In the Journals

Despite global decline in child deaths, progress varies by country

Global child and adolescent deaths have decreased from 14.18 million in 1990 to 7.26 million in 2015, due in part to reductions in mortalities related to infectious diseases, neonatal disorders and nutritional concerns in some areas.

However, these declines were unevenly distributed, with low-income countries and countries with lower sociodemographic indices demonstrating a disproportionate burden of mortality compared with that of countries with higher income, education and fertility levels.

“Global progress in reducing death in children younger than 5 years has been substantial, but much less attention has been focused on quantifying and minimizing mortality burden among older children and adolescents,” Nicholas J. Kassebaum, MD, assistant professor at the Institute for Health Metrics and Evaluation at the University of Washington, and colleagues wrote. “Likewise, nonfatal health outcomes have received comparatively little attention despite the fact that injuries, noncommunicable diseases and acquired chronic conditions with childhood onset profoundly affect long-term health trajectories, future health care needs, intellectual development and economic and productivity prospects.”

To describe the quantity of mortality and nonfatal health outcomes and possible trends for children and adolescents between 1990 and 2015, the researchers analyzed data regarding these outcomes in 195 countries and territories regarding age group, sex, and year of those aged 19 and younger. The findings were also analyzed to obtain depictions of geographic location and time among those 19 and younger. The collected data also assisted in creating a composite indicator of income, education and fertility for each geographic area and year.

Although a major decrease in global pediatric and adolescent deaths was seen between 1990 and 2015, the countries with a lower socio-demographic index (SDI) carried 75% of the burden in 2015. This percentage has increased significantly since 1990, when countries with a low SDI encompassed 61% of mortalities.

The majority of deaths occurring in 2015 were located in sub-Saharan Africa and South Asia, with an increase in prevalence related to injuries and noncommunicable diseases explaining the current global disease burden. Pediatric and adolescent disability, including long-term sequelae of neonatal conditions at birth (disorders, birth defects, hemoglobinopathies, etc.), increased 4.3% within the examined time frame. Much of this is attributed to the increase in global population and improved survival rates.

Additionally, anemia, developmental intellectual disabilities, hearing loss, epilepsy and vision loss contribute significantly to issues concerning pediatric and adolescent disability and can be caused by various catalysts.

Researchers also observed that for adolescent girls in countries with low SDIs, maternal and reproductive health is an area of concern. In these countries, there is a higher rate of death than disability. Epidemiology transition patterns vary according to specific diseases and injuries. The researchers note that the information provided by this study promotes an outline for policy discussion.

“One possible explanation for growing inequality in disease burden among children and adolescents is that many of the geographical areas with the lowest SDIs have not historically been significant recipients of development assistance for health — DAH,” Klein and colleagues wrote. “Although development for assistance for child and newborn health has been among the fastest growing focus areas of DAH since 1990 and is one of the few areas in which funding has continued to increase since 2010, it has been uneven.” by Katherine Bortz

Disclosure: Dr. Larson reported that her research group at the London School of Hygiene and Tropical Medicine has received funding from GlaxoSmithKline and Merck to convene research symposia, that she has received finding from GlaxoSmithKline for advising on issues related to vaccine hesitancy and that she has served on the Merck Vaccines Strategy Advisory Board. No other disclosures were reported.