ArticlesGlobal, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis
Introduction
In 2013, an estimated 6·3 million liveborn children worldwide died before age 5 years.1 This number decreased from 9·9 million in 2000, despite an increase in the number of livebirths, showing that countries have made great progress in improving child survival since the turn of the millennium. Nevertheless, Millennium Development Goal (MDG) 4—to reduce child mortality by two-thirds between 1990 and 2015—will probably only be achieved by a few countries.2, 3, 4
As we approach the post-2015 era, a new set of country targets to reduce child deaths are being formulated. These targets include A Promise Renewed target of 20 or fewer under-5 deaths per 1000 livebirths by 2035 (or 25 or fewer deaths by 2030),5, 6 and the Every Newborn Action Plan target of ten or fewer neonatal deaths per 1000 livebirths by 2035 (or 12 or fewer neonatal deaths by 2030).7 These targets have either already been set or are being discussed within the framework of the Lancet Commission on Investing in Health and the Sustainable Development Goals (SDGs), to be met by 2035 and 2030, respectively.8, 9 To achieve these targets and end preventable child deaths, substantial effort is needed. The global effect will be dependent on high coverage of the most effective interventions, on the biggest causes of death, in the places with the most deaths.10, 11, 12 As such, national, regional, and global trend data for causes of child death are crucial to inform what countries and interventions to prioritise and should be routinely updated. We report child mortality by cause estimates in 2000–13, and cause-specific mortality scenarios to 2030 and 2035.
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Estimation of the causes of child mortality
Detailed descriptions of the input data and statistical methods have been published elsewhere.13 In brief, we estimated the distributions of causes of child mortality separately for neonates and children aged 1–59 months. Dependent on data availability and quality, we estimated the distribution of child mortality by cause with application of one of various methods. First, we used vital registration data reported to WHO for countries with an adequate vital registration system (>80% coverage of
Results
Of the 6·3 million children who died in their first 5 years of life in 2013, 51·8% (3·257 million) died of infectious causes. Pneumonia, diarrhoea, and malaria were the leading infectious causes: pneumonia caused 0·935 million deaths (UR 0·817–1·057 million; 14·9% of total deaths, UR 13·0–16·8) deaths, diarrhoea caused 0·578 million deaths (0·448–0·750 million; 9·2%, 7·1–11·9), malaria caused 0·456 million deaths (0·351–0·546 million; 7·3%, 5·6–8·7) in children younger than 5 years (table,
Discussion
Of the 6·3 million children who died before age 5 years in 2013, roughly half died of infectious causes and just over two-fifths died in the neonatal period. The three leading causes of death were preterm birth complications, pneumonia, and intrapartum-related complications. Reductions in pneumonia, diarrhoea, and measles collectively were responsible for half the 3·6 million fewer deaths that took place in 2013 versus 2000. Causes with the slowest progress included congenital, preterm,
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