Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals

doi:10.1016/S2352-4642(21)00311-4

. 2022 Feb;6(2):106-115.

doi: 10.1016/S2352-4642(21)00311-4. Epub 2021 Nov 17.

Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals

Jamie Perin ¹, Amy Mulick ², Diana Yeung ¹, Francisco Villavicencio ¹, Gerard Lopez ³, Kathleen L Strong ³, David Prieto-Merino ², Simon Cousens ², Robert E Black ¹, Li Liu ⁴

Affiliations

¹ Department of International Health, Johns Hopkins University, Baltimore, MD, USA.
² Epidemiology and Population Health, London School of Tropical Medicine & Hygiene, London, UK.
³ Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland.
⁴ Department of International Health, Johns Hopkins University, Baltimore, MD, USA; Department of Population, Family, and Reproductive Health, Johns Hopkins University, Baltimore, MD, USA. Electronic address: lliu26@jhu.edu.

PMID: 34800370
PMCID: PMC8786667
DOI: 10.1016/S2352-4642(21)00311-4

Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals

Jamie Perin et al. Lancet Child Adolesc Health. 2022 Feb.

. 2022 Feb;6(2):106-115.

doi: 10.1016/S2352-4642(21)00311-4. Epub 2021 Nov 17.

Authors

Jamie Perin ¹, Amy Mulick ², Diana Yeung ¹, Francisco Villavicencio ¹, Gerard Lopez ³, Kathleen L Strong ³, David Prieto-Merino ², Simon Cousens ², Robert E Black ¹, Li Liu ⁴

Affiliations

¹ Department of International Health, Johns Hopkins University, Baltimore, MD, USA.
² Epidemiology and Population Health, London School of Tropical Medicine & Hygiene, London, UK.
³ Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland.
⁴ Department of International Health, Johns Hopkins University, Baltimore, MD, USA; Department of Population, Family, and Reproductive Health, Johns Hopkins University, Baltimore, MD, USA. Electronic address: lliu26@jhu.edu.

PMID: 34800370
PMCID: PMC8786667
DOI: 10.1016/S2352-4642(21)00311-4

Erratum in

Correction to Lancet Child Adolesc Health 2021; published online Nov 17. https://doi.org/10.1016/S2352-4642(21)00311-4.
[No authors listed] [No authors listed] Lancet Child Adolesc Health. 2022 Jan;6(1):e4. doi: 10.1016/S2352-4642(21)00382-5. Lancet Child Adolesc Health. 2022. PMID: 34921809 Free PMC article. No abstract available.

Abstract

Background: Causes of mortality are a crucial input for health systems for identifying appropriate interventions for child survival. We present an updated series of cause-specific mortality for neonates and children younger than 5 years from 2000 to 2019.

Methods: We updated cause-specific mortality estimates for neonates and children aged 1-59 months, stratified by level (low, moderate, or high) of mortality. We made a substantial change in the statistical methods used for previous estimates, transitioning to a Bayesian framework that includes a structure to account for unreported causes in verbal autopsy studies. We also used systematic covariate selection in the multinomial framework, gave more weight to nationally representative verbal autopsy studies using a random effects model, and included mortality due to tuberculosis.

Findings: In 2019, there were 5·30 million deaths (95% uncertainty range 4·92-5·68) among children younger than 5 years, primarily due to preterm birth complications (17·7%, 16·1-19·5), lower respiratory infections (13·9%, 12·0-15·1), intrapartum-related events (11·6%, 10·6-12·5), and diarrhoea (9·1%, 7·9-9·9), with 49·2% (47·3-51·9) due to infectious causes. Vaccine-preventable deaths, such as for lower respiratory infections, meningitis, and measles, constituted 21·7% (20·4-25·6) of under-5 deaths, and many other causes, such as diarrhoea, were preventable with low-cost interventions. Under-5 mortality has declined substantially since 2000, primarily because of a decrease in mortality due to lower respiratory infections, diarrhoea, preterm birth complications, intrapartum-related events, malaria, and measles. There is considerable variation in the extent and trends in cause-specific mortality across regions and for different strata of all-cause under-5 mortality.

Interpretation: Progress is needed to improve child health and end preventable deaths among children younger than 5 years. Countries should strategize how to reduce mortality among this age group using interventions that are relevant to their specific causes of death.

Funding: Bill & Melinda Gates Foundation; WHO.

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Conflict of interest statement

Declaration of interests We declare no competing interests.

