Child Mortality Drops Worldwide, but Fails to Meet Goals

Norra MacReady

May 10, 2012

May 10, 2012 — The decline in global child mortality during the past decade has not met goals established by the United Nations in 2000, a new study shows.

Between 2000 and 2010, the number of children dying before their fifth birthday dropped 21%, from 9.6 million to 7.6 million, or from 73 per 1000 live births to 57, Robert E. Black, PhD, from the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, and colleagues write in an article published online May 11 in the Lancet.

Nearly two thirds of those deaths were from infectious diseases, almost all of which were preventable, the investigators say. Forty percent of the children who died were neonates, defined as infants aged from 0 to 27 days.

Pneumonia was the leading cause of death, followed by complications associated with prematurity. Preterm birth "is likely to become the top cause of death by 2015 unless rapid scale-up of available interventions occurs," the authors warn.

Intrapartum-related complications and sepsis completed the list of leading killers of neonates, with pneumonia, diarrhea, and malaria emerging as the biggest killers of older children.

These findings show "improved child survival at the global level in the past decade," but they fall short of Millennium Development Goal (MDG) 4 of reducing child mortality by two thirds between 1990 and 2015, the authors explain. "Only a few countries are on track to achieve this goal, and much acceleration in progress is needed in other countries." MDG 4 is 1 of 8 MDGs established by the United Nations in 2000 as part of a plan to fight extreme poverty, hunger, and disease worldwide.

To obtain these results, the investigators analyzed country-specific data from the World Health Organization and the United Nations Interagency Group for Child Mortality, as well as from surveys, censuses, verbal autopsy studies, and vital registration systems maintained by the individual nations in which such systems were adequate.

Five countries accounted for 3.754 million (49.3%) of the deaths: India, Nigeria, Democratic Republic of the Congo, Pakistan, and China. Those countries "also accounted for half (2.440 million) the global deaths from infections and 53.3% (1.636 million) of neonatal deaths," the authors write.

Although infectious disease was still the leading cause of death, it decreased more rapidly than noncommunicable causes, "with reductions in deaths caused by pneumonia, diarrhoea, and measles contributing most to the overall reduction." However, the authors note, only tetanus, measles, and AIDS declined "at a rate that was sufficient to achieve MDG 4, and these causes contribute only a small fraction of the overall burden of deaths in children younger than 5 years."

The overall reduction in the leading causes of death accelerated in the decade from 2000 to 2010 compared with the 1990s, which suggests that "merely maintaining the rate of change at the 2000–10 level will not be sufficient," the authors warn.

Scarcity of data was the major obstacle in the effort to obtain accurate estimates, with medically certified vital registration data available from only 61 of the 193 countries studied, representing 2.7% of the 7.6 million deaths among children in 2010. Sub-Saharan Africa had a particularly large evidence gap. Better methods of collecting and reporting this information are essential to guide the setting of priorities and implementing effective interventions to achieve MDG 4, the authors write.

In an editorial accompanying the study, Zulfiqar A. Bhutta, MBBS, from the Division of Women and Child Health, the Aga Khan University, Karachi, Pakistan, calls the overall reduction in child mortality "commendable," but says the tweaking of figures and estimates every few years is "problematic," especially when such adjustments result in a lowering of mortality estimates. This "can easily be misinterpreted as progress." For example, the annual number of deaths from diarrhea in children has fallen to fewer than 800,000 during the last 20 years, but this mostly represents trends in large countries such as Brazil, China, and India. "[T]he overall incidence of diarrhoeal disorders has hardly changed," Dr. Bhutta notes. Also needed is more information on place of death and quality-of-care indicators.

Toward this effort, the investigators "challenge countries and the entire global health community to promote registration and medical certification of deaths and strengthen national health information systems to enable better accountability for the survival of children."

Funding for the study was provided by the Bill & Melinda Gates Foundation. The study authors and Dr. Bhutta have disclosed no relevant financial relationships.

Lancet. Published online May 11, 2012.

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