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

Jamie Perin, Amy Mulick, Diana Yeung, Francisco Villavicencio, Gerard Lopez, Kathleen L. Strong, David Prieto-Merino, Simon Cousens, Robert E. Black, Li Liu

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)106-115
Number of pages10
JournalThe Lancet Child and Adolescent Health
Volume6
Issue number2
DOIs
StatePublished - Feb 2022

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Pediatrics, Perinatology, and Child Health

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