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Causes of Child Death |
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<< Previous Child Mortality | Where Deaths Occur Next >>
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Neonatal | Pneumonia | Diarrhea | Malaria | Measles | AIDS | Other | Malnutrition
Nearly 4 million deaths occur in the first month of life (i.e., during the neonatal period). This number is roughly equivalent to the number of children born annually in the U.S or in the 23 largest countries of Western Europe.
- Neonatal deaths comprise 38 percent of all child deaths.1
- The leading causes of death are severe infection (sepsis or pneumonia, tetanus and diarrhea), birth asphyxia, complications of prematurity and low birth weight, and congenital conditions. It is estimated that 18 million babies are born each year with a low birth weight (2,500 grams or about 5.5 pounds).2
- Nearly all (98 percent) of neonatal deaths each year occur in developing countries and more than half of neonatal deaths occur in four large countries: India, China, Pakistan and Nigeria.2
Why and Where do Newborns Die? 3, 4
The perinatal period (from birth through the first week of life) is the riskiest time, with 22 percent of all child deaths occurring during this period. In fact, the highest number of deaths occurs on the first day of life.
- A quarter of the 3.3 million babies who are stillborn each year, die during the birthing process.5
- The majority of births in sub-Saharan Africa (59 percent) and in Asia (62 percent) take place without a skilled attendant present, increasing the risk of death or disability for both mother and newborn.6
- Incomplete records of vital statistics and underreporting of deaths among newborns are common, suggesting that deaths during the perinatal period may actually be much higher.
Low birth weight. The World Health Organization (WHO) cites under-nutrition as the largest single contributor to premature death, as infants weighing less than 2,500 grams or 5.5 pounds at birth are at greater risk of death and disease than those with normal birth weight (2,500 – 4,000 grams, or up to about 8.5 pounds). Two key interventions for low birth weight infants are breastfeeding and management of the newborn’s temperature. Since the majority of infant deaths occur at home, educating mothers about the importance of immediate and exclusive breastfeeding is one of the most cost-effective survival solutions known.
- Skin-to-skin contact between mother and newborn (the Kangaroo method) helps keep the infant warm, promotes breastfeeding, and assists with forming a bond between mother and baby.
- Low birth weight is associated with the mother being underweight or having poor nutrition. Maternal vitamin and mineral deficiencies substantially increase infant mortality. Therefore, efforts during pregnancy to provide healthy food and supplements of essential vitamins and minerals such as Vitamin A, iron and Zinc can have high impact.
- Breast milk provides not only the safest and best food source but strengthens the infant’s immune system; it confers protection against infections.7
- In comparison with giving the newborn milk-based fluids or solids in addition to breast milk, immediate (within an hour of birth) and exclusive breastfeeding has been shown to reduce neonatal deaths from all causes by 22 percent.8
| A study in Uttar Pradesh, India demonstrated a 50 percent decline in neonatal mortality through raising awareness in the community of such simple survival strategies as cleaning, drying and warming the newborn, skin-to-skin contact with the mother, and exclusive breastfeeding for the first six months.9
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Pneumonia
Pneumonia causes 29 percent of all child deaths, 10 percent of which occur in the neonatal period.3
Each year, there are more than 150 million cases of childhood pneumonia and nearly 2 million children under five lose their lives to an acute bout of pneumonia or another acute respiratory infection.10
- About 200,000 child deaths that are attributed to pneumonia each year occur in the neonatal period, and pneumonia and sepsis are responsible for a quarter of all neonatal deaths.
- Pneumonia causes 19 percent of child deaths between the neonatal period and age five.
- Most deaths due to pneumonia occur in developing countries where poor children’s immune systems are already weakened by malnutrition and other diseases, including malaria, measles, or HIV/AIDS.
Pneumonia is the most serious of the lower respiratory infections, despite the fact that it can usually be effectively prevented and treated.10,11 It is primarily a bacterial infection of the lungs that makes breathing difficult.
