The search strategy for the model used to estimate proportionate causes of death has been described.32 Estimates of the importance of risk factors were taken from published results.12 For our comorbidity analyses we also contacted researchers and directors of demographic surveillance areas in low-income and middle-income countries.
SeriesWhere and why are 10 million children dying every year?
Section snippets
Where do most child deaths occur?
The estimate for global child deaths in 2000 is 10·8 million.7 In this series, data from 2000 will be used throughout because they are most complete for this period and little has changed in the past 2 years. About 41% of child deaths occur in sub-Saharan Africa and another 34% in south Asia.7 Because there is substantial variation in death rates within these regions, planning for health interventions should take place at a national level. The incomplete and unreliable nature of these data in
Risk factors for child mortality
Unhygienic and unsafe environments place children at risk of death.2, 12 Ingestion of unsafe water, inadequate availability of water for hygiene, and lack of access to sanitation contribute to about 1-5 million child deaths and around 88% of deaths from diarrhoea.2, 12 Other health-related behaviours, such as birth spacing, are also important risk factors for child mortality.13
Infants aged 0–5 months who are not breastfed have seven-fold and five-fold increased risks of death from diarrhoea and
Underlying causes of death
WHO's work on the global burden of disease, consistent with the International Classification of Diseases (ICD), stipulates one cause of death, which is considered to be the “disease or injury which initiated the train of morbid events leading directly to death”.18 This measure ensures that the sum of deaths from all possible causes will not exceed the total number of child deaths. However, such a classification oversimplifies the situation in low-income and middle-income countries where serious
Classification
All countries need sound epidemiological information to prioritise, plan, and implement public health interventions. Vital event registration that includes cause-of-death data is used to establish the cause structure of mortality in high-income and some middle-income countries, but these are generally not available for the countries where 90% of child deaths take place. Of these countries, only Mexico records more than 95% of causes of death.27 Where coverage is incomplete, the poorer segments
Synergy in causes of death
An interaction of two health disorders can have a synergistic effect on mortality—ie, a rate of death that is greater than the sum of the two individual rates of mortality. This has been documented most clearly for the relation between being underweight and infectious diseases.24, 35 For example, children who are mildly underweight (−2≤z scores<−1) have about a two-fold higher risk of death than those who are better nourished. This risk increases to 5–8 fold in moderately (−3≤z scores≤−2) to
Conclusions
Child health epidemiology is developing and increasingly can provide information useful for public health planning, monitoring, and evaluation. Ideally, information on causes and determinants of death would be available for planning at national or subnational levels. Our epidemiological profiles show the extent of variation between major causes of death even within commonly used regional groupings, which highlights the need for disaggregation at regional and global levels to allow public health
Search strategy
References (41)
- et al.
Selected major risk factors and global and regional burden of disease
Lancet
(2002) Incidence and sociodemographic determinants of childhood mortality in rural Upper Egypt
Soc Sci Med
(2000)- et al.
The effect of malnutrition on the risk of diarrheal and respiratory mortality in children <2y of age in Cebu, Philippines
Am J Clin Nutr
(1997) - et al.
The decline in child mortality: a reappraisal
Bull World Health Organ
(2000) The world health report 2002: reducing risks, promoting healthy life
(2002)State of the world's children 2003
(2002)Progress since the world summit for children: a statistical review
(2001)General assembly, 56th session
Road map towards the implementation of the United Nations millennium declaration: report of the Secretary-General (UN document no. A/56/326)
(2001)- et al.
An analytical framework for the study of child survival in developing countries
Popul Develop Rev
(1984) Child mortality statistics
World population prospects, the 2000 revision
Trends in child mortality in the developing world 1960 to 1996
2000 national family health survey (NFHS-2), 1998–99: India, Mumbai
Population and health dynamics in Nairobi's informal settlements
Birth spacing: three to five saves lives
Population Reports, series L, no 13
Infant feeding and deaths due to diarrhea: a case-control study
Am J Epidemiol
Exclusive breastfeeding reduces acute respiratory infection and diarrhoea deaths among infants in Dhaka slums
Pediatrics
Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis
Lancet
Millennium edition. Vol 1 and 2
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