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Child deaths: Causes and epidemiological dimensions

Child deaths: Causes and epidemiological dimensions. Robert E. Black, M.D., M.P.H. Johns Hopkins Bloomberg School of Public Health. 10.5 milllion annual child deaths. Where are they? How much progress is there? What are the causes?. Complete vital registration.

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Child deaths: Causes and epidemiological dimensions

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  1. Child deaths: Causes and epidemiological dimensions Robert E. Black, M.D., M.P.H. Johns Hopkins Bloomberg School of Public Health

  2. 10.5 milllion annual child deaths • Where are they? • How much progress is there? • What are the causes?

  3. Complete vital registration Age-specific mortality rates Incomplete vital registration Sample registration system Censuses DHS, MICS and other surveys Under-5 and adult mortality rates Life tables UN estimates UN population estimates Country-level all-cause mortality envelope by age and sex UNICEF/WHO methods for estimating the child mortality envelope

  4. Child mortality trends in Egypt Source: UNICEF

  5. Trends in child mortality relative to MDG-4 Sub-Saharan Africa South Asia 244 Latin America 206 East Asia 188 Under- Five Mortality Rate 171 123 129 122 92 58 62 MDG-4 Goals 36 42.6 54 19.1 31 17.8 1970 1990 2004 2015 Source: The State of the World’s Children, 2006

  6. Current and needed annual rate of reduction in child mortality to achieve MDG-4 Source: The State of the World’s Children, 2006

  7. Where do we need to focus to achieve MDG-4? Achievement of MDG-4 will depend on accelerating interventions in South Asia and sub-Saharan Africa.

  8. Trends in childhood mortality in Bangladesh

  9. Relation between U5MR and percentage of deaths in neonates Source: Black et al., Lancet 2003

  10. Age group focus • Currently nearly 4 million neonatal deaths • Achievement of MDG-4 will depend on success with neonatal interventions

  11. WHO methods for estimating cause-specific child mortality Independent studies/reports/models, e.g.,CHERG WHO program estimates UNAIDS estimates Cause-specific mortality patterns Country level age-, sex- and cause-specific mortality estimates Country-level all-cause mortality envelope by age and sex Global and regional level age, sex and cause specific mortality estimates

  12. Causes of under-five child mortality Source: Bryce J. et al., Lancet, 2005

  13. Causes of Under 5 Mortality by WHO Region Source: Bryce J. et al., Lancet, 2005

  14. New evidence on causes of death • Advances in building the evidence base on causes of child deaths must be incorporated into policies and programs: • Five causes (pneumonia/sepsis, diarrhea, malaria, preterm birth, and birth asphyxia) account for 73% of all under-five deaths. • Role of undernutrition must also be considered.

  15. RR Relative Risk (RR) of death by cause due to underweight, estimated from random effects models Source: Caulfield L, et al., Am J Clin Nutr, 2004

  16. Prevalence of underweight in children 0 - 4 years old, by WHO region Prevalence (%) 2 - 1 1 1 1 - 2 0 2 0 - 2 8 2 8 - 3 7 3 7 - 4 6 Source: de Onis and Blossner, Int J Epi, 2001

  17. 52% Under Study 57% Under Study 45% 61% Major causes of death in neonates and children aged 28 days to 5 years (yearly average for 2000-03) Deaths among children aged 28 days to five years ( 6.6 million/year) Neonatal deaths ( 4 million/year) The % of deaths from this infection that are due to the presence of undernutrition The % of deaths due to maternal and neonatal undernutrition is under study

  18. Global distribution of disease burden attributable to 20 selected risk factors Underweight Unsafe sex High blood pressure Tobacco Alcohol Unsafe water, sanitation & hygiene High cholesterol Indoor smoke from solid fuels Iron deficiency High BMI Zinc deficiency Low fruit and vegetable intake Vitamin A deficiency Physical inactivity High-mortality developing Occupational injury Lower-mortality developing Lead exposure Illicit drugs Developed Unsafe health care injections Lack of contraception Childhood sexual abuse 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% 9.0% 10.0% Attributable DALY (% of global DALY - Total 1.46 billion) Source: Ezzati M et al., Lancet 2002

  19. Implications for child survival • Focused acceleration of child survival interventions is critical now to achieve MDG-4 • South Asia and sub-Saharan Africa • Neonatal deaths, nearly 40% and more important as child mortality declines

  20. Implications for child survival • Evidence on causes of child deaths must be incorporated into policies and programs: • Five causes in particular must be addressed • Pneumonia/sepsis, including in neonates • Diarrhea • Malaria • Preterm birth • Birth asphyxia

  21. Implications for child survival • Undernutrition is an underlying cause in half of deaths from diarrhea, pneumonia, malaria and measles. • Interventions to improve nutrition can have a large effect because of reduced fatality from several major infectious causes. • The role of undernutrition in cause-specific deaths in the neonatal period needs further study.

  22. Conclusion Knowledge of the causes of child deaths, especially at the country level, can lead to rational choices of interventions and delivery strategies to have the greatest impact on child mortality.

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