- The two main pathogens that cause pneumonia among children in the developing world are Streptococcus pneumoniae and Haemophilus influenzae type b (Hib). Studies indicate that S. pneumoniae is responsible for over 50 percent of severe cases in Africa and a larger proportion of deaths, and Hib causes about 20 percent of severe cases.
- Other pathogens that cause pneumonia are respiratory synctial virus (RSV), influenza, Staphlococcus aureaus, Klebsiella pneumoniae, and Pneumocystis jiroveci; the latter is problematic for young children with AIDS.
- Pneumonia can also be a complication of other diseases, including measles, particularly when the child is weakened by co-infection, a compromised immune system, or malnutrition.
- The pneumococcal conjugate vaccine (against S. pneumoniae) and the Hib vaccine are important prevention tools.
- Prevention of conditions in which pneumonia can develop is also critical to reduce cases of pneumonia. Adequate nutrition (e.g., exclusive breastfeeding and zinc supplementation) and measles immunization can reduce the risk of developing pneumonia. Infants who are exclusively breastfed in the first six months of life are five times less likely to die of pneumonia than those who are not breastfed. Zinc reduces both the incidence of pneumonia and the severity of illness.
- Antibiotics can effectively treat children with pneumonia, though only one in five caregivers can identify the early signs of pneumonia and only about half of children in need of care are taken to a health care provider.12
Diarrhea
Diarrhea causes 17 percent of under-five deaths plus three percent of neonatal deaths.3
Cholera, shigellosis, rotavirus, typhoid, dysentery and other diarrheal diseases kill nearly 1.8 million children each year, accounting for 17 percent of childhood deaths.3
- Diarrhea is a symptom of infection by water- or food-borne parasites, resulting in dehydration and electrolyte imbalances. Contaminated water causes 90 percent of diarrheal cases among children.
- Children are more vulnerable than adults to the effects of diarrhea because their immune systems are less able to respond to these infections.13 In children, severe diarrhea may quickly lead to death, particularly among those who have vitamin deficiencies and other infections. Severe diarrhea can kill quickly if a child becomes dehydrated and goes into shock.14 Many care givers don’t recognize the danger until it is too late.15
Millions of children live in communities with little or no access to safe water and adequate sanitation, making prevention of food- and water-borne diarrheal infections extremely difficult.
While nearly all fatalities attributed to diarrhea can be averted through the use of an inexpensive solution of glucose and sodium (oral rehydration salts), repeat episodes are inevitable in the absence of safe water and improved hygiene practices. Without these, diarrhea will remain a leading global health threat for the world’s children.
Although respiratory and diarrheal diseases combined are responsible for more than half of child deaths, funding to address these specific causes is largely absent. Interventions to reduce occurrence of these diseases are known, but prevention and treatment tools have not been delivered effectively, especially in low-resource settings. More research is needed to determine the best delivery approaches and to monitor and evaluate the effectiveness of interventions.
The Global Forum for Health Research’s Child Health and Nutrition Research Initiative (CHNRI) has developed a research priority-setting framework that takes into account likely effectiveness of the intervention, deliverability, affordability, sustainability and potential to relieve disease burden.15 When health researchers in South Africa used this approach to set research priorities, they highlighted the importance of pneumonia and diarrhea research and interventions. Child health policy and systems research to increase handwashing with soap, promote antibiotic treatment of pneumonia, exclusive breastfeeding, case management of pneumonia, and use of oral rehydration salts, as well as to reduce the costs of safe water systems, were among the top 10 priorities identified.
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Malaria
Malaria causes about 8 percent of child deaths.3
About 40 percent of the world’s population is at risk of malaria and at least 1 million people die from this disease each year. Because malaria deaths may be attributed to other co-infections, the actual number of deaths due to malaria may be as high as 3 million. The majority of malaria deaths occur among young children.16
- About 850,000 children under five die annually from malaria, with 94 percent of deaths occurring in Africa.17
- Malaria accounts for 18 percent of deaths among African children as compared to 8 percent globally.
- Pregnant women are also particularly vulnerable to malaria, which can result in both maternal and fetal death.
