By Tim Parsons
School of Public Health

Seventy-three percent of the 10.6 million child deaths worldwide each year are the result of six causes: pneumonia, diarrhea, malaria, neonatal sepsis, pre-term delivery and asphyxia at birth. Researchers at the Johns Hopkins Bloomberg School of Public Health and the World Health Organization have developed the most accurate estimates to date of the causes of death of children under age 5. The estimates, which are published in the March 26 edition of The Lancet, will help guide public health policies and programs that address child mortality worldwide.

According to the study, four communicable disease categories account for 54 percent of all child deaths globally. Pneumonia accounts for 19 percent of all child deaths; diarrhea, 17 percent; malaria, 8 percent; and neonatal sepsis, 10 percent. Undernutrition is an underlying cause in more than half of all deaths before age 5. More than 37 percent of all child deaths occur during the first 28 days of life, the neonatal period. The researchers noted that child mortality is greatest in Africa. The study shows that 42 percent of child deaths under age 5 occur in Africa, which is also where 94 percent of all child deaths attributed to malaria occur.

"Achievement of the WHO's goal of reducing child mortality by two-thirds from the 1990 rate will depend on renewed efforts to prevent and control pneumonia, diarrhea and undernutrition in all regions, and malaria in the Africa region," said Robert Black, chair of the Department of International Health at the Bloomberg School. Black chaired the WHO Child Health Epidemiology Reference Group, which developed the new estimates by analyzing data and developing statistical models from previous publications and ongoing studies. The estimates cover a period from 2000 to 2003.

"In all regions of the world, deaths in the neonatal period, primarily due to pre-term delivery, sepsis or pneumonia and birth asphyxia, should also be addressed. The new estimates of the causes of child deaths should be used to guide public health policies and programs," he said.

Previous research by Black and others has shown that many of the causes of child mortality could be prevented with existing and proven measures.

Funding for the new study was provided by the Bill and Melinda Gates Foundation.

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