December 27, 2016
2 min read

Despite reductions in childhood mortality, infectious diseases, childbirth carry significant risk

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Although child mortality decreased between 2000 and 2015, efforts to reach a two-thirds reduction based on the Millennium Development Goal target failed in high-burden populations, according to recent data.

“Child survival has improved substantially since the Millennium Development Goals were set, even though the target to reduce child deaths by two-thirds was not achieved,” Li Liu, PhD, MHS, MBBS, from the Johns Hopkins Bloomberg School of Public Health, said in a press release. “The problem is that this progress is uneven across all countries, meaning a high child death rate persists in many countries. Substantial progress is needed for countries in sub-Saharan Africa and Southern Asia to achieve the child survival target of the Sustainable Development Goals.”

Liu and colleagues sought to ascertain the current mortality rates for children younger than 5 years in all 194 countries within WHO. They developed a model that increased estimation input data for causes of death by 43% among neonates and 23% among children aged 1 to 59 months. In addition, the researchers updated the estimation to include Plasmodium falciparum parasite exposure in place of the malaria index to model malaria-related deaths, an adjusted empirical model for death estimates in China, and considered pneumococcal conjugate vaccine and rotavirus vaccine.

Model analysis showed that among 5.9 million deaths in children younger than 5 years in 2015, 2.7 million deaths occurred in neonates. Mortality rates for pneumonia, diarrhea, malaria and measles were reduced by 30% during the study period; however, the leading causes of mortality in children younger than 5 years were premature birth complications (1.055 million; 95% uncertainty range [UR], 0.935-1.179), pneumonia (0.921 million; 95% UR, 0.812-1.117) and death during birth (0.691 million; 95% UR, 0.598-0.778).

Some of the countries with the highest rates of child mortality were located in sub-Saharan Africa. The researchers wrote that effective, low cost public health policies, such as promoting breastfeeding, vaccinating for pneumonia and malaria; and taking steps to reduced diarrhea, such as by improving water safety and  sanitation would address many of the infectious causes of mortality.

“Focusing on the high-burden regions, sub-Saharan African countries had a quarter of the world’s live births in 2015,” the researchers wrote. “This figure is projected to increase to a third in 2030. Ensuring family planning needs of adolescent girls, women and couples are satisfied with modern contraception is a key to reduce the number of child deaths in this region and globally in the next 15 years.

“Major infectious causes in sub-Saharan Africa had reductions in 2000 to 2015, but infectious causes such as pneumonia, diarrhea, malaria and sepsis or meningitis remain important and should be a focus of child survival efforts going forward.”

In a separate commentary, Peter Byass, PhD, professor in the department of public health and clinical medicine at Umeå Centre for Global Health Research, wrote that a more nuanced approach needs to be implemented with better individual documentation of births and deaths in poorer countries to understand the changing patterns in child mortality.

“Of the estimated six million under-5 child deaths in 2015, only a small proportion were adequately documented at the individual level, with particularly low proportions evident in low-income and middle-income countries, where most childhood deaths occur,” Byass wrote. “That six million under-5 children continue to die every year in our 21st century world is unacceptable, but even worse is that we seem collectively unable to count, and hence be accountable for, most of those individual deaths.” – by Kate Sherrer

Disclosure: The study was funded by the Bill & Melinda Gates Foundation and the World Health Organization. The researchers report no relevant financial disclosures.