Child mortality is falling but some developing regions will miss millennium targets

BMJ 2012; 345 doi: (Published 29 August 2012) Cite this as: BMJ 2012;345:e5801
  1. Susan Mayor
  1. 1London

Deaths in children under 5 years are continuing to fall but huge variations in the rate of reduction between countries mean that developing regions will not achieve millennium development goals, according to United Nations figures published in the open access journal PLOS Medicine.1

The figures showed that between 1990 and 2010 the global mortality rate for children under 5 fell from 88 to 57 per 1000 live births. The number of deaths in this age group each year fell by 37% from 12 million to 7.6 million over this period.

But figures for each country showed huge variations in the rate of reductions in child mortality. Northern Africa has already achieved the millennium development goal of reducing deaths in under 5s by two thirds, with a 68% reduction between 1990 and 2010. In contrast, child mortality in countries in sub-Saharan Africa and Oceania fell by only 30% with many countries still having mortality rates in children under 5 of at least 100 deaths per 1000 live births.

Countries in southern Asia also continue to have high child mortality rates of 65.5 deaths per 1000 live births or about one in every 15 children in 2010.

“These findings indicate that a more concerted effort is needed to increase further the pace of progress,” say the researchers, led by Kenneth Hill, from the Harvard Center for Population and Development Studies.

Child mortality is a key indicator not only of child health and nutrition but also of social and economic development more broadly. One of the UN’s millennium development goals is to reduce the mortality rate in children under five by two thirds between 1990 and 2015.

UN researchers have been developing new approaches designed to improve the accuracy of tracking country specific estimates of child mortality. These include adjusting for bias due to AIDS, estimating sex differences in childhood mortality, and methods to determine what proportion of deaths in children under 5 occurs in those younger than 1 year compared to those aged 1 and over.

“Countries in sub-Saharan African and southern Asia in particular must give high priority to the reduction of child mortality,” the group suggests. Figures showed that 64% of deaths of children under 5 in 2010 were caused by infectious diseases, primarily pneumonia (18%), diarrhoea (11%), and malaria (7%). “Effective interventions exist to prevent or treat all three conditions,” they point out.

“Major improvements in data availability and advances in analytic methods over the last two decades have greatly expanded our knowledge of child mortality levels and trends in the developing world,” Hill and colleagues suggest.

But they add that estimates for child mortality in almost all of sub-Saharan Africa are derived from household sample surveys so are affected by biases and sampling errors. “Improved monitoring of child mortality trends requires the development of complete and accurate civil registration systems in developing countries,” they conclude.


Cite this as: BMJ 2012;345:e5801