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Child survival improved dramatically throughout the world over the past century. Measured as the under-five death rate (the probability of dying before reaching the fifth birthday), child mortality declined from values as high as 300 to 600 per 1000 live births to values as low as 5 to 10 per 1000 in most advanced countries, sometimes even lower, and values around or below 100 per 1000 in most developing countries. [Stolnitz, 1955 & 1965; United Nations, 1982; Ahmad et al., 2000] In industrialized countries this mortality decline was associated firstly with the development of hygiene, clean water supply, sanitation, improved nutrition, and more recently with major advances in preventive and curative medicine. [Szreter, 2003] In developing countries of Africa and Asia, child mortality decline seems more associated with preventive and curative medicine, and less so with hygiene and nutrition, although these have also improved in most cases. [Preston, 1980; Feachem and Jamison, 1991; Ahmad et al., 2000; Jamison et al., 2006] Beyond regular improvements associated with economic development, social change and modern medicine, reversals in the health transition might occur as a result of external shocks, such as emerging diseases. When a new very lethal disease appears, it may cause an increase in child mortality, despite a decline in mortality from other causes of death. Since 1980, the most important of these emerging diseases is HIV/AIDS, and the continent the most hardly hit by HIV is sub-Saharan Africa. [Newell et al., 2004; UNAIDS, 2010; Jamison et al., 2006] In addition to emerging infectious diseases, other heath threats could also contribute to increasing mortality, for instance various pollutions or exposure to health hazards which may cause cancer, and behavioural changes such as smoking, substance abuse and obesity, although these are more likely to affect adults than under-five children. Sub-Saharan Africa is very heterogeneous in terms of level of income, level of education, hygiene and sanitation, as well as culturally. Some countries are already quite advanced and modern (e.g. countries in the Southern cone), whereas others lag behind, with low income, low education, low hygiene and poor public health (e.g. Sahelian countries). The effects of an external shock such as an emerging disease are therefore likely to differ among these countries, partly because the spread of the disease might differ, partly because the response to it might differ, and partly because baseline values also differ. Trends in under-five mortality are also determined by other dynamics, and are often related with political

The Impact of HIV/AIDS on the Health Transition Among Under-Five Children in Africa