Figures

Figure 1

Figure 1

Global causes of under-5 deaths in 2019 Deaths of neonates (aged 0–27 days) are on the right-hand side and deaths of children aged 1–59 months are on the left-hand side.

Figure 2

Figure 2

Cause-specific under-5 mortality in 2019 (A) Cause-of-death mortality fraction. (B) Mortality per 1000 livebirths. Mortality strata are defined as very low (<25 deaths per 1000 livebirths), low (25–50 deaths per 1000 livebirths), moderate (50–75 deaths per 1000 livebirths), moderate-to-high (75–100 deaths per 1000 livebirths), and high (>100 deaths per 1000 livebirths).

Figure 3

Figure 3

Global trends in cause-specific mortality rates in neonates and children aged 1–59 months, 2000–19 The length of each bar represents the amount of change in all-cause under five mortality rate attributable to changes in the mortality rate for each cause. The numbers above the bars are the change in each cause-specific mortality rate. *63% of the reduction is due to lower respiratory infections, diarrhoea, neonatal preterm birth complications, neonatal intrapartum-related events, malaria, and measles.

Figure 4

Figure 4

Projected cause-specific progress needed to meet the SDG child survival target for under-5 mortality by 2030 The SDG target for mortality in children younger than 5 years is <25 deaths per 1000 livebirths, and that among neonates is <12 per 1000 livebirths. Progress is shown for countries with very low (<25 deaths per 1000 livebirths; eg, Indonesia), low (25–50 deaths per 1000 livebirths; eg, India), moderate (50–75 deaths per 1000 livebirths; eg, Pakistan), moderate-to-high (75–100 deaths per 1000 livebirths; eg, Niger), and high under-5 mortality (>100 deaths per 1000 livebirths; eg, Nigeria). SDG=Sustainable Development Goals.

See this image and copyright information in PMC

References

1. UN The millennium development goals report 2015. Sept 15, 2015. https://www.un.org/millenniumgoals/2015_MDG_Report/pdf/MDG%202015%20rev%...
1. UN General Assembly Transforming our world: the 2030 Agenda for Sustainable Development. September, 2015. https://sustainabledevelopment.un.org/post2015/transformingourworld
1. Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388:3027–3035. - PMC - PubMed
1. Efron B. Cambridge University Press; Cambridge: 2012. Large-scale inference: empirical Bayes methods for estimation, testing, and prediction.
1. Mulick AR, Oza S, Prieto-Merino D, Villavicencio F, Cousens S, Perin J. A Bayesian hierarchical model with integrated covariate selection and misclassification matrices to estimate neonatal and child causes of death. medRxiv. 2021 https://www.medrxiv.org/content/10.1101/2021.02.10.21251488v1 published online Feb 12. (preprint). - DOI

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[1] UN The millennium development goals report 2015. Sept 15, 2015. https://www.un.org/millenniumgoals/2015_MDG_Report/pdf/MDG%202015%20rev%...

[2] UN The millennium development goals report 2015. Sept 15, 2015. https://www.un.org/millenniumgoals/2015_MDG_Report/pdf/MDG%202015%20rev%...

[3] UN General Assembly Transforming our world: the 2030 Agenda for Sustainable Development. September, 2015. https://sustainabledevelopment.un.org/post2015/transformingourworld

[4] UN General Assembly Transforming our world: the 2030 Agenda for Sustainable Development. September, 2015. https://sustainabledevelopment.un.org/post2015/transformingourworld

[5] Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388:3027–3035. - PMC - PubMed

[6] Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388:3027–3035. - PMC - PubMed

[7] Efron B. Cambridge University Press; Cambridge: 2012. Large-scale inference: empirical Bayes methods for estimation, testing, and prediction.

[8] Efron B. Cambridge University Press; Cambridge: 2012. Large-scale inference: empirical Bayes methods for estimation, testing, and prediction.

[9] Mulick AR, Oza S, Prieto-Merino D, Villavicencio F, Cousens S, Perin J. A Bayesian hierarchical model with integrated covariate selection and misclassification matrices to estimate neonatal and child causes of death. medRxiv. 2021 https://www.medrxiv.org/content/10.1101/2021.02.10.21251488v1 published online Feb 12. (preprint). - DOI

[10] Mulick AR, Oza S, Prieto-Merino D, Villavicencio F, Cousens S, Perin J. A Bayesian hierarchical model with integrated covariate selection and misclassification matrices to estimate neonatal and child causes of death. medRxiv. 2021 https://www.medrxiv.org/content/10.1101/2021.02.10.21251488v1 published online Feb 12. (preprint). - DOI

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Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals

Affiliations

Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical