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

Abstract

Summary 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.

National, regional, and global causes of mortality in 5–19-year-olds from 2000 to 2019: a systematic analysis

“…Integrated community and school case management and vaccinations could be effective in reducing malaria and diarrhoea mortality. 27 , 45 …”

“…Considering the epidemiological evidence that deaths due to malaria in 5–14-year-olds do not exceed the proportions of deaths due to malaria in 1–59-month-olds, 25 , 26 we capped malaria CSMFs in this group at the 1–59-month level for the corresponding country-year and redistributed excess malaria deaths pro rata between the remaining causes post-hoc. 27 The modelling process is summarised in the appendix (p 19) .…”

Addressing the Data Gaps on Child and Adolescent Tuberculosis

“…The Maternal and Child Epidemiology Estimation (MCEE) group produces estimates of child and maternal mortality attributable to several causes. Most recently, Perin et al [ 26 ] included TB as a specific cause of mortality. These estimates were based on WHO estimates, with additional age disaggregation applied and further disaggregation into respiratory and non-respiratory causes, based on the WHO mortality database.…”

“…These estimates were based on WHO estimates, with additional age disaggregation applied and further disaggregation into respiratory and non-respiratory causes, based on the WHO mortality database. They estimated 130,000 TB deaths in children aged less than five years in 2019, making TB one of the top ten causes of death in this age group [ 26 ]. Based on work undertaken for IHME, Kyu et al [ 27 ] estimated that 66,000 children <15 years died in 2019 (excluding TB deaths among people living with HIV).…”

Quality of care for children with acute respiratory infections in health facilities: a comparative analysis of assessment tools

“…Child mortality is a focus of the Sustainable Development Goals (SDGs) aimed at ending preventable deaths of young children by 2030. Outside the neonatal period, pneumonia is the leading cause of under-five mortality and, at the end of 2019, was responsible for 14% of all under-five deaths [ 1 ].…”