Cause-specific child mortality performance and contributions to all-cause child mortality, and number of child lives saved during the Millennium Development Goals era: a country-level analysis

Abstract

Background: During the Millennium Development Goal (MDG) era, impressive reductions in the under-5 mortality rate (U5MR) have been observed, although the MDG 4 target was not met. So far, cause-specific progress in child mortality has been analyzed and discussed mainly at the global and regional levels.

Objectives: We aimed to explore annual changes in cause-specific mortality at the country level, assess which causes contributed the most to child mortality reduction in 2000-2015, and estimate how many child lives were saved.

Methods: We used the cause-specific child mortality estimates published by Liu and colleagues. We derived average annual changes in cause-specific child mortality rates and cause-specific contribution to overall child mortality in 2000-2015. We estimated the number of cause-specific child deaths averted during the MDG era, assuming that cause-specific child mortality remained the same as in 2000. We targeted the 75 Countdown countries where 95% of maternal and child deaths occurred during the MDG era.

Results: Wide disparities existed across causes within countries, both in neonatal and post-neonatal mortality reduction, except for a few countries such as China, Rwanda, and Cambodia. In 20 of the 45 sub-Saharan African countries, malaria was the main contributor to post-neonatal mortality reduction, and pneumonia was the main contributor in only six countries. A single disease often contributed to a substantial proportion of the child mortality reduction, particularly in west and central African countries. Diarrhea-specific post-neonatal child mortality reduction accounted for 7.1 million averted child deaths (24.5%), while pneumonia accounted for another 6.7 million averted child deaths (23%).

Conclusions: This study demonstrates country-specific characteristics with regards to cause-wise child mortality that could not be identified by global or regional analyses. These findings provide the global community with evidence for formulating national policies and strategies to achieve the Sustainable Development Goals in child mortality reduction.

Keywords: Annual average reduction rate; Millennium Development Goal (MDG) era; cause-specific child mortality; cause-specific contribution to child mortality; number of child lives saved.

Figure 1.

Average annual change^a of cause-specific child mortality at country level for 75 countries (1–59-month-olds).

Figure 2.

Average annual change^a of cause-specific neonatal mortality at country level for 75 countries.

Figure 3.

Overall and cause-specific child mortality progress of 75 countries in 2000–2015 (1–59-month-olds, green: success, average annual change of 4.4% or above; yellow: insufficient progress, 1% to 4.3%; grey: no progress, 0% to 1%; red: negative, increase in mortality rate).

Figure 4.

Cause-specific contribution to overall child mortality at country level for 75 countries (1–59-month-olds).

Figure 5.

Key contributor of under-5 child mortality reduction of 75 countries in 2000–2015 (green: malaria; blue: AIDS; red: pneumonia; yellow: measles; brown: diarrhea; grey: other diseases).

Figure 6.

Number of child lives saved during the MDG era by disease among 75 countries (1–59-month-olds, above: accumulated number of lives saved; below: annual number of lives saved).

Figure 7.

Number of cause-specific child deaths averted during the MDG era by region (above: neonates; below: 1–59-month-olds).

^aGreen: success (average annual change of 4.4% or above); yellow: insufficient progress (1% to 4.3%); grey: no progress (0% to 1%); red: negative (increase in mortality rate); N/A: <1death per 1000 live births in 2000; ^bunder-5 child ; ^cpost neonatal; ^dpneumonia; ^epreterm birth complication; ^fintrapartum-related events; ^gmeningitis; ^hother diseases; ⁱcongenital anomaly; ^jdiarrhea; ^kmeasles: ^linjuries; ^mmalaria; ⁿAIDS; ^opertusis.

^agreen: success (average annual change of 4.4% or above); yellow: insufficient progress (1% to 4.3%); grey: no progress (0% to 1%); red: negative (increase in mortality rate); N/A: <1death per 1000 live births in 2000; ^bunder-5 child ; ^cpost neonatal; ^dpneumonia; ^epreterm birth complication; ^fintrapartum-related events; ^gmeningitis; ^hother diseases; ⁱcongenital anomaly; ^jdiarrhea; ^kmeasles: ^linjuries; ^mmalaria; ⁿAIDS; ^opertusis.