Four parasites cause malaria – Plasmodium falciparum, P. vivax, P. ovale and P. malariae – and all are transmitted through the bite of an Anopheles mosquito.18 Symptoms include fever, headache and vomiting. There are effective and affordable measures to prevent and treat malaria.16
- Malaria deaths can be prevented through the use of insecticide treated bednets and indoor spraying with insecticides to prevent mosquito bites. Yet, only one in 25 children in sub-Saharan Africa sleeps under an insecticide-treated bednet.19
- Antimalraial drugs, i.e., artemisinin-based combination therapies (ACTs), are effective in treating malaria and are relatively affordable.
- Resistance has developed in many countries to chloroquine and sulfa-doxine-pyrimethemine, formerly first-line drugs for treating malaria, which are now ineffective in these countries. Resistance undermines efforts to prevent and treat the disease through treatment failure, prolonged illness, hospitalization and death, and through increased transmission of resistant parasites. It requires additional surveillance to monitor its development, and research to address the potential impact and to find a new solution.20
Measles
Measles infects 30 to 40 million children each year.10
Until recently, measles killed nearly 900,000 children each year. Following a joint WHO and UNICEF plan to expand measles vaccine coverage, deaths have declined by 60 percent since 1999 – to about 345,000.21
- About 60 percent of measles deaths occur in Africa and 25 percent in Asia.
- Nearly 90 percent of all deaths due to measles occur to children under age five.
Caused by a virus, measles is highly communicable and is transmitted by contact with nasal or throat secretions emitted through sneezing or coughing of infected persons.
- Measles symptoms typically consist of a high fever, cough, runny nose and a generalized rash.
- Complications that develop with measles, such as pneumonia and diarrhea, as well as undernutrition, contribute to fatalities for children in developing countries.
- Measles remains endemic in a number of countries. Because it is highly infective, high vaccine coverage is needed if measles is to be eradicated.
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In Southern Africa, measles has been nearly eliminated as a cause of child death in just four years through a vaccination campaign costing just $1.10 per child.22
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HIV/AIDS
An estimated 2.3 million children under age 15 are infected with HIV; more than 530,000 young children become infected with HIV each year.23, 24 More than 95 percent of HIV-infected infants acquired their infection in utero (before birth), during delivery, or through breast milk. About one-third of infected infants die within one year and more than half die before age two years unless they receive treatment. In 2006, 380,000 children died from AIDS-related causes and nearly all lived in sub-Saharan Africa.24, 25
- Only one in 10 HIV positive pregnant women has access to the anti-retroviral drugs that can substantially reduce the risk of transmitting HIV to her child.26
- A single dose of an antiretroviral drug costing only $1- $5 can cut the mother-to-child transmission of HIV by 50 percent.
- In the absence of an inexpensive antiretroviral treatment to prevent infection, there is a 35 percent chance that HIV will be transmitted to a newborn.
- About 15 to 20 percent of HIV-infected infants are infected during pregnancy, half became infected during delivery, and one-third is infected through breastfeeding.
- HIV-infected parents may not survive or be well enough to care for their children. Globally, 15 million children under the age of 18 have lost one or both parents to AIDS.
- Exclusive breastfeeding for six months carries a significantly lower risk of HIV infection than does supplementing breast milk with formula or solid foods. UNAIDS advises, “Where replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding is recommended. Otherwise, exclusive breastfeeding is recommended for the first few months of life.”
- Despite the risk of contracting HIV through breast milk, children in low-resource settings without access to safe water and sanitation are often at even greater risk of death from causes other than HIV if they are not breastfed. Infants who are not breastfed are seven times more likely to die of diarrhea and five times more likely to die of pneumonia than infants who are exclusively breastfed.
Other
Nearly 1.4 million deaths per year to children under five are due to other causes, such as intentional and unintentional injuries, other infectious diseases, non-communicable diseases, and nutritional deficiencies.
Injuries. Road and traffic accidents, fires, drowning, falls, poisonings and other unintentional injuries account for about 280,000 deaths per year for children under five.27 Intentional injuries, resulting from violence or war, cause nearly 14,000 deaths among children under five. These causes of death vary widely by region and over time due to differences in environmental conditions and outbreaks of armed conflict.
