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 (Umeå 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."
Contact: Professor Robert E Black, Department of International Health Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room E8527, Baltimore MD 21205-2179, USA.
Comment: Professor Peter Byass, Department of Public Health & Clinical Medicine,
Umeå University, Umeå International School of Public Health, Epidemiology and Public Health Sciences, S-90185 Umeå, Sweden.
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