Elsevier

The Lancet

Volume 379, Issue 9832, 9–15 June 2012, Pages 2151-2161
The Lancet

Articles
Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000

https://doi.org/10.1016/S0140-6736(12)60560-1Get rights and content

Summary

Background

Information about the distribution of causes of and time trends for child mortality should be periodically updated. We report the latest estimates of causes of child mortality in 2010 with time trends since 2000.

Methods

Updated total numbers of deaths in children aged 0–27 days and 1–59 months were applied to the corresponding country-specific distribution of deaths by cause. We did the following to derive the number of deaths in children aged 1–59 months: we used vital registration data for countries with an adequate vital registration system; we applied a multinomial logistic regression model to vital registration data for low-mortality countries without adequate vital registration; we used a similar multinomial logistic regression with verbal autopsy data for high-mortality countries; for India and China, we developed national models. We aggregated country results to generate regional and global estimates.

Findings

Of 7·6 million deaths in children younger than 5 years in 2010, 64·0% (4·879 million) were attributable to infectious causes and 40·3% (3·072 million) occurred in neonates. Preterm birth complications (14·1%; 1·078 million, uncertainty range [UR] 0·916–1·325), intrapartum-related complications (9·4%; 0·717 million, 0·610–0·876), and sepsis or meningitis (5·2%; 0·393 million, 0·252–0·552) were the leading causes of neonatal death. In older children, pneumonia (14·1%; 1·071 million, 0·977–1·176), diarrhoea (9·9%; 0·751 million, 0·538–1·031), and malaria (7·4%; 0·564 million, 0·432–0·709) claimed the most lives. Despite tremendous efforts to identify relevant data, the causes of only 2·7% (0·205 million) of deaths in children younger than 5 years were medically certified in 2010. Between 2000 and 2010, the global burden of deaths in children younger than 5 years decreased by 2 million, of which pneumonia, measles, and diarrhoea contributed the most to the overall reduction (0·451 million [0·339–0·547], 0·363 million [0·283–0·419], and 0·359 million [0·215–0·476], respectively). However, only tetanus, measles, AIDS, and malaria (in Africa) decreased at an annual rate sufficient to attain the Millennium Development Goal 4.

Interpretation

Child survival strategies should direct resources toward the leading causes of child mortality, with attention focusing on infectious and neonatal causes. More rapid decreases from 2010–15 will need accelerated reduction for the most common causes of death, notably pneumonia and preterm birth complications. Continued efforts to gather high-quality data and enhance estimation methods are essential for the improvement of future estimates.

Funding

The Bill & Melinda Gates Foundation.

Introduction

Globally, 7·6 million children died in 2010 before reaching their fifth birthday.1 This number decreased from 9·6 million in 2000 and the mortality rate per 1000 livebirths in children younger than 5 years decreased from 73 to 57,1 showing improved child survival at the global level in the past decade. However, less than 3 years is left to reach the deadline for Millennium Development Goal (MDG) 4—to reduce child mortality by two-thirds between 1990 and 2015.2 Only a few countries are on track to achieve this goal, and much acceleration in progress is needed in other countries.3, 4 Efforts to accelerate progress could be especially efficient if interventions to save lives from important causes of death can be more rapidly scaled up.5, 6, 7 To guide global and national programmes and research efforts, information about the distribution of causes of child deaths should be periodically updated. To assess the lasting effects of child health interventions and assist the development of long-term child survival strategies, time trends of child deaths by cause should also be made available with consistent methods. WHO and UNICEF's Child Health Epidemiology Reference Group (CHERG) has published a series of estimates of the distribution of causes of child death during the past decade, during which time estimation methods and the quality and quantity of input data have improved.8, 9, 10, 11, 12 With additional vital registration data, verbal autopsy data, and improved methods available, we report updated estimates of the distribution of child deaths by cause in 2010 and time trends of child deaths by cause since 2000.

Section snippets

Estimation of the number of child deaths

Procedures for the estimation of causes of deaths in children younger than 5 years were based on previous methods (figure 1 and appendix p 3).8

To obtain the number of deaths in neonates (aged <29 days) and children aged 1–59 months, the country-specific under-5 mortality rates (U5MR) and neonatal mortality rates are needed (appendix p 3). U5MRs were from the latest publication of the UN Interagency Group for Child Mortality Estimation (IGME).1 The estimation process was largely similar to what

Results

Of 7·6 million children who died in the first 5 years of their life in 2010,1 64·0% (4·879 million) died of infectious causes (table 1). Of all infectious disorders, pneumonia, diarrhoea, and malaria were the leading causes of death worldwide (figure 2)—of all deaths in children younger than 5 years, pneumonia caused 1·396 million deaths (uncertainty range [UR] 1·189–1·642 million; 18·3% of total deaths), diarrhoea caused 0·801 million deaths (UR 0·555–1·182 million, 10·5%), and malaria caused

Discussion

In 2010, of 7·6 million children who died before their fifth birthday, almost two-thirds died of infectious causes, nearly all of which were preventable.7 Two-fifths of deaths in children younger than 5 years occurred in the first 28 days of their life, indicating the crucial importance of the reduction of neonatal deaths if countries are to achieve MDG 4.11, 33 Preterm birth is now the second leading cause of child death after pneumonia, and is likely to become the top cause of death by 2015

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