Other infectious diseases. About 535,000 under-five deaths per year are due to infectious diseases other than those listed above (e.g., HIV/AIDS, measles, and malaria).27 Pertussis (whooping cough) causes more than 290,000 child deaths per year and is easily prevented with vaccination. Together, meningitis and tuberculosis cause about 100,000 child deaths. Other diseases that cause child deaths include: syphilis, diphtheria, hepatitis B and C, dengue fever, and tropical and intestinal parasitic infections. These diseases can be prevented and treated through immunization (diphtheria, pertussis, tuberculosis and hepatitis), screening efforts, and medication.
Non-communicable diseases. About 400,000 child deaths occur due to non-communicable diseases, such as digestive, respiratory (including asthma), and cardiovascular diseases; malignant neoplasms; neuropsychiatric disorders (including epilepsy); and endocrine disorders.
Nutritional deficiencies. About 200,000 under-five deaths are attributed to severe nutritional deficiencies, including protein-energy malnutrition and lack of vitamin A and micronutrients (e.g., iodine and iron).27
Malnutrition
Malnutrition and under-nutrition contributes to more than half of child deaths.3
Under-nutrition and malnutrition underlie more than half of all child deaths (53 percent) by leaving the child more vulnerable to severe consequences from common infections.3
- More than 200 million children under five are malnourished. Because of the effect of malnourishment on physical and brain development, these children are unlikely to achieve their development potential.
- In 79 low- and middle-income countries, the physical and intellectual growth of more than a quarter of all children is stunted due to poor nutrition and illness. Stunting is defined by the National Center for Health Statistics as height for age that is more than two standard deviations below average for the reference group.
- Children in poor families are much more likely to be deficient in essential micronutrients such as vitamin A, iron, and zinc. The effects of chronic malnutrition in the first two years of life on cognitive ability are largely irreversible.28
- Africa is the only continent in which malnutrition among children is rising, but child malnutrition remains most pervasive in Asia.29
- Vitamin A deficiency increases the risk of child death from diarrhea, measles and malaria by 20-24 percent and zinc deficiency increases the risk of death from diarrhea, pneumonia and malaria by 13-21 percent.30, 31
| 1 |
Lawn JE, Cousens S, Darmstadt GL, Bhutta Z, Martines J, Paul V, et al. 1 year after The Lancet Neonatal Survival Series--was the call for action heard? Lancet 2006;367:1541-7 |
| 2 |
Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? where? why? Lancet 2005;365:891-900. |
| 3 |
Bryce J, Boschi-Pinto C, Shibuya K, Black RE, WHO Child Health Epidemiology Reference Group. WHO estimates the causes of death in children. Lancet 2005;365(9465):1147-52 |
| 4 |
UNICEF. Statistics: Under 5 Mortality Rate. [cited May 11, 2007]; Available from: http://www.childinfo.org/areas/childmortality/u5data.php |
| 5 |
Johns B, Sigurbjornsdottir K, Fogstad H, Zupan J, Mathai M, Tan-Torres Edejer T. Estimated global resources needed to attain universal coverage of maternal and newborn health services Bulletin of the World Health Organization 2007;85(4):256-63. |
| 6 |
Bernstein S, Hansen CJ. Public choices, private decisions: sexual and reproductive health and the Millennium Development Goals. New York: U.N. Millennium Project; 2006. |
| 7 |
Shekar M, Heaver R, Lee Y-K. Repositioning nutrition as central to development: a strategy for large-scale action. Washington, DC: The World Bank; 2006. |
| 8 |
Edmond KM, Zandoh C, Quigley MA, Amenga-Etego S, Owusu-Agyei S, Kirkwood BR. Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics 2006;117(3):e380-6 |
| 9 |
