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

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

Prof Robert E Black a , Prof Simon Cousens b, Hope L Johnson a, Joy E Lawn c, Prof Igor Rudan d, Diego G Bassani e,
Prof Prabhat Jha e, Prof Harry Campbell d, Christa Fischer Walker a, Richard Cibulskis f, Thomas Eisele h, Li Liu  a, Colin Mathers g

a Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

b London School of Hygiene and Tropical Medicine, London, UK

c Saving Newborn Lives/Save the Children, Cape Town, South Africa

d University of Edinburgh Medical School, Edinburgh, UK

e Centre for Global Health Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada

f Global Malaria Programme, WHO, Geneva, Switzerland

g Department of Health Statistics and Informatics, WHO, Geneva, Switzerland

h Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA

The Lancet: Available online 11 May 2010 - doi:10.1016/S0140-6736(10)60549-1 

Child Health Epidemiology Reference Group of WHO and UNICEF

Website: http://bit.ly/cUjwZ1

 

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

Supplementary webappendix. 
Supplement to:
Black RE, Cousens S, Johnson HL, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis.
Lancet 2010; published online May 12. DOI:10.1016/S0140-6736(10)60549-1.

 

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