Elsevier

The Lancet

Volume 385, Issue 9966, 31 January–6 February 2015, Pages 430-440
The Lancet

Articles
Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis

https://doi.org/10.1016/S0140-6736(14)61698-6Get rights and content

Summary

Background

Trend data for causes of child death are crucial to inform priorities for improving child survival by and beyond 2015. We report child mortality by cause estimates in 2000–13, and cause-specific mortality scenarios to 2030 and 2035.

Methods

We estimated the distributions of causes of child mortality separately for neonates and children aged 1–59 months. To generate cause-specific mortality fractions, we included new vital registration and verbal autopsy data. We used vital registration data in countries with adequate registration systems. We applied vital registration-based multicause models for countries with low under-5 mortality but inadequate vital registration, and updated verbal autopsy-based multicause models for high mortality countries. We used updated numbers of child deaths to derive numbers of deaths by causes. We applied two scenarios to derive cause-specific mortality in 2030 and 2035.

Findings

Of the 6·3 million children who died before age 5 years in 2013, 51·8% (3·257 million) died of infectious causes and 44% (2·761 million) died in the neonatal period. The three leading causes are preterm birth complications (0·965 million [15·4%, uncertainty range (UR) 9·8−24·5]; UR 0·615–1·537 million), pneumonia (0·935 million [14·9%, 13·0–16·8]; 0·817–1·057 million), and intrapartum-related complications (0·662 million [10·5%, 6·7–16·8]; 0·421–1·054 million). Reductions in pneumonia, diarrhoea, and measles collectively were responsible for half of the 3·6 million fewer deaths recorded in 2013 versus 2000. Causes with the slowest progress were congenital, preterm, neonatal sepsis, injury, and other causes. If present trends continue, 4·4 million children younger than 5 years will still die in 2030. Furthermore, sub-Saharan Africa will have 33% of the births and 60% of the deaths in 2030, compared with 25% and 50% in 2013, respectively.

Interpretation

Our projection results provide concrete examples of how the distribution of child causes of deaths could look in 15–20 years to inform priority setting in the post-2015 era. More evidence is needed about shifts in timing, causes, and places of under-5 deaths to inform child survival agendas by and beyond 2015, to end preventable child deaths in a generation, and to count and account for every newborn and every child.

Funding

Bill & Melinda Gates Foundation.

Introduction

In 2013, an estimated 6·3 million liveborn children worldwide died before age 5 years.1 This number decreased from 9·9 million in 2000, despite an increase in the number of livebirths, showing that countries have made great progress in improving child survival since the turn of the millennium. Nevertheless, Millennium Development Goal (MDG) 4—to reduce child mortality by two-thirds between 1990 and 2015—will probably only be achieved by a few countries.2, 3, 4

As we approach the post-2015 era, a new set of country targets to reduce child deaths are being formulated. These targets include A Promise Renewed target of 20 or fewer under-5 deaths per 1000 livebirths by 2035 (or 25 or fewer deaths by 2030),5, 6 and the Every Newborn Action Plan target of ten or fewer neonatal deaths per 1000 livebirths by 2035 (or 12 or fewer neonatal deaths by 2030).7 These targets have either already been set or are being discussed within the framework of the Lancet Commission on Investing in Health and the Sustainable Development Goals (SDGs), to be met by 2035 and 2030, respectively.8, 9 To achieve these targets and end preventable child deaths, substantial effort is needed. The global effect will be dependent on high coverage of the most effective interventions, on the biggest causes of death, in the places with the most deaths.10, 11, 12 As such, national, regional, and global trend data for causes of child death are crucial to inform what countries and interventions to prioritise and should be routinely updated. We report child mortality by cause estimates in 2000–13, and cause-specific mortality scenarios to 2030 and 2035.

Section snippets

Estimation of the causes of child mortality

Detailed descriptions of the input data and statistical methods have been published elsewhere.13 In brief, we estimated the distributions of causes of child mortality separately for neonates and children aged 1–59 months. Dependent on data availability and quality, we estimated the distribution of child mortality by cause with application of one of various methods. First, we used vital registration data reported to WHO for countries with an adequate vital registration system (>80% coverage of

Results

Of the 6·3 million children who died in their first 5 years of life in 2013, 51·8% (3·257 million) died of infectious causes. Pneumonia, diarrhoea, and malaria were the leading infectious causes: pneumonia caused 0·935 million deaths (UR 0·817–1·057 million; 14·9% of total deaths, UR 13·0–16·8) deaths, diarrhoea caused 0·578 million deaths (0·448–0·750 million; 9·2%, 7·1–11·9), malaria caused 0·456 million deaths (0·351–0·546 million; 7·3%, 5·6–8·7) in children younger than 5 years (table,

Discussion

Of the 6·3 million children who died before age 5 years in 2013, roughly half died of infectious causes and just over two-fifths died in the neonatal period. The three leading causes of death were preterm birth complications, pneumonia, and intrapartum-related complications. Reductions in pneumonia, diarrhoea, and measles collectively were responsible for half the 3·6 million fewer deaths that took place in 2013 versus 2000. Causes with the slowest progress included congenital, preterm,

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