Post on 25-Dec-2015
transcript
Child deaths: Causes and epidemiological dimensions
Robert E. Black, M.D., M.P.H.Johns Hopkins Bloomberg School of
Public Health
UNICEF/WHO methods for estimating the child mortality envelope
Age-specific mortality rates
Under-5 and adult mortality rates
Complete vital registration
Sample registration system
DHS, MICS and other surveys Life tables
Country-level all-cause mortality envelope
by age and sex
Incomplete vital registration
Censuses
UN estimatesUN population
estimates
Trends in child mortality relative to MDG-4
Sub-Saharan Africa
South Asia
Latin America
East Asia
Under-Five
MortalityRate
244
188
171
62
206
129
92
42.6
122
5431
17.8
123
58
36
19.1
1970 1990 2004 2015
MDG-4Goals
Source: The State of the World’s Children, 2006
Average annual rate of reduction
UNICEF
Region
1970-1990
%
Current
1990-2004
%
Needed to Achieve MDG4
2005-2015
%
L. America/ Caribbean
4.1 4.0 1.2
E. Asia 3.7 3.4 1.5
Mid-East/ N. Africa
4.4 2.6 2.7
S. Asia 2.3 2.4 4.5
Sub Saharan Africa
1.3 0.7 9.9
Current and needed annual rate of reduction in child mortality
to achieve MDG-4
SourceSource: The State of the World’s Children, 2006: The State of the World’s Children, 2006
Where do we need to focus to achieve MDG-4?
Achievement of MDG-4 will depend on accelerating
interventions in South Asia and sub-Saharan Africa.
Trends in childhood mortality in Bangladesh
0
20
40
60
80
100
120
140
1989-93 1992-6 1995-9 2000-4
Under-5 mortalityNeonatal mortality
Relation between U5MR and percentage of deaths in neonates
SourceSource: Black et al., Lancet 2003: Black et al., Lancet 2003
Age group focus
Currently nearly 4 million neonatal deaths
Achievement of MDG-4 will depend on success with neonatal interventions
WHO methods for estimating cause-specific child mortality
Country-level all-cause mortality envelope
by age and sex
Cause-specific mortality patterns
Independent studies/reports/models,
e.g.,CHERG
WHO program estimates
UNAIDS estimates
Global and regional level age, sex and cause specific
mortality estimates
Country level age-, sex- and cause-
specific mortality estimates
New evidence on causes of death
Advances in building the evidence base on causes of child deaths must be incorporated into policies and programs:
• Five causes (pneumonia/sepsis, diarrhea, malaria, preterm birth, and birth asphyxia) account for 73% of all under-five deaths.
• Role of undernutrition must also be considered.
Relative Risk (RR) of death by cause due to underweight, estimated from
random effects models
0
2
4
6
8
10
12
14
-3.5 -2.5 -1.5
Average weight-for-age z-score
Diarrhea
Pneumonia
Malaria
Measles
OverallRR
Source: Caulfield L, et al., Am J Clin Nutr, 2004
Prevalence of underweight in children 0 - 4 years old, by WHO region
Source: de Onis and Blossner, Int J Epi, 2001
2 - 1111 - 2020 - 2828 - 3737 - 46
Prevalence (%)
Major causes of death in neonates and children aged 28 days to 5 years
(yearly average for 2000-03)Deaths among children
aged 28 days to five years ( 6.6 million/year)
Neonatal deaths ( 4 million/year)
Preterm
Congenital
Asphyxia
Other
Diarrhoea
Tetanus
Pneumonia/ sepsis
The % of deaths due to maternal and neonatal undernutrition is under study
Diarrhoea
Measles
HIV/AIDS
Other non-communicable
Injuries
Pneumonia
Other infectious
Malaria
52%
61%
57%
UnderStudy
UnderStudy
45%
The % of deaths from this infection that are due to the presence of undernutrition
Global distribution of disease burden attributable to 20 selected risk factors
0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% 9.0% 10.0%
Underweight Underweight Unsafe sex
High blood pressure
Tobacco
Alcohol
Unsafe water, sanitation & hygiene
High cholesterol
Indoor smoke from solid fuels
Iron deficiency
High BMI
Zinc deficiencyZinc deficiency Low fruit and vegetable intake
Vitamin A deficiencyVitamin A deficiency Physical inactivity
Occupational injury
Lead exposure
Illicit drugs Unsafe health care injections
Lack of contraception
Childhood sexual abuse
Attributable DALY (% of global DALY - Total 1.46 billion)
High-mortality developing
Lower-mortality developing
Developed
Source: Ezzati M et al., Lancet 2002
Implications for child survival
1. Focused acceleration of child survival interventions is critical now to achieve MDG-4
• South Asia and sub-Saharan Africa
• Neonatal deaths, nearly 40% and more important as child mortality declines
2. Evidence on causes of child deaths must be incorporated into policies and programs: Five causes in particular must be addressed
- Pneumonia/sepsis, including in neonates- Diarrhea- Malaria- Preterm birth- Birth asphyxia
Implications for child survival
3. Undernutrition is an underlying cause in half of deaths from diarrhea, pneumonia, malaria and measles. Interventions to improve nutrition can have a large
effect because of reduced fatality from several major infectious causes.
The role of undernutrition in cause-specific deaths in the neonatal period needs further study.
Implications for child survival