Since 1990, significant improvements have been made in child health. The under-five mortality rate has decreased by 49%, from 90 deaths per 1,000 live births in 1990 to 46 per 1,000 in 2013. However, improvements in child survival and health have not been equally distributed and several countries and communities continue facing unacceptably high levels of child mortality. Significant gaps remain between the richest and poorest families, both between countries and within countries. Moreover, the majority of deaths in low-income countries are still from preventable infectious diseases including pneumonia, diarrhea, and malaria. Progress is hindered in many low- and middle-income countries by weak health systems, resulting in global recognition of the importance of investing in health systems strengthening, with particular focus on strengthening the community as an integral component of the broader health system.    
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