New research shows that pneumonia, birth asphyxia, and preterm birth complications are the leading causes of death in children under five in China (2008 data), with each accounting for between 15—17% of deaths in children in this age group. The findings are reported in an Article in this week's China Special Issue of the Lancet, written jointly by Professor Igor Rudan, Croatian Centre for Global Health, Split, Croatia, Dr Kit Yee Chan, Nossal Institute for Global Health, Melbourne, Australia, Professor Harry Campbell, Centre for Population Health Sciences, University of Edinburgh, UK, and Professor Yan Guo, Institute of Global Health, Peking University Health Science Centre, Beijing, China, and colleagues on behalf of WHO/UNICEF's Child Health Epidemiology Reference Group (CHERG).
CHERG, in collaboration with Peking University, systematically searched Chinese databases that were available to the public. Information was obtained from the Chinese Ministry of Health and Bureau of Statistics websites, Chinese National Knowledge Infrastructure database, and Chinese Health Statistics yearbooks for 1990-2008. CHERG also obtained information from 206 high-quality community-based longitudinal studies of different causes of deaths in children (<5 years) that were written in the Chinese language. A statistical model was developed to estimate the total number of deaths in children according to provinces, age groups, and main causes.
The research showed that, in addition to the causes above, congenital abnormalities (11%), accidents (10%), and sudden infant death syndrome (5%), were all important causes of death Chinese children under five. During 1990-2008, the mortality rates in neonates, postneonatal infants, and children were reduced by 70% (from 34•0 to 10•2 per 1000 livebirths), 72% (from 53•5 to 14•9 per 1000 livebirths), and 71% (from 64•6 to 18•5 per 1000 livebirths), respectively, meeting the targets set in the Millennium Development Goal 4. However, the also data showed that children born in poor rural areas were three to six times more likely to die before their fifth birthday.
While pneumonia and birth asphyxia are and will remain important causes of death in Chinese children under five, their relative importance has decreased overtime. Pneumonia was responsible for 28% of deaths in this age group in 2000, compared with 17% in 2008. Birth asphyxia caused 19% of deaths in 2000 and 16% in 2008. During this same period, the proportion of deaths caused by congenital abnormalities increased from 6% to 11%, and that caused by accidents from 9% to 10%. The proportion of deaths caused by preterm birth complications also increased slightly from 14% to 15%. Deaths from diarrhoea (3%) were low, the authors point out this could be partially due to cultural trends such as boiling water before drinking and other hygiene practices.
The authors point out that the quality and quantity of studies pooled for their analysis was much higher than in many other low-income and middle-income countries, and that, due to its population size, there can be no further justification for omitting Chinese studies from global estimates of any disease burden.
They conclude: "Publically available Chinese databases contain much important information that has been underused in the estimation of global and regional burden of disease. On the basis of trends, preterm birth complications are expected to become the leading cause of child mortality in China, whereas deaths from congenital abnormalities, accidents, and sudden infant death syndrome are predicted to continue increasing in importance in the long term."
In an accompanying Comment, Professor Zulfiqar A Bhutta, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan, says: "This new analysis is a landmark effort at extraction of Chinese language publications for relevant information about child mortality, rather than reliance on English language publications alone. Key next steps include collation and interpretation of information about maternal and reproductive health and mortality for the same period, because that could well be the key to understanding the rapid decline in neonatal and child mortality rates in China."
Professor Harry Campbell, Centre for Population Health Sciences, University of Edinburgh, UK. T) +44-131-650-3218; E) Harry.Campbell@ed.ac.uk
Professor Yan Guo, Institute of Global Health, Peking University Health Science Centre, Beijing, China. T) +86-108-280-5061; E) guoyan@bjmu.edu.cn
Professor Igor Rudan, Croatian Centre for Global Health, University of Split, Croatia; T) +385-21-557-920 E) igor.rudan@ed.ac.uk
Dr Kit Yee Chan, Nossal Institute for Global Health, University of Melbourne, Australia; T) +86-108-280-5061; E) k.chan@unimelb.edu.au
Professor Zulfiqar A Bhutta, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan. T) +92-300-8236813 E) zulfiqar.bhutta@aku.edu
For full Article and Comment, see: http://press.thelancet.com/chinachildren.pdf
Journal
The Lancet