Child and Adolescent Health From 1990 to 2015

Abstract

Importance Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health. Objective To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion. Evidence Review Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss. Findings Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries. Conclusions and Relevance Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progr...

Adolescent Undernutrition: Global Burden, Physiology, and Nutritional Risks

“…Approximately 60% (588,000) of these were among those aged 15–19. The leading cause of death among 10–14 year olds was HIV/AIDS due to its prevalence in Sub-Saharan Africa and the Caribbean [4] (Fig. 1).…”

“…The maternal mortality ratio (MMR) for 10–19 year olds is 278 per 100,000, as compared to the global MMR for 25–29 year olds of 132 per 100,000. And the rate of decline in MMR for adolescents has been slower than for other age groups [4]. Given the leading causes of mortality, existing global adolescent health programs focus primarily on HIV and sexual and reproductive health services [5].…”

Global Emergency Medicine: A Review of the Literature From 2016

“…The accuracy of chest x-rays in identifying the cause of tachypnea was demonstrated to be relatively poor in India, 27 emphasizing further the need for improved diagnostic tools when assessing children in respiratory distress, especially given that pneumonia continues to account for the greatest burden of mortality in children worldwide. 35 Another diagnostic technology that has revolutionized EM in recent years and is now starting to embed itself into emergency practice worldwide, just as it has in well-resourced settings, is point-of-care ultrasound (POCUS). This year, two high-quality articles were identified that present data on the use of, and training in, POCUS in resource-limited settings.…”

Strategy using a new antigenic test for rapid diagnosis of Streptococcus pneumoniae infection in respiratory samples from children consulting at hospital

“…Pneumonia is a major health problem worldwide. It is one of the leading causes of death and morbidity in children, especially in those under 5 years of age [1,2]. Despite vaccination programs, Streptococcus pneumoniae remains among the main microorganisms involved in bacterial pneumonia, notably in terms of severity [3].…”