations between regions and between countries. While the rate receded by 55 per cent in North Africa, this trend was reversed in Central Africa where child mortality increased by 13 per cent. Only 32.7 per cent of countries have attained or are on course to attain the goal by 2015. Besides the North African countries, some countries (Eritrea, Malawi, Mauritania, Namibia, Comoros and Gabon) with initially high mortality rates made remarkable progress by having already attained the goal (with a more than 45 per cent reduction). Likewise, Gambia, Madagascar, Uganda and Djibouti, all on course, recorded rates of decline of about 40 per cent. However, in 31 countries, performances are distinctly inadequate and four countries (Democratic Republic of Congo, Côte d’Ivoire, Nigeria and Angola) exhibited a deterioration of the indicator. A significant proportion of countries with below-average ranking followed. In addition, there is a strong correlation between the status and performance in Goal 1 and the position achieved in terms of infant mortality. Deaths are attributable to poverty responsible for increasing malnutrition and declining conditions of hygiene thus reducing immune system defences and causing diseases that could have been prevented by immunisation. Measles is the leading cause of death in children in Africa before AIDS, tuberculosis and malaria (World Health Organization, 2008). While vaccination coverage against measles has registered an improvement in Sub-Saharan Africa (56 per cent in 1990 and 72 per cent in 2006), it remains inadequate to effectively ensure children’s chances of survival. Beyond the average trends, it appears that the scale of the challenge of child survival varies from one country to the next. A number of countries, even poor ones, have displayed noteworthy performances (Eritrea, Malawi and Namibia) raising the possibility that progress is possible with political will, adequate resources and targeted strategies.