In the Journals

Global report: Child mortality greatest among those younger than 5 years

The majority of worldwide child mortality occurred among those aged younger than 5 years, according to a comprehensive global report published in JAMA Pediatrics that also included data on disease burden among children and adolescents.

“We identified levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children, older children and adolescents … in 188 countries,” Theo Vos, PhD, MSc, of the Institute for Health Metrics and Evaluation at the University of Washington, and colleagues wrote. “Knowing the current burden and trends of the leading causes of death and disability in these age groups is critically important to shed light on areas that need more attention.”

Theo Vos

Theo Vos

The report — the Global Burden of Disease (GBD) 2013 study — used data from vital registration, verbal autopsies, maternal and child death surveillance and other sources to estimate mortality statistics from 1990 through 2013. The researchers analyzed data related to mortality and morbidity by age, including children aged younger than 5, children aged 5 to 9 years and adolescents aged 10 to 19 years. Epidemiological data were obtained from 35,620 sources to determine diseases and morbidity.

The researchers reported 7.7 million deaths among children and adolescents in 2013. An estimated 6.3 million of those deaths occurred in children aged younger than 5 years, about 500,000 were children aged 5 to 10 years and 1 million were in adolescents. Lower respiratory infections were the leading cause of death among children aged younger than 5 years, accounting for 905,059 deaths in 2013. Preterm birth, neonatal encephalopathy, asphyxia, malaria and diarrheal disease also were among the leading causes of death in this age group. The leading cause of death among adolescents was road injuries, accounting for approximately 115,186 deaths, the report said.

Regionally, countries with the slowest declines in all-cause mortality had stagnant or increasing trends in most leading causes of death. Nigeria accounted for 38% of all global deaths from malaria and 12% of all deaths caused by lower respiratory tract infections. India made up more than one-third of all global deaths caused by neonatal encephalopathy. The researchers also wrote that India, the Democratic Republic of the Congo, Pakistan, Nigeria and Ethiopia accounted for half of all global deaths related to diarrheal diseases.

“Detailed information on causes of death and nonfatal health outcomes in children and adolescents by age, sex, and country over time is an essential input into policy decision making on resource allocation to disease prevention and treatment programs,” Vos and colleagues wrote. “The findings indicate that proven health interventions could save millions of lives.”

Paul Wise

Paul H. Wise

Gary Darmstadt

Gary L. Darmstadt

In an accompanying editorial, Paul H. Wise, MD, MPH, and Gary L. Darmstadt, MD, MS, both of the department of pediatrics at Stanford University School of Medicine, wrote that this report provides a troubling amount of information to suggest there are diverging trends in global child health. They cautioned, however, that unreliable data sources could skew results among the most problematic countries.

“There is a danger that for a general child health readership, the GBD 2013 study’s sophisticated methods and beautifully produced, detailed tables will mask the underlying weakness of available data in areas of greatest concern,” Wise and Darmstadt wrote. “This risk is less one of misinterpretation than of complacency, a willingness to accept the status quo as adequate. This is not inherently a critique of the GBD 2013 study effort. Rather, it is a critique of global systems that do not provide the GBD 2013 study investigators with the data they require to generate greater confidence in their estimates and analytic findings.” – by David Costill

Disclosure: Vos reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

The majority of worldwide child mortality occurred among those aged younger than 5 years, according to a comprehensive global report published in JAMA Pediatrics that also included data on disease burden among children and adolescents.

“We identified levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children, older children and adolescents … in 188 countries,” Theo Vos, PhD, MSc, of the Institute for Health Metrics and Evaluation at the University of Washington, and colleagues wrote. “Knowing the current burden and trends of the leading causes of death and disability in these age groups is critically important to shed light on areas that need more attention.”

Theo Vos

Theo Vos

The report — the Global Burden of Disease (GBD) 2013 study — used data from vital registration, verbal autopsies, maternal and child death surveillance and other sources to estimate mortality statistics from 1990 through 2013. The researchers analyzed data related to mortality and morbidity by age, including children aged younger than 5, children aged 5 to 9 years and adolescents aged 10 to 19 years. Epidemiological data were obtained from 35,620 sources to determine diseases and morbidity.

The researchers reported 7.7 million deaths among children and adolescents in 2013. An estimated 6.3 million of those deaths occurred in children aged younger than 5 years, about 500,000 were children aged 5 to 10 years and 1 million were in adolescents. Lower respiratory infections were the leading cause of death among children aged younger than 5 years, accounting for 905,059 deaths in 2013. Preterm birth, neonatal encephalopathy, asphyxia, malaria and diarrheal disease also were among the leading causes of death in this age group. The leading cause of death among adolescents was road injuries, accounting for approximately 115,186 deaths, the report said.

Regionally, countries with the slowest declines in all-cause mortality had stagnant or increasing trends in most leading causes of death. Nigeria accounted for 38% of all global deaths from malaria and 12% of all deaths caused by lower respiratory tract infections. India made up more than one-third of all global deaths caused by neonatal encephalopathy. The researchers also wrote that India, the Democratic Republic of the Congo, Pakistan, Nigeria and Ethiopia accounted for half of all global deaths related to diarrheal diseases.

“Detailed information on causes of death and nonfatal health outcomes in children and adolescents by age, sex, and country over time is an essential input into policy decision making on resource allocation to disease prevention and treatment programs,” Vos and colleagues wrote. “The findings indicate that proven health interventions could save millions of lives.”

Paul Wise

Paul H. Wise

Gary Darmstadt

Gary L. Darmstadt

In an accompanying editorial, Paul H. Wise, MD, MPH, and Gary L. Darmstadt, MD, MS, both of the department of pediatrics at Stanford University School of Medicine, wrote that this report provides a troubling amount of information to suggest there are diverging trends in global child health. They cautioned, however, that unreliable data sources could skew results among the most problematic countries.

“There is a danger that for a general child health readership, the GBD 2013 study’s sophisticated methods and beautifully produced, detailed tables will mask the underlying weakness of available data in areas of greatest concern,” Wise and Darmstadt wrote. “This risk is less one of misinterpretation than of complacency, a willingness to accept the status quo as adequate. This is not inherently a critique of the GBD 2013 study effort. Rather, it is a critique of global systems that do not provide the GBD 2013 study investigators with the data they require to generate greater confidence in their estimates and analytic findings.” – by David Costill

Disclosure: Vos reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.