Child mortality

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Child mortality, also known as child death, refers to the death of children under the age of 14 and encompasses national mortality, under-5 mortality, and mortality of children aged 5–14. [1] Many child deaths go unreported for a variety of reasons, including lack of death registration and lack of data on child migrants. [2] [3] Without accurate data on child deaths, we cannot fully discover and combat the greatest risks to a child's life.

Contents

Reduction of child mortality is reflected in several of the United Nations' Sustainable Development Goals. Rapid progress has resulted in a significant decline in preventable child deaths since 1990, with the global under-5 mortality rate declining by over half between 1990 and 2016. [1] While in 1990, 12.6 million children under age five died, in 2016 that number fell to 5.6 million children. [1] However, despite advances, there are still 15,000 under-five deaths per day from largely preventable causes. [1] About 80 per cent of these occur in sub-Saharan Africa and South Asia, and just 6 countries account for half of all under-five deaths: India, Nigeria, Pakistan, the Democratic Republic of the Congo, Ethiopia and China. [1] 45% of these children died during the first 28 days of life. [4]

United Nations Intergovernmental organization

The United Nations (UN) is an intergovernmental organization that was tasked to maintain international peace and security, develop friendly relations among nations, achieve international co-operation and be a centre for harmonizing the actions of nations. The headquarters of the UN is in Manhattan, New York City, and is subject to extraterritoriality. Further main offices are situated in Geneva, Nairobi, and Vienna. The organization is financed by assessed and voluntary contributions from its member states. Its objectives include maintaining international peace and security, protecting human rights, delivering humanitarian aid, promoting sustainable development and upholding international law. The UN is the largest, most familiar, most internationally represented and most powerful intergovernmental organization in the world. In 24 October 1945, at the end of World War II, the organization was established with the aim of preventing future wars. At its founding, the UN had 51 member states; there are now 193. The UN is the successor of the ineffective League of Nations.

Sustainable Development Goals set of 17 global development goals defined by the United Nations for the year 2030

The Sustainable Development Goals (SDGs) are a collection of 17 global goals set by the United Nations General Assembly in 2015 for the year 2030. The SDGs are part of Resolution 70/1 of the United Nations General Assembly: "Transforming our World: the 2030 Agenda for Sustainable Development". That has been shortened to "2030 Agenda".

This 1860 woodcut by Julius Schnorr von Karolsfeld depicts the death of Bathsheba's first child with David, who lamented, "I shall go to him, but he will not return to me"( 2 Samuel 12:23 ) Schnorr von Carolsfeld Bibel in Bildern 1860 103.png
This 1860 woodcut by Julius Schnorr von Karolsfeld depicts the death of Bathsheba's first child with David, who lamented, "I shall go to him, but he will not return to me"( 2 Samuel 12:23 )

Measurement

Child mortality refers to number of child deaths under the age of 5 per 1000 live births. However, the child mortality could be simplified into more specific terms such as prenatal, perinatal, Neonatal, infancy and under 5. Prenatal: child death before the birth, Perinatal: child death before one week of birth, Neonatal: child death before 28 days of birth, Infancy: child death before 1st birthday, and child mortality under 5 refer to any deaths from birth to the 5th birthday. [5]

Prenatal development includes the development of the embryo and of the fetus during a viviparous animal's gestation. Prenatal development starts with fertilization, in the germinal stage of embryonic development, and continues in fetal development until birth.

An infant is the more formal or specialised synonym for "baby", the very young offspring of a human. The term may also be used to refer to juveniles of other organisms.

Perinatal mortality rate: Number of child deaths within first week of birth/ total number of birth [5]

Neonatal mortality rate: number of child deaths within first 28 days of life/ total number of birth [5]

Infancy mortality rate: number of child deaths within first 12 months of life/ total number of birth [5]

Under 5 mortality rates: number of child deaths within 5th birthday/ total number of birth [5]

Causes

Child mortality is high in countries where women have many children (high fertility rates). Wealthy countries have lower child mortality rates than poor ones. Child Mortality vs Fertility Rate.svg
Child mortality is high in countries where women have many children (high fertility rates). Wealthy countries have lower child mortality rates than poor ones.

