Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals

Abstract

Background: Causes of mortality are a crucial input for health systems for identifying appropriate interventions for child survival. We present an updated series of cause-specific mortality for neonates and children younger than 5 years from 2000 to 2019.

Methods: We updated cause-specific mortality estimates for neonates and children aged 1-59 months, stratified by level (low, moderate, or high) of mortality. We made a substantial change in the statistical methods used for previous estimates, transitioning to a Bayesian framework that includes a structure to account for unreported causes in verbal autopsy studies. We also used systematic covariate selection in the multinomial framework, gave more weight to nationally representative verbal autopsy studies using a random effects model, and included mortality due to tuberculosis.

Findings: In 2019, there were 5·30 million deaths (95% uncertainty range 4·92-5·68) among children younger than 5 years, primarily due to preterm birth complications (17·7%, 16·1-19·5), lower respiratory infections (13·9%, 12·0-15·1), intrapartum-related events (11·6%, 10·6-12·5), and diarrhoea (9·1%, 7·9-9·9), with 49·2% (47·3-51·9) due to infectious causes. Vaccine-preventable deaths, such as for lower respiratory infections, meningitis, and measles, constituted 21·7% (20·4-25·6) of under-5 deaths, and many other causes, such as diarrhoea, were preventable with low-cost interventions. Under-5 mortality has declined substantially since 2000, primarily because of a decrease in mortality due to lower respiratory infections, diarrhoea, preterm birth complications, intrapartum-related events, malaria, and measles. There is considerable variation in the extent and trends in cause-specific mortality across regions and for different strata of all-cause under-5 mortality.

Interpretation: Progress is needed to improve child health and end preventable deaths among children younger than 5 years. Countries should strategize how to reduce mortality among this age group using interventions that are relevant to their specific causes of death.

Funding: Bill & Melinda Gates Foundation; WHO.

Conflict of interest statement

Declaration of interests We declare no competing interests.

Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1

Global causes of under-5 deaths in 2019 Deaths of neonates (aged 0–27 days) are on the right-hand side and deaths of children aged 1–59 months are on the left-hand side.

Figure 2

Cause-specific under-5 mortality in 2019 (A) Cause-of-death mortality fraction. (B) Mortality per 1000 livebirths. Mortality strata are defined as very low (100 deaths per 1000 livebirths).

Figure 3

Global trends in cause-specific mortality rates in neonates and children aged 1–59 months, 2000–19 The length of each bar represents the amount of change in all-cause under five mortality rate attributable to changes in the mortality rate for each cause. The numbers above the bars are the change in each cause-specific mortality rate. *63% of the reduction is due to lower respiratory infections, diarrhoea, neonatal preterm birth complications, neonatal intrapartum-related events, malaria, and measles.

Figure 4

Projected cause-specific progress needed to meet the SDG child survival target for under-5 mortality by 2030 The SDG target for mortality in children younger than 5 years is 100 deaths per 1000 livebirths; eg, Nigeria). SDG=Sustainable Development Goals.