New under-5 mortality statistics: CHERG 2012 Report

What has changed:
A study has been published in the Lancet which supercedes WaterAid’s previous primary source of under-5 mortality statistics (Black et al. 2010). The new source is (CHERG, 2012)


With contributions from many of the same authors, and published on behalf of the Child Health Epidemiology Reference Group of WHO and UNICEF (CHERG), it uses an improved methodology and some more data sources to provide estimates of U5 mortality in 2010. It also provides revised estimates for earlier years, going back to 2000.


The report contains some good news – fewer children are dying. The authors estimate that 2 million fewer children died in 2010 than in 2000.


This still leaves 7.6 million children under-5 dying in 2010, and the world is off-track to meet the MDG4 target of reducing by two-thirds under-5 mortality. The authors observe that MDG4 cannot be attained unless “life saving ... interventions are rapidly scaled up in high-burden regions ... and across major causes in the next few years”.


This work is not the Global Burden of Disease (GBD), which is expected to produce some new estimates later in the year. The GBD includes different age analysis (0-14yrs, 15-64yrs, 65+yrs) which is not comparable with this data. There will not be new estimates of under-5 mortality caused by diarrhoea.


The publication of new estimates explicitly superseding the data we’ve been referencing constitutes a reputational risk if we don’t update our communications.


Headline figures
Total U-5 diarrhoea deaths 801,000; 751,000 between 1 and 59 months (i.e. excluding the neonatal period)
Africa – most child deaths occur in Africa. Main causes:
• Pneumonia 17%; Malaria 15%; Diarrhoea 12%
South Asia – main causes:
• Pneumonia 22%; Diarrhoea 11%
Global main causes of death:
• Pneumonia 18%; Diarrhoea 11%;
Malaria 7%; Injury 5%; AIDS 2%; Meningitis 2%; Measles 1%
• Five countries accounted for half of all the world’s under 5 deaths: India; Nigeria; DRC; Pakistan and China.
• For Pneumonia and Diarrhoea, the five countries with the most under-5 deaths were India, Nigeria, DRC, Pakistan and Ethiopia.
What we can say:
• Diarrhoea deaths have decreased by 359,000 per year since 2000.
• Reductions in diarrhoea deaths have contributed 17.9% to the total reduction in under-5 mortality between 2000 and 2010.
• Diarrhoea is the second leading cause of under-5 mortality globally
• Diarrhoea causes more under-5 deaths than AIDS, malaria and measles combined
• Diarrhoea is the second leading cause of under-5 mortality in South Asia
• Poor WASH is also linked to pneumonia and undernutrition, not just diarrhoea; improved handwashing practices help reduce pneumonia transmission, and there is increasing evidence about repeated diarrhoea episodes making children more predisposed to pneumonia
• This paper does not look at disease morbidity (the rate of incidence of a disease). Estimates of time lost, education missed, undernutrition and other consequences of diarrhoea sickness remain unchanged.
• See below for some country level analysis for use by CPs.
 What we cannot say:
• Diarrhoea is the biggest killer of children in sub-Saharan Africa
• Diarrhoea kills 4,000 children a day - we should avoid messaging on specific ‘number of children dying per day’. U5 mortality will continue to reduce as health systems improve, and it’s more helpful to look at the distribution of causes of death.
• Direct comparisons with Black et al. 2010 cannot be made; the new paper includes revised estimates for previous years. Download Report


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