The leading causes of death of children under five include:

There is variation of child mortality around the world; countries that are in the second or third stage of the Demographic Transition Mode (DTM) have higher rates of child mortality than countries in the fourth or fifth state of the DTM. Chad infant mortality is about 96 per 1,000 live births. And developed country such as Japan infant mortality is about 2.2 per 1,000 live births. [5] In 2010, there were estimated to 7.6 million child deaths around the world and most of it occurred in less developed countries and 4.7 [6] million died from infection and disorder. [6] Child mortality isn’t only caused by infection and disorder, it is also caused by premature birth, birth defect, new born infection, birth complication, and disease like malaria, sepsis, and diarrhea. [7] In less developed countries, malnutrition is the main source of child mortality. [7] Pneumonia, diarrhea and malaria together are the cause of 1 out of every 3 child deaths before the age of 5 and nearly half of under-five deaths globally are attributable to under nutrition. [8]

Prevention

Child survival is a field of public health concerned with reducing child mortality. Child survival interventions are designed to address the most common causes of child deaths that occur, which include diarrhea, pneumonia, malaria, and neonatal conditions. Of the portion of children under the age of 5 alone, an estimated 5.6 million children die each year mostly from such preventable causes. [9]

The child survival strategies and interventions are in line with the fourth Millennium Development Goals (MDGs) which focused on reducing child mortality by 2/3 of children under five before the year 2015. In 2015, the MDGs were replaced with the Sustainable Development Goals (SDGs), which aim to end these deaths by 2030. In order to achieve SDG targets, progress must be accelerated in more than 1/4 of all countries (most of which are in sub-Saharan Africa) in order to achieve targets for under-5 mortality, and in 60 countries (many in sub-Saharan Africa and South Asia) to achieve targets for neonatal mortality. [9] Without accelerated progress, 60 million children under age 5 will die between 2017 and 2030, about half of which would be newborns.

Low-cost interventions

Two-thirds of child deaths are preventable. [10] Most of the children who die each year could be saved by low-tech, evidence-based, cost-effective measures such as vaccines, antibiotics, micronutrient supplementation, insecticide-treated bed nets, improved family care and breastfeeding practices, [11] and oral rehydration therapy. [12] Empowering women, removing financial and social barriers to accessing basic services, developing innovations that make the supply of critical services more available to the poor and increasing local accountability of health systems are policy interventions that have allowed health systems to improve equity and reduce mortality. [13]

In developing countries, child mortality rates related to respiratory and diarrheal diseases can be reduced by introducing simple behavioral changes, such as handwashing with soap. This simple action can reduce the rate of mortality from these diseases by almost 50 per cent. [14]

Proven, cost-effective interventions can save the lives of millions of children per year. The UN Vaccine division as of 2014 supported 36% of the world's children in order to best improve their survival chances, yet still, low-cost immunization interventions do not reach 30 million children despite success in reducing polio, tetanus, and measles. [15] Measles and tetanus still kill more than 1 million children under 5 each year. Vitamin A supplementation costs only $0.02 for each capsule and given 2–3 times a year will prevent blindness and death. Although vitamin A supplementation has been shown to reduce all-cause mortality by 12 to 24 per cent, only 70 per cent of targeted children were reached in 2015. [9] Between 250,000 and 500,000 children become blind every year, with 70 percent of them dying within 12 months. Oral rehydration therapy (ORT) is an effective treatment for lost liquids through diarrhea; yet only 4 in 10 (44 per cent) of children ill with diarrhea are treated with ORT. [9]

Essential newborn care - including immunizing mothers against tetanus, ensuring clean delivery practices in a hygienic birthing environment, drying and wrapping the baby immediately after birth, providing necessary warmth, and promoting immediate and continued breastfeeding, immunization, and treatment of infections with antibiotics - could save the lives of 3 million newborns annually. Improved sanitation and access to clean drinking water can reduce childhood infections and diarrhea. Over 30% of the world's population does not have access to basic sanitation, and 844 million people use unsafe sources of drinking water. [16]

Efforts

Agencies promoting and implementing child survival activities worldwide include UNICEF and non-governmental organizations; major child survival donors worldwide include the World Bank, the British Government's Department for International Development, the Canadian International Development Agency and the United States Agency for International Development. In the United States, most non-governmental child survival agencies belong to the CORE Group, a coalition working, through collaborative action, to save the lives of young children in the world's poorest countries.

