In the Journals

Infectious diseases leading cause of death in children aged younger than 5 years

The total number of deaths worldwide in children aged younger than 5 years decreased from 2000 to 2010 by approximately 2 million, but preventable infectious diseases caused nearly two-thirds of all deaths in that age group in 2010, according to researchers who conducted a systematic analysis of worldwide child mortality.

Robert Black, MD, MPH, professor and chair of the department of international health at Johns Hopkins Bloomberg School of Public Health, and colleagues reported that without greater efforts to intervene, the deadline for the fourth Millennium Development Goal (MGD4) — that of reducing the child mortality rate by two-thirds from 1990 to 2015 —could be missed.

“Only a few countries are on track to achieve this goal, and much acceleration in progress is needed in other countries,” they wrote.

To update the numbers of deaths in children aged younger than 5 years across 193 countries, the researchers used vital registration data for countries with a working vital registration system and multinomial logistic regression models for both low-mortality and high-mortality countries lacking adequate vital registration. For low-mortality countries, they used vital registration data from other countries in the model, and for high-mortality countries, they used data from postmortem interviews with family members of the deceased. The researchers developed national models for India and China, and aggregated country results to assess both regional and global estimates.

Of all infectious disorders, results show that pneumonia, diarrhea and malaria were the leading causes of death worldwide. Of all deaths in children aged younger than 5 years, pneumonia accounted for 18.3%, or almost 1.4 million deaths. Preterm birth complications (14.1%), intrapartum-related complications (9.4%) and sepsis or meningitis (5.2%) were the leading causes of neonatal death. Pneumonia (14.1%), diarrhea (9.9%) and malaria (7.4%) were the leading causes of death in older children.

Most of the deaths were reported in Africa (3.6 million), according to researchers, followed by Southeast Asia (2.1 million). The patterns of the causes of death were different in the two regions, with 73.2% of deaths in children aged younger than 5 years caused by infectious diseases in Africa; this number included 95.7% of all child deaths worldwide due to malaria and 89.5% due to AIDS. Neonatal mortality was the highest in Southeast Asia, with 19.2% of deaths attributed to preterm birth complications and 21.8% linked to pneumonia. India, the Democratic Republic of the Congo, Nigeria, Pakistan and China contributed to almost half of the deaths of children aged younger than 5 years in 2010.

According to the researchers, the 2 million fewer deaths from 2000 to 2010 were “attributable to the collective reduction in infectious cases,” with 50% of the reduction due to fewer deaths from pneumonia, diarrhea and measles.

“The trends of the last decade indicate that there is progress in child survival and the availability of proven therapies, and preventive measures such as vaccines suggest that it should be possible to reduce child mortality much faster by eliminating the major infectious diseases,” Black told He added that the major causes of death in the first month of life will then become “proportionally even more important and will require further effort both in health facilities to ensure safe deliveries and to provide newborn care.”

Disclosure: The study was funded by the Bill and Melinda Gates Foundation.