The most accurate estimates of the causes of child deaths to date, published in this weeks issue of The Lancet, reveal that worldwide more than 70 percent of the 10.6 million child deaths that occur annually are attributable to six causes: pneumonia (19 percent), diarrhea (18 percent), malaria (8 percent), neonatal sepsis or pneumonia (10 percent), preterm delivery (10 percent), and asphyxia at birth (8 percent).
Robert Black, of the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues in an independent group on child health epidemiology, along with those from the World Health Organization (WHO), analyzed 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 percent) 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 percent 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 percent occur in the WHO Africa region, and an additional 29 percent 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.
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, diarrhea, 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 programs.
In an accompanying commentary Peter Byass of Umeå University in Sweden, states, Counting the worlds children is not all that is involved in making the worlds 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 todays world, an Ethiopian child is over 30 times more likely than a western European to die before his or her fifth birthday.