Study finds falling child mortality rates

Birth certificates are useful for more than just getting a passport. Vital statistics, specifically the documentation of births and deaths within a population, play a critical role in evaluating the progress toward achieving worldwide health goals. One such health goal is the U.N. Millennium Development Goal of reducing mortality in children under the age of five by two-thirds between 1990 and 2015.

A study led by the Bloomberg School of Public Health, published Oct. 1 in The Lancet Medical Journal, investigated the most prevalent causes of child mortality between 2000 and 2013 in 194 World Health Organization member states. It discovered that based on the trends in mortality, 4.4 million children under the age of five will die in 2030.

According to the most recent estimates presented by the U.N. Inter-agency Group for Child Mortality Estimation, 6.3 million children under the age of five died in 2013, a significant decline from the 12.7 million deaths in 1990. While 17,000 fewer children died every day in 2013 than in 1990, current trends indicate that not many countries will experience the accelerated improvement in child survival rates that is necessary for the achievement of the Millennium Development Goal.

Of the 6.3 million children who died in 2013, 51.8 percent died of infectious causes, and 44 percent of the deaths occurred in the neonatal period, the period from birth to 28 days of age known to be the most vulnerable time for an infant. The three leading causes of death before five years of age were determined, in order of significance, to be preterm birth complications, which are complications from a baby being born too soon; pneumonia; and intrapartum-related complications, otherwise known as birth asphyxia, which is when a baby doesn’t get enough oxygen before, during or after birth.

While preterm birth complications and pneumonia were also leading causes in 2000, intrapartum-related complications, in place of diarrhea, became the third most common cause of death in children under the age of five in 2013. Of special concern to the investigators were the minimal reductions in deaths due to congenital and preterm conditions, as well as neonatal sepsis, which is an infection in the blood of a baby, and injury, in the period from 2000 to 2013. However, there was a marked decrease in deaths attributed to pneumonia, diarrhea and measles.

The existence of interventions such as measles vaccinations helped greatly to lower the number of child deaths due to infectious causes.

Li Liu, lead author of the study and assistant professor in the departments of Population, Family and Reproductive Health and International Health at the Bloomberg School of Public Health, said that the disparity of resources between different hospital divisions is a problem.

“There needs to be a transition in terms of resources available in pediatric wards that will address the shift from infectious diseases to neonatal fatality as the leading cause of child mortality,” she said.

This shift, according to Liu, would require additional investment in the construction of viable neonatal resuscitation programs.

More resources are not only required for the aggressive expansion of high-quality health care, but also for the improvement in measuring child health statistics, a concern elaborated within the discussion section of the study in The Lancet. The validity of the estimates for cause-specific child mortality rates, as investigators noted, was limited by the quality of the available cause-of-death data.

Less than three percent of the 194 World Health Organization member states evaluated in the research had adequate vital registration systems. 90.2 percent of the countries lacked comprehensive data-gathering systems. Although the investigators were able to apply models to estimate worldwide cause-specific child mortality rates, the estimates would have been much more valid had the existing data been more accurate.

“Momentum to strengthen civil and vital registration systems would help bring some resources to shift the paradigm so that lawmakers and decision-makers are more aware of the importance of vital registration systems,” Liu said. The further development of localized studies such as sample registration systems would also result in the advancement of health statistics.

The inclusive compilation of birth-and-death statistics within populations, as well as the accurate reporting of the circumstances of children’s deaths, are imperative to decision-making since allocation of finite resources is based on existing data.

The cause-specific mortality rates estimated for the 6.3 million children who died in 2013 were founded on accessible health statistics. It is unclear as to how progress towards such laudable goals as the Millennium Development Goal of reducing mortality rates in children under the age of five can be tracked accurately without the betterment of health gathering systems.