Child health epidemiology
Key facts
- Between 1990 and 2010, under-five mortality dropped by 35% worldwide.
- Yet, every day, nearly 21 000 children under-five die mostly from preventable causes.
- 99% of all under-five deaths occur in developing countries.
- About three-quarters of all child deaths happen in two WHO regions (Africa and South-east Asia) where childhood mortality continues to be very high.
- More than 50% of these deaths are clustered in only six countries: China, Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan.
- Under-five mortality is higher in rural areas and among poorer and less educated communities.
- Three-quarters of all child deaths are mainly due to preventable causes: neonatal conditions, pneumonia, diarrhoea, malaria, and measles. Many of these deaths could be averted by known, affordable, low-technology interventions.
- Appropriate infant and young child feeding and the prevention and management of diarrhea, pneumonia, malaria and HIV infection can save the lives of millions of under-five children.
- Coverage of key child health interventions is low and unequally distributed between and within countries.
- Strengthening the health system and integrating the interventions into packages of care that can be delivered at all levels – from home to hospital – during pregnancy, childbirth, neonatal period, and childhood will be key to increasing the coverage of health interventions and saving the lives of under-five children.
- Good quality information for evidence-based decisions and planning is lacking.
Millennium Development Goals (MDGs)
The Department of Maternal, Newborn, Child and Adolescent Health directly addresses two of the eight Millennium Development Goals (MDGs), adopted by the international community in the year 2000 1.
Under MDGs 4 and 5, respectively, countries are committed to:
- Reduce child mortality (MDG4): Target 4.A - to reduce by two thirds, between 1990 and 2015, under-five mortality; and
- Improve maternal health (MDG5): Target 5.A - to reduce the maternal mortality ratio by three quarters between 1990 and 2015
Recent data show that some progress has been made in reducing maternal, newborn and under-five mortality, but not swiftly enough to reach the aimed targets by 2015. MDGs 4 and 5 are the furthest of the eight Goals from being achieved by 2015.
Efforts need to be expanded and intensified to accelerate progress towards reducing the still very wide disparities between developing and developed worlds as well as to provide universal coverage of key interventions over the continuum of care.
Under-five mortality
7.6 million under-five children died in 2010 . The risk of death among under-fives is highest closest to birth and then decreases over the subsequent days, months, and years. An estimated 3 million deaths, or 40% of all under-five deaths, occurred during the first 28 days after birth, and 2.4 million deaths in the following 11 months, meaning that 5.4 million deaths (71% of all under-five deaths) happened within the first year of life. Roughly the same number of deaths that took place between 1-11 months of age, also occurred over the next four-year age period (2.2 million) 2.
Trends
Globally, under-five mortality has decreased by 35%, from an estimated rate of 88 deaths per 1000 live births in 1990 to 57 deaths per 1000 live births in 2010. This decline translates into an average annual decrease in child mortality of 2.2%. Although the rate of decline in under-five mortality has accelerated - from 1.9% a year in the period 1990-2000 to 2.5% a year over 2000-2010, it remains insufficient to achieve the MDG4 target of reducing under-five mortality rates by two-thirds between 1990 and 2015. The number of under-five deaths worldwide has declined from more than 12 million in 1990 to 7.6 million in 2010. Nearly 21 000 children under-five died everyday in 2010, about 12 000 fewer a day than in 1990 2.
While progress has been made, it is unequally distributed. The region of the Americas, the European and the Western Pacific regions have reduced their under-five mortality rate by 50% or more while the African and Eastern Mediterranean regions have reduced theirs in 31% and 32% respectively.
Distribution
The risk of a child dying in a low-income country before completing five years of age is about 18 times higher than that of an under-five child from a high-income country. Within countries, under-five mortality is higher among children living in rural areas, less educated communities and poorest households.
Distribution of under-five mortality rates
Three-quarters of all under-five deaths are concentrated in just two regions of the world: 46% in the African region and 28% in South-east Asia. More than half of all these deaths were clustered in only six countries: China, Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan 2.
Inequities
The risk of a child dying in a low-income country before completing five years of age is about 18 times higher than that of an under-five child from a high-income country 2. Within countries, under-five mortality is higher among children living in rural areas, less educated communities and poorest households.
Similarly, the likelihood that a mother or child will have access to key health interventions is much lower for those in the poorest quintile than for those in the richest quintile.
Causes of under-five mortality
Almost half of under-five deaths are due to infectious diseases. Pneumonia is the largest single cause of death in children less than five years of age, and is responsible for nearly 1.4 million deaths every year. Diarrhoeal disease accounts for 840 000 deaths among under-five children. Malaria, another potent cause of child death, kills an estimated 610 000 children less than five years of age 3.
Malnutrition contributes to more than one-third of all under-five deaths. Patterns of the distribution of causes of death vary widely between regions. The lowest proportion of neonatal deaths occurred in the African Region. In the Americas, Europe and South-East Asia, a high proportion of under-five child deaths occurred during the neonatal period.
Most of these deaths can be prevented by known, simple, affordable and low cost interventions such as antenatal care, skilled care during birth and in the weeks after childbirth, early initiation of breastfeeding, exclusive breastfeeding up to 6 months of age, immunization, appropriate use of antibiotics, oral rehydration therapy and zinc, insecticide treated bednets, and anti-malarials, while bolstering nutrition.
WHO response
Improving maternal, newborn and under-five health is one of WHO’s key priorities. MCA is working to reduce maternal, newborn and under-five mortality by providing evidence-based clinical and programmatic guidance, setting global standards, and providing technical support to Member States. In addition, WHO advocates for more affordable and effective treatments, designs training materials and guidelines for health workers, and supports countries to implement policies and programmes and monitor progress.
1 The Millennium Development Goals Report 2011
2 UN-IGME. Levels & trends in child mortality. Report 2011
3 WHO. World Health Statistics 2011