Child survival efforts can be effective only if they are based on accurate information
about causes of deaths. Here, we report on a 4-year effort by WHO to improve the accuracy
of this information.
WHO established the external Child Health Epidemiology Reference Group (CHERG) in
2001 to develop estimates of the proportion of deaths in children younger than age
5 years attributable to pneumonia, diarrhoea, malaria, measles, and the major causes
of death in the first 28 days of life. Various methods, including single-cause and
multi-cause proportionate mortality models, were used. The role of undernutrition
as an underlying cause of death was estimated in collaboration with CHERG.
In 2000-03, six causes accounted for 73% of the 10.6 million yearly deaths in children
younger than age 5 years: pneumonia (19%), diarrhoea (18%), malaria (8%), neonatal
pneumonia or sepsis (10%), preterm delivery (10%), and asphyxia at birth (8%). The
four communicable disease categories account for more than half (54%) of all child
deaths. The greatest communicable disease killers are similar in all WHO regions with
the exception of malaria; 94% of global deaths attributable to this disease occur
in the Africa region. Undernutrition is an underlying cause of 53% of all deaths in
children younger than age 5 years.
Achievement of the millennium development goal of reducing child mortality by two-thirds
from the 1990 rate will depend on renewed efforts to prevent and control pneumonia,
diarrhoea, and undernutrition in all WHO regions, and malaria in the Africa region.
In all regions, deaths in the neonatal period, primarily due to preterm delivery,
sepsis or pneumonia, and birth asphyxia should also be addressed. These estimates
of the causes of child deaths should be used to guide public-health policies and programmes.