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Causes of Child Deaths

Where and why are 10 million children dying every year?
Complete report available from The Lancet The most accurate estimates of the causes of child deaths to date, published in the March 26, 2005 of THE LANCET, reveal that worldwide more than 70% of the 10.6 million child deaths that occur annually are attributable to six causes: pneumonia (19%), diarrhoea (18%), malaria (8%), neonatal sepsis or pneumonia (10%), preterm delivery (10%), and asphyxia at birth (8%). Robert Black (Johns Hopkins Bloomberg School of Public Health, Baltimore, USA) and colleagues in an independent group on child health epidemiology, along with those from the World Health Organisation (WHO), analysed available data from publications and ongoing studies in 2000 to 2003 to obtain new estimates for mortality by cause in children younger than age 5 years. They found the four communicable disease categories account more than half (54%) of all child deaths. Infection of the blood or pneumonia in newborn babies and pneumonia in older children constitute 29% of all deaths. Undernutrition is an underlying cause of 53% of all deaths in children aged younger than 5 years. The investigators also calculated the total numbers and proportional distributions of deaths in children younger than age 5 years by cause for the six WHO-defined regions. Among deaths in children, 42% occur in the WHO Africa region, and an additional 29% occur in the south-east Asia region. The authors state that the causes of child deaths can be addressed through existing, available, and affordable interventions. Reducing deaths in the neonatal period will confront health systems with new challenges, especially in low-income countries they add. (See The Lancet Neonatal Survival Series, March 2005) Professor Black comments: "Achievement of the millennium development goals of reducing child mortality by two-thirds from the 1990 rate will depend on renewed efforts to prevent and control pneumonia, diarrhoea, and undernutrition in all WHO regions, and malaria in the Africa region. In all regions, deaths in the neonatal period, primarily due to preterm delivery, sepsis or pneumonia, and birth asphyxia should also be addressed. The new estimates of the causes of child deaths should be used to guide public-health policies and programmes." In an accompanying commentary Peter Byass (Umeň University, Sweden) states: "Counting the world's children is not all that is involved in making the world's children count. It is important to look at the single most important determinant of childhood death -- which has to be poverty. Childhood mortality is strongly inversely correlated with per-capita health expenditure. In today's world, an Ethiopian child is over 30 times more likely than a western European to die before his or her fifth birthday."

Two Key Diarrhoea Facts:
  • Of the 10.6 million yearly deaths in children younger than age 5 years: 1.9 million (18%) are caused by diarrhoea.
  • Of the 6.6 million deaths among children aged 28 days to five years: 1.7 million (26%) are caused by diarrhoea. 1 million (61%) of these deaths are due to the presence of undernutrition.

Child deaths: Causes and epidemiological dimensions
Robert E. Black, M.D., M.P.H. - Johns Hopkins Bloomberg School of Public Health
complete Powerpoint presentation available for download from The Lancet
complete presentation in flash 384 kb click on an image to enlarge

* For the purposes of these charts, one cause has been allocated for each child death. In practice, children often die of multiple causes and malnutrition is a contributory cause in approximately one third of all child deaths. Measles deaths are sometimes ascribed to acute respiratory infection as a severe case of measles renders a child highly susceptible to other infections and pneumonia is often the ultimate reason for a death for which measles is primarily responsible.

Infant and Child Mortality

Reducing infant and child mortality is among the eight U.N. Millennium Development Goals and one of the agreed upon goals outlined in A World Fit for Children, the final document of the United Nations Special Session on Children.

  • Infant mortality rate = the number of deaths of infants under one year of age, in a given period of time, per 1,000 live births in the same amount of time.
  • Children-under-five mortality rate (U5MR) = the probability of children dying between birth and their fifth birthday, expressed as per of 1,000 children born alive.

The goal is to reduce by two thirds the mortality rate among children under five. Global Crisis and Statistics

30,500 children die every day in the lesser-developed world, and half of these deaths are associated with malnutrition.

  • Lesser-developed countries currently have a child mortality rate of 91*, and the least developed countries have a rate of 161*.
    * out of 1,000 live births

  • From 1990 to 2000 there has been a 14 percent reduction in the children-under-5-mortality-rate (U5MR) globally with 3 million fewer deaths.

  • More than sixty countries have reached the goal of reducing the U5MR by one-third (33 percent).

  • Unfortunately, U5MR rates increased in 14 countries (nine of them in sub-Saharan Africa) and were unchanged in eleven others.

Source: The World Health Organization

Under-Five Mortality Rate

There are wide health inequalities within countries, as well as between countries. Comparisons made between countries, are comparisons of the average levels in each country. Within each country, differences between rich and poor, between men and women, and between dominant and marginalized ethnic groups, all lead to differences in health and longevity.

UNICEF - Progress for Children: A Child Survival Report Card: Number 1, 2004

Under 5 Mortality: Differences between Rich and Poor

The graph is sorted by child mortality in low income groups, with the highest child mortality to the left. The mortality rate of the poorest quintile (20%) of the population in each country is shown in orange, while that of the richest quintile is shown in blue. The purple, jagged line indicates the ratio of child mortality for the poor and the rich (poor/rich). This latter line indicates that some countries, including Bolivia, Turkey, and Peru, have very large differences between the health of rich and poor children. This graph suggests that inequality demands particular attention in Bolivia, Turkey, Peru, the Dominican Republic and several other countries.
From UC Atlas of Global Inequality

Life Expectancy at Birth, 1965 and 1998

Life Expectancy at Birth, 1965 and 1998

Life expectancy has increased over the past several decades, especially in low- and middle-income countries. Much of this increase is a result of improved access to nutritious food, safe water, sanitation, and basic health care This chart also shows that life expectancy in the United States in 1900 * was 47 years--what it was in low-income countries in 1965. *Source: U.S. Bureau of the Census, Historical Statistics of the United States: Colonial Times to 1970 (Washington, D.C., 1976). World Bank

Map. Life Expectancy at Birth, 1990-98

Life expectancy at birth is the average number of years newborn babies can be expected to live if health conditions stay the same. It reflects the health of a country's people and the quality of care they receive when they are sick. Countries with low life expectancy at birth tend to be located in Sub-Saharan Africa and parts of Asia. Countries with high life expectancy at birth tend to be located in Europe, North America and parts of Asia and Latin America.

*Source: World Bank

UNDP charts listing the Life expectancy at birth for all countries and groups are available: Male | Female | Annual Estimates | Quinquennial Estimates

updated: 23 April, 2014