Child mortality falls worldwide, but more progress is needed, study suggests

Despite advances, millions of children worldwide still die before their fifth birthday, with complications from preterm birth and pneumonia together killing nearly 2 million young children in 2013, according to a study led by the Johns Hopkins Bloomberg School of Public Health.

Their report, published online this week in The Lancet, examines what caused an estimated 6.3 million children under the age of 5 to die in 2013, one-third fewer than the 9.9 million estimated to have died around the world in 2000. While preterm births and pneumonia were also the top killers in 2000, complications from childbirth are now the third most common cause of death in this group, displacing diarrhea, a disease for which there have been many advances in treatment in the developing world.

The largest burden of child mortality is in sub-Saharan Africa, where nearly half of the deaths worldwide (3.1 million) occurred in 2013, and where 60 percent of child deaths are estimated to occur in 2030 if trends continue, says study lead author Li Liu, an assistant professor at the School of Public Health.

Liu and colleagues from the London School of Hygiene and Tropical Medicine, the World Health Organization, and University of Edinburgh analyzed vital statistics records and verbal autopsy data and estimated causes of child deaths for 194 World Health Organization member states through computer modeling. Of the 3.6 million fewer child deaths in 2013 compared to 2000, half were due to reductions in pneumonia, diarrhea, and measles deaths. Deaths from measles, tetanus, HIV, and diarrhea fell at the fastest rates since 2000.

"We have seen huge successes, but there is still a long way to go," says the study's senior author, Robert E. Black, a professor in the Department of International Health at the Bloomberg School. "Millions of children are still dying of preventable causes at a time when we have the means to deliver cost-effective interventions. And if we don't continue to devote research, resources, and attention to the issue of child survival, we are going to lose the battle."

The United Nations, in an eight-point blueprint known as the Millennium Development Goals, set a goal of reducing the mortality rate for children under 5—the most vulnerable group—by two-thirds between 1990 and 2015. The rate has fallen, but that goal remains. If current trends continue, the world will still see an estimated 4.4 million deaths of children under 5 in 2030.

"Going forward, it's going to be harder and harder to make the kind of headway we have seen in child deaths," Liu says. "We have gone after some low-hanging fruit, but even in those areas there is still so much room for improvement. More, not fewer, resources are needed."

The research was supported by a grant from the Bill & Melinda Gates Foundation.