Elsevier

The Lancet

Volume 375, Issue 9730, 5–11 June 2010, Pages 1969-1987
The Lancet

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Global, regional, and national causes of child mortality in 2008: a systematic analysis

https://doi.org/10.1016/S0140-6736(10)60549-1Get rights and content

Summary

Background

Up-to-date information on the causes of child deaths is crucial to guide global efforts to improve child survival. We report new estimates for 2008 of the major causes of death in children younger than 5 years.

Methods

We used multicause proportionate mortality models to estimate deaths in neonates aged 0–27 days and children aged 1–59 months, and selected single-cause disease models and analysis of vital registration data when available to estimate causes of child deaths. New data from China and India permitted national data to be used for these countries instead of predictions based on global statistical models, as was done previously. We estimated proportional causes of death for 193 countries, and by application of these proportions to the country-specific mortality rates in children younger than 5 years and birth rates, the numbers of deaths by cause were calculated for countries, regions, and the world.

Findings

Of the estimated 8·795 million deaths in children younger than 5 years worldwide in 2008, infectious diseases caused 68% (5·970 million), with the largest percentages due to pneumonia (18%, 1·575 million, uncertainty range [UR] 1·046 million–1·874 million), diarrhoea (15%, 1·336 million, 0·822 million–2·004 million), and malaria (8%, 0·732 million, 0·601 million–0·851 million). 41% (3·575 million) of deaths occurred in neonates, and the most important single causes were preterm birth complications (12%, 1·033 million, UR 0·717 million–1·216 million), birth asphyxia (9%, 0·814 million, 0·563 million–0·997 million), sepsis (6%, 0·521 million, 0·356 million–0·735 million), and pneumonia (4%, 0·386 million, 0·264 million–0·545 million). 49% (4·294 million) of child deaths occurred in five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan, and China.

Interpretation

These country-specific estimates of the major causes of child deaths should help to focus national programmes and donor assistance. Achievement of Millennium Development Goal 4, to reduce child mortality by two-thirds, is only possible if the high numbers of deaths are addressed by maternal, newborn, and child health interventions.

Funding

WHO, UNICEF, and Bill & Melinda Gates Foundation.

Introduction

Child mortality has been declining worldwide as a result of socioeconomic development and implementation of child survival interventions, yet 8·8 million children die every year before their fifth birthday.1 The aim of UN Millennium Development Goal 4 (MDG 4) is to reduce mortality of children younger than 5 years by two-thirds between 1990 and 2015, but many countries, especially in south Asia and sub-Saharan Africa, are not on track to meet this target.1 An acceleration of the decline in mortality is possible with expansion of interventions targeting the important causes of death.2, 3, 4 In view of the short time left to meet MDG 4, demand is increasing for frequently updated national data on the causes of child mortality to guide national and global programmatic priorities and research.

Updates of total mortality in children younger than 5 years are published every year, and the most recent estimates are for 2008. WHO and UNICEF's Child Health Epidemiology Reference Group (CHERG) undertook the last comprehensive review of the causes of child mortality worldwide for 2000–03.5 The Countdown to 2015 Initiative used these estimates to produce country profiles for 68 countries of low and middle income to assess their progress towards MDG 4.6 Availability of more recent data and improved methods will enable updated estimates of cause-specific child mortality. We present estimates of the distribution of causes of child deaths in 2008 for 193 countries, with aggregated regional and global totals.

Section snippets

Mortality rates in children younger than 5 years

Figure 1 summarises the process used to develop the estimates. Methods to estimate the country-specific mortality rates in children younger than 5 years (5q0) have been developed and agreed by the Inter-agency Group for Child Mortality Estimation (IGME), which consists of representatives of WHO, UNICEF, UN Population Division, World Bank, and academic institutions.7, 8 Every year, IGME assesses and incorporates data from all available surveys, censuses, and vital registration systems to

Results

Of 8·795 million child deaths that occurred in 2008,1 68% (5·970 million) were caused by infectious diseases. The total numbers of deaths by cause are listed in Table 1, Table 2 and in webappendix pp 13–25, and the distribution of deaths by cause is shown in figure 4. The most important infectious diseases were pneumonia in neonates and older children, diarrhoea, and malaria. Deaths occurring in the neonatal period (aged 0–27 days) accounted for 41% (3·575 million) of all deaths in children

Discussion

Collectively, the most important causes of death in children younger than 5 years were infectious diseases, especially pneumonia, diarrhoea, and malaria. The most important single causes of death were pneumonia, diarrhoea, and preterm birth complications. Two-fifths of deaths occurred in the neonatal period, during which the greatest single causes of death were preterm birth complications and birth asphyxia, but collectively, infectious diseases were also important. Numbers of deaths varied

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