Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with
Jamie Perin1, Amy Mulick2, Diana Yeung1
1Department of International Health, Johns Hopkins University, Baltimore, MD, USA.
Insights
Child mortality has declined since 2000, with preterm birth complications and lower respiratory infections as leading causes in 2019. Strategies are needed to address specific causes and end preventable child deaths.
Area of Science:
- Global child health epidemiology
- Biostatistics and epidemiological modeling
- Public health interventions
Background:
- Understanding child mortality causes is vital for effective health system interventions.
- Updated cause-specific mortality data for children under five are presented for the period 2000-2019.
Purpose of the Study:
- To provide updated cause-specific mortality estimates for neonates and children under five years old.
- To analyze trends and variations in child mortality across different regions and mortality strata.
Main Methods:
- Utilized a Bayesian framework incorporating a structure for unreported causes in verbal autopsy data.
- Employed systematic covariate selection and gave more weight to nationally representative verbal autopsy studies.
- Included mortality data for tuberculosis and stratified estimates by mortality level (low, moderate, high).
Main Results:
- In 2019, 5.30 million deaths occurred in children under five, with preterm birth complications (17.7%) and lower respiratory infections (13.9%) as primary causes.
- Infectious causes accounted for 49.2% of under-five deaths; vaccine-preventable diseases represented 21.7%.
- Significant declines in under-five mortality were observed since 2000, driven by reductions in deaths from lower respiratory infections, diarrhea, preterm birth complications, and other key causes.
Conclusions:
- Despite progress, substantial efforts are required to improve child health and eliminate preventable deaths.
- Countries must develop targeted strategies to reduce child mortality based on their specific leading causes of death.
Background:
Causes of mortality are a crucial input for health systems for identifying appropriate interventions for child survival. We present an updated series of cause-specific mortality for neonates and children younger than 5 years from 2000 to 2019.
Methods:
We updated cause-specific mortality estimates for neonates and children aged 1-59 months, stratified by level (low, moderate, or high) of mortality. We made a substantial change in the statistical methods used for previous estimates, transitioning to a Bayesian framework that includes a structure to account for unreported causes in verbal autopsy studies. We also used systematic covariate selection in the multinomial framework, gave more weight to nationally representative verbal autopsy studies using a random effects model, and included mortality due to tuberculosis.
Findings:
In 2019, there were 5·30 million deaths (95% uncertainty range 4·92-5·68) among children younger than 5 years, primarily due to preterm birth complications (17·7%, 16·1-19·5), lower respiratory infections (13·9%, 12·0-15·1), intrapartum-related events (11·6%, 10·6-12·5), and diarrhoea (9·1%, 7·9-9·9), with 49·2% (47·3-51·9) due to infectious causes. Vaccine-preventable deaths, such as for lower respiratory infections, meningitis, and measles, constituted 21·7% (20·4-25·6) of under-5 deaths, and many other causes, such as diarrhoea, were preventable with low-cost interventions. Under-5 mortality has declined substantially since 2000, primarily because of a decrease in mortality due to lower respiratory infections, diarrhoea, preterm birth complications, intrapartum-related events, malaria, and measles. There is considerable variation in the extent and trends in cause-specific mortality across regions and for different strata of all-cause under-5 mortality.
Interpretation:
Progress is needed to improve child health and end preventable deaths among children younger than 5 years. Countries should strategize how to reduce mortality among this age group using interventions that are relevant to their specific causes of death.
Funding:
Bill & Melinda Gates Foundation; WHO.
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