GENEVA - About 9.7 million children die each year before their fifth birthday from diseases that could be prevented with simple, affordable measures, the U.N. Children's Fund (UNICEF) said on Tuesday.

While the annual toll fell below 10 million for the first time, it still means more than 26,000 young children succumb every day to pneumonia, malaria and other scourges. Four million of them die in their first month of life.

"It is still completely and totally unacceptable that nearly 10 million children die every year of largely preventable causes," UNICEF Executive Director Ann Veneman said, noting that many infants also lose their mothers in childbirth.

"There is a great deal of work to be done, but it shows progress has been made and can continue to be made," she told Reuters in an interview.

UNICEF warned that despite recent advances, Africa, South Asia and the Middle East are falling short of a United Nations goal to reduce child mortality by two thirds between 1990 and 2015, to less than 5 million deaths per year.

"The enormity of the challenge should not be underestimated," the agency said in its annual report, "The State of the World's Children."

The toughest steps toward the U.N. target lie ahead - attempting to boost children's life expectancy in countries ravaged by the HIV/AIDS epidemic and plagued by weak governance and poor health systems, it said.

SUB-SAHARAN AFRICA FARES WORST

Sub-Saharan Africa has fared worst of the world's regions, and now accounts for 49 percent of under-five deaths worldwide but only 22 percent of births. A child born there has a one-in-six chance of dying before turning five.

Nearly half of the 46 countries in sub-Saharan Africa have had either stable or worsening child mortality rates since 1990, the report said. Only three - Cape Verde, Eritrea and the Seychelles - are on track to meet the 2015 child survival goal.

"It is a region of the world we have to concentrate on, but we also look at it country by country," Veneman said.

There has been "tremendous progress" in some African states - including Ethiopia and Malawi - which have reduced child mortality by 40 percent since 1990, she said, though others emerging from conflict have stalled.

Civil war-ravaged Sierra Leone has the world's worst ranking for under-five mortality, with 270 deaths per 1,000 live births.

Children in the developing world are frequently killed by respiratory or diarrhoeal infections that no longer threaten lives in rich countries. Many also die from measles and other diseases that can be prevented through vaccines, and suffer as a result of unsafe water and poor sanitation.

Simple, affordable measures such as breast-feeding, vaccinations and insecticide-treated bed nets can dramatically reduce child deaths, according to UNICEF.

"Having a healthy child with an opportunity to survive starts with the health of the mother. So is the mother getting prenatal care and proper nutrition?," Veneman said.

"If we're going to save children's lives, we have to make sure that they are healthy at birth," she added.

Veneman said it was critical to provide sustainable basic health care for pregnant women and children.

"You need a community-based system to provide the immunisations, the vitamin A supplementation and bed nets. You can provide these in an integrated package at the community level," she said.