Epidemiology

Child mortality has been dropping as each country reaches a high stage of DTM. From 2000 to 2010, child mortality has dropped from 9.6 million to 7.6 million. In order to reduce child mortality rates, there needs to be better education, higher standards of healthcare and more caution in childbearing. Child mortality could be reduced by attendance of professionals at birth and by breastfeeding and through access to clean water, sanitation, and immunization. [7] In 2016, the world average was 41 (4.1%), down from 93 (9.3%) in 1990. [1] This is equivalent to 5.6 million children less than five years old dying in 2016. [1]

Variation

Huge disparities in under-5 mortality rates exist. Globally, the risk of a child dying in the country with the highest under-5 mortality rate is about 60 times higher than in the country with the lowest under-5 mortality rate. [1] Sub-Saharan Africa remains the region with the highest under-5 mortality rates in the world: All six countries with rates above 100 deaths per 1,000 live births are in sub-Saharan Africa. [1]

Furthermore, approximately 80% of under-5 deaths occur in only two regions: sub-Saharan Africa and South Asia. [1] 6 countries account for half of the global under-5 deaths, namely, India, Nigeria, Pakistan, the Democratic Republic of the Congo, Ethiopia and China. [1] India and Nigeria alone account for almost a third (32 per cent) of the global under-five deaths. [1]

Likewise, there are disparities between wealthy and poor households in developing countries. According to a Save the Children paper, children from the poorest households in India are three times more likely to die before their fifth birthday than those from the richest households. [17]

The child survival rate of nations varies with factors such as fertility rate and income distribution; the change in distribution shows a strong correlation between child survival and income distribution as well as fertility rate, where increasing child survival allows the average income to increase as well as the average fertility rate to decrease. [18]

See also

Related Research Articles

Diarrhea Loose or liquid bowel movements

Diarrhea is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed, however, are normal.

Infant mortality

Infant mortality is the death of young children under the age of 1. This death toll is measured by the infant mortality rate (IMR), which is the number of deaths of children under one year of age per 1000 live births. The under-five mortality rate is also an important statistic, considering the infant mortality rate focuses only on children under one year of age.

Oral rehydration therapy Electrolytic Replacement Therapy

Oral rehydration therapy (ORT) is a type of fluid replacement used to prevent and treat dehydration, especially that due to diarrhea. It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium. Oral rehydration therapy can also be given by a nasogastric tube. Therapy should routinely include the use of zinc supplements. Use of oral rehydration therapy has been estimated to decrease the risk of death from diarrhea by up to 93%.

Global health Health of populations in a global context

Global health is the health of populations in the global context; it has been defined as "the area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide". Problems that transcend national borders or have a global political and economic impact are often emphasized. Thus, global health is about worldwide health improvement, reduction of disparities, and protection against global threats that disregard national borders. Global health is not to be confused with international health, which is defined as the branch of public health focusing on developing nations and foreign aid efforts by industrialized countries. Global health can be measured as a function of various global diseases and their prevalence in the world and threat to decrease life in the present day.

India's population, as per census 2011 stood at 1.21 billion. There are great inequalities in health between states. The infant mortality in Kerala is 6 per thousand live births, but in Uttar Pradesh it is 64.

Diseases of poverty is the term used to describe diseases that are more prevalent in low-income populations. It includes infectious diseases as well as diseases related to malnutrition and poor health behaviors. Poverty is one of the major social determinants of health. The World Health Report, 2002 states that diseases of poverty account for 45% of the disease burden in the countries with high poverty rate which are preventable or treatable with exciting interventions. Diseases of poverty are often co-morbid and ubiquitous with malnutrition.

Vitamin A deficiency Vitamin A deficiency

Vitamin A deficiency (VAD) or hypovitaminosis A is a lack of vitamin A in blood and tissues. It is common in poorer countries, but rarely is seen in more developed countries. Nyctalopia is one of the first signs of VAD. Xerophthalmia, keratomalacia, and complete blindness can also occur since vitamin A has a major role in phototransduction. The three forms of vitamin A include retinols, beta-carotenes, and carotenoids.

Integrated Management of Childhood Illness, or IMCI, is a systematic approach to children's health which focuses on the whole child. This means not only focusing on curative care but also on prevention of disease. The approach was developed by United Nations Children's Fund and the World Health Organization in 1995.

Neonatal tetanus Human disease

Neonatal tetanus is a form of generalised tetanus that occurs in newborns. Infants who have not acquired passive immunity from the mother having been immunised are at risk. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. Neonatal tetanus mostly occurs in developing countries, particularly those with the least developed health infrastructure. It is rare in developed countries.

Health in Indonesia is affected by air quality, disease, poverty and smoking.

