Six preventable conditions—pneumonia, diarrhea, malaria, neonatal infections, preterm delivery, and asphyxia at birth—account for nearly 75% of the 10.6 million annual deaths of younger children, the World Health Organization has concluded.
The vast majority of these deaths occurred in developing countries and could be prevented easily and inexpensively, said Robert Black, M.D., chair of WHO's Child Health Epidemiology Reference Group (Lancet 2005;365:1147–52).
“Virtually all of these causes can be addressed right now with interventions that work and are inexpensive and easy to deliver,” he told FAMILY PRACTICE NEWS. “This information should be enough to wake us up and say 'We haven't been doing enough on this issue.' We hope this report can be used to guide policy and direct programs aimed at saving these children. If countries realize 50% of child death is from infectious diseases, that's where the program efforts and funds should go.”
WHO established the reference group in 2001 to estimate causes of death in young children worldwide. The 2004 report used vital registration data and published and unpublished epidemiologic data to create epidemiologic models in six global regions: Africa, the Americas, the Eastern Mediterranean, Europe, Southeast Asia, and the Western Pacific.
Four communicable diseases are responsible for more than half of deaths in children younger than 5 years: pneumonia (19%), diarrhea (18%), malaria (8%) and neonatal pneumonia or sepsis (10%), with malnourishment an underlying cause of 53% of these deaths. Preterm births accounted for 10% of mortality in the group, and asphyxia at birth another 8%: thus, 28% of deaths in children under 5 years occurred in the neonatal period. The report found that most of the deaths of children under 5 years occurred in Africa and Southeast Asia. Africa was especially hard-hit, with 94% of global child deaths from malaria, 46% of deaths from pneumonia, 40% of deaths from diarrhea, and 21% of deaths from neonatal pneumonia or sepsis.
This is the first time WHO has broken out neonatal death data from the general population, said Dr. Black of the Bloomberg School of Public Health, Johns Hopkins University, Baltimore. “Previously, this information was lumped into deaths in the perinatal period, which really makes no sense. We tried to get better estimates and present them in a more meaningful way.”
Measles, neonatal tetanus, and HIV/AIDS accounted for only a small proportion of deaths across the globe. The low number of measles deaths (less than 5% of deaths in young children) “is a success story,” the study said, but high immunization rates must be sustained for that success to continue.
HIV/AIDS accounted for only about 3% of global deaths in young children, but the infection remains a significant problem. “All countries need to take action against this growing threat,” the study said.
Neonatal tetanus deaths were halved in the 1990s. Although the report noted that “this is good news,” WHO will not meet its goal of eliminating this as a cause of death by 2005.
It's no surprise that the highest proportion of deaths occurred in the poorest countries, Peter Byass and Tedros A. Ghebreyesus said in an accompanying editorial. Poverty is the single most important risk factor for childhood death (Lancet 2005;365:1114–6).
“In terms of preventing children dying, the old adage that 'you get what you pay for' seems to apply. 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,” said Mr. Byass of Umeå University (Sweden) and Mr. Ghebreyesus of the Federal Ministry of Health, Addis Ababa, Ethiopia.
Meanwhile, they noted, every day, the average citizen in any of the four countries that spend the most on health consumes the equivalent health resources available to a typical Ethiopian in an entire year.