Darmstadt GL, Kumar V, Singh P, et al. Community mobilization and behaviour change communication promote evidence-based essential newborn care practices and reduce neonatal mortality in Uttar Pradesh, India, (poster). Countdown to 2015: Tracking Progress in Child Survival. London; 2005. |
| 10 |
Wardlaw T, Johansson EW, Hodge M. Pneumonia: the forgotten killer of children. New York: UNICEF, The World Bank; 2006. http://www.unicef.org/publications/files/Pneumonia_The_Forgotten_Killer_of_Children.pdf |
| 11 |
Wardlaw T, Salama P, Johansson EW, Mason E. Pneumonia: the leading killer of children. Lancet 2006;368:1048-50. |
| 12 |
Bryce J, Terreri N, Victora CG, Mason E, Daelmans B, Bhutta ZA, et al. Countdown to 2015: tracking intervention coverage for child survival. Lancet 2006;368:1067-76. |
| 13 |
Lochery P. The impact of water and sanitation on the health of children under five: Global Health Council; 2005. http://www.globalhealth.org/images/pdf/HL_special.pdf |
| 14 |
Jamison I, Breman JG, Measham AR, et al, editors. Priorities in health. Washington D.C.: The World Bank; 2006 |
| 15 |
Rudan I, El Arifeen S, Black RE, Campbell H. Childhood pneumonia and diarrhoea: setting our priorities right. Lancet Infec Dis 2007;7:56-61. |
| 16 |
World Health Organization. Malaria fact sheet. [cited May 21, 2007]; Available from: http://www.who.int/mediacentre/factsheets/fs094/en/ |
| 17 |
World Health Organization. The world health report 2005: make every mother and child count. Geneva: World Health Organization; 2005. http://www.who.int/whr/2005/en/ |
| 18 |
Heymann DL, editor. Control of communicable diseases manual. 18 ed. Washington, DC: American Public Health Association; 2004. |
| 19 |
UNICEF. The state of the world's children 2007. 2007 [cited April 23, 2007]; Available from: http://www.unicef.org/publications/index_36587.html |
| 20 |
Barnes K, Folb P. The role of artemisinin-based combination therapy in malaria management. In: Murphy C, Ringheim K, Waldehanna S, editors. Reducing Malaria’s Burden,. Washington D.C: Global Health Council; 2004. |
| 21 |
Elliman D, Bedford H. Achieving the goal for global measles mortality. Lancet 2007;369(165-166). |
| 22 |
Levine R, Kinder M. Millions saved: proven successes in global health. Washington, DC: Center for Global Development; 2004. |
| 23 |
Coovadia HM, Rollins NC, Bland RM, Little K, Coutsoudis A, Bennish ML, et al. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months on life: an intervention cohort study. Lancet 2007;369:1107-16. |
| 24 |
UNAIDS. Children and AIDS: a stocktaking report. Geneva: UNAIDS; 2007. http://data.unaids.org/pub/Report/2007/20060116_stocktaking_report.pdf |
| 25 |
World Health Organization. Taking stock: HIV in children. [cited May 24, 2007]; Available from: http://www.who.int/hiv/toronto2006/takingstockchildren.pdf |
| 26 |
UNICEF. Prevention of parent-to-child transmission of HIV/AIDS. [cited June 12, 2007]; Available from: http://www.unicef.org/aids/index_preventionMTCT.html |
| 27 |
World Health Organization. WHO global burden of disease (GBD) 2002 estimates (revised); 2004. www.who.int/healthinfo/bodestimates/en |
| 28 |
Mendez MA, Adair LS. Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. Journal of Nutrition 1999;129(8):1555-62. |
| 29 |
Council on Foreign Relations. More than humanitarianism: a strategic U.S. approach toward Africa. New York: Council on Foreign Relations; 2006. http://www.cfr.org/content/publications/attachments/Africa_Task_Force_Web.pdf |
| 30 |
UNICEF. Vitamin A deficiency: the challenge. [cited June 12, 2007]; Available from: http://www.childinfo.org/areas/vitamina/ |
| 31 |
Black RE. Nutritional risks and interventions for child survival in low income countries. [cited June 12, 2007]; Available from: http://www.msh.org/news_room/seminars/pdf/childsurvival_112003/Black_Hopkins_112003.pdf |
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