Health care services in Nepal are provided by both public and private sectors and are generally regarded as failing to meet international standards. Prevalence of disease is significantly higher in Nepal than in other South Asian countries, especially in rural areas. Moreover, the country’s topographical and sociological diversity results in periodic epidemics of infectious diseases, epizootics and natural hazards such as floods, forest fires, landslides, and earthquakes. A large section of the population, particularly those living in rural poverty, are at risk of infection and mortality by communicable diseases, malnutrition and other health-related events. Nevertheless, some improvements in health care can be witnessed; most notably, there has been significant improvement in the field of maternal health. These improvements include:

A landlocked sub-Saharan country, Burkina Faso is among the poorest countries in the world—44 percent of its population lives below the international poverty line of US$1.90 per day —and it ranks 185th out of 188 countries on UNDP’s 2016 Human Development Index .Rapid population growth, gender inequality, and low levels of educational attainment contribute to food insecurity and poverty in Burkina Faso. The total population is just over 20 million with the estimated population growth rate is 3.1 percent per year and seven out of 10 Burkinabe are younger than 30. Total health care expenditures were an estimated 5% of GDP. Total expenditure on health per capita is 82 in 2014. Despite increased government funding and an effective expansion of proven health interventions, Burkina Faso still faces major challenges in the health sector.Communicable diseases continue to be the primary cause of morbidity and mortality in the country, with malaria being the largest contributor to mortality for children under 5 years of age. In addition, Burkina Faso did not fully meet Millennium Development Goals in child mortality, maternal mortality and sanitation. USAID is contributing to new advances in health by increasing malaria prevention and control and expanding access to improved water resources, sanitation and family planning.

The 2010 maternal mortality rate per 100,000 births for Tanzania was 790. This is compared with 449 in 2008 and 610.2 in 1990. The UN Child Mortality Report 2011 reports a decrease in under-five mortality from 155 per 1,000 live births in 1990 to 76 per 1,000 live births in 2010, and in neonatal mortality from 40 per 1,000 live births to 26 per 1,000 live births. The aim of the report The State of the World's Midwifery is to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal health. In Tanzania there are only two midwives per 1,000 live births; and the lifetime risk of death during delivery for women is one in 23.

The African country of Zambia faces a number of ongoing health challenges.

Both maternal and child health are interdependent and substantially contributing to high burden of mortality worldwide. Every year, 289 000 women die due to complications in pregnancy and childbirth, and 6.6 million children below 5 years of age die of complications in the newborn period and of common childhood diseases. Sub-Saharan Africa (SSA), which includes Tanzania, contribute higher proportion of maternal and child mortality. Due to considerable proportion of mortality being attributed by maternal and child health, the United Nations together with other international agencies incorporated the two into Millennium Development Goals (MDGs) 4 and 5. In this regard, Tanzania through the Ministry of Health and Social Welfare (MoHSW) adopted different strategies and efforts to promote safe motherhood and improve child survival. Similarly, in an effort to improve maternal and child health, Tanzania’s government has declared maternal and child health services to be exempt from user fees in government facilities.

Malnutrition in children A condition in children from eating a diet in which some nutrients are either not enough or are too much

Malnutrition in children is common globally and may result in both short and long term irreversible negative health outcomes. The World Health Organization (WHO) estimates that malnutrition accounts for 54 percent of child mortality worldwide, about 1 million children. Another estimate also by WHO states that childhood underweight is the cause for about 35% of all deaths of children under the age of five years worldwide.

Non-specific effect of vaccines

Non-specific effects of vaccines are effects which go beyond the specific protective effects against the targeted diseases. Non-specific effects can be strongly beneficial, increasing protection against non-targeted infections, but also at times negative, increasing susceptibility to non-targeted infections. This depends on both the vaccine and the sex of the infant.

The child survival revolution was an effort started by UNICEF to reduce child mortality in the developing world. The effort lasted from 1982 to the 1990s, and generally coincides with James P. Grant's tenure as executive director of UNICEF (1980–1995). The child survival revolution included various programs and conferences, including the World Summit for Children in 1990.

Child health and nutrition in Africa is concerned with the health care of children through adolescents in the various countries of Africa. The right to health and a nutritious and sufficient diet are internationally recognized fundamental human rights protected by international treaties and conventions on the right to life, as well as in charters, strategies and declarations. Millennium Development Goals (MDGs) 1, 4, 5 and 6 highlight, respectively, how poverty, hunger, child mortality, maternal health, the eradication of HIV/AIDS, malaria, tuberculosis and other diseases are of particular significance in the context of child health.

Child Mortality in Ghana describes the child mortality in the country of Ghana. Like in other parts of the world, child mortality is declining in Ghana.

References

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