Fast track — ArticlesGlobal, regional, and national causes of child mortality in 2008: a systematic analysis
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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