Running head: CHILDHOOD MORTALITY 1

Childhood Mortality

Kedene wellington

Pediatric

Ms. Coppee

Carleen Health Institute of South Florida

September 12, 2016

CHILDHOOD MORTALITY 2

Childhood Mortality

It is projected that as much as 21, 000 children die each day (Lozano et al., 2011). As of

2013, it is suggested that at least seven million children died before reaching age five (Lozano et

al., 2011). Specifically, infant mortality refers to the death of infants and children under the age

of five years. Sadly most of the causes of child deaths arise from preventable conditions or

diseases including malnutrition, unsafe drinking water, infection, and disease (Rudan, Nair,

Marušić & Campbell, 2013). Most developing countries suffer from inefficient services

supporting adequate conditions of living, health care, and nutrition to the heightened child

mortality rates globally (Rudan, Nair, Marušić & Campbell, 2013). The way forward is

preventative healthcare based on cultural, social and behavioral change so as to achieve an

immediate long-term impact especially on the lives of children and women (You, New &

Wardlaw, 2011). It is imperative that the concerned work strengthens existing social services in

areas affected and promote family-based support systems (Rudan, Nair, Marušić & Campbell,

2013). It is thus not new that this issue is captured in millennium development goals, the fourth

goal.

Equally important is that progress in addressing child mortality as a millennium is

convincing. Efforts to reduce infant mortality throughout the world are bearing fruit (Rudan,

Nair, Marušić & Campbell, 2013). As a result lives of millions of children under five years have

been saved. However much needs to be done in addressing the millennium development fourth

goal, reducing infant mortality (Rudan, Nair, Marušić & Campbell, 2013). Over the last 25 years,

the global mortality rate dropped to 53% from 915 deaths per 1,000 live births. In fact, the rate is

now 43% per 1, 000 live births in 2015 (Lozano et al., 2011). Experts argue that a child’s risk of

dying is highest during the neonatal period or the first 28 days of life (Lozano et al., 2011). In
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this regard, safe childbirth and effective neonatal care are critical to prevent these deaths.

Notably, 45% of child deaths happen under the age five during the neonatal period (You, New &

Wardlaw, 2011). It emerges that diarrhea, malaria, and pneumonia are leading causes most child

deaths for children aged below five years (MacDorman, Hoyert & Mathews, 2013). Malnutrition

remains the underlying contributing factor in at least 45% of all child deaths by making children

more susceptible to severe diseases (Lozano et al., 2011).

Causes of Child Mortality

As earlier pointed out, most deaths among children aged one to five years arise from

preventable diseases. Most of these diseases can be addressed at home or in local health facilities

(Rudan, Nair, Marušić & Campbell, 2013). For instance, the deadly childhood diseases such as

measles are completely immunizable, and this can protect the child from measles illness and

death (MacDorman, Matthews, Mohangoo & Zeitlin, 2014). The other leading causes of infant

mortality fall under the category of acute respiratory illness like pneumonia (MacDorman,

Matthews, Mohangoo & Zeitlin, 2014). It is important to address the primary risk factors for the

illness which include malnutrition and indoor air contamination (Liu et al., 2012). Vaccination

can also help resolve acute respiratory diseases. Children who have contracted severe respiratory

disease need appropriate care by a trained health personnel as well as access to oxygen and

antibiotics.

Another cause of child mortality is diarrhea and is preventable with exclusive good

hygiene and breastfeeding as well as sanitary practices (Rudan, Nair, Marušić & Campbell,

2013). For instance, when a child with diarrhea becomes dehydrated, immediate treatment is

critical with oral rehydration salts and zinc supplements. The other cause of child mortality,

malaria, can be addressed by use of treated mosquito nets that prevent mosquitoes from a biting a
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child (Lozano et al., 2011). When a child is bitten and develops malaria, rapid and suitable care

is essential. HIV/AIDS is another major cause of child mortality, and the infection occurs mainly

from mothers through mother-to-child transmission, yet this is preventable (MacDorman,

Matthews, Mohangoo & Zeitlin, 2014). Through the use of anti-retroviral, transmission of HIV

from mother to the child can be prevented as well as practicing safe delivery and feeding

practices (Liu et al., 2012). Notably, an anti-retroviral therapy for children living with HIV

greatly enhances survival rates and quality of life. In fact without any interventions, over half of

all children living with HIV die before reaching the second year (Liu et al., 2012). Malnutrition

is another leading cause of child mortality. Specifically, as many as 20 million young children

globally suffer from acute malnutrition which predisposes them more to illness and early death

(MacDorman, Matthews, Mohangoo & Zeitlin, 2014). In this regard, mothers and other

caregivers need to know how to feed their children so as to prevent nutritional problems

correctly.

State of Child Mortality

A report by the World Health Organization helps give an overview of the subject of child

mortality globally. For a start, significant global progress has been realized in reducing child

deaths since 1990 (MacDorman, Hoyert & Mathews, 2013). Over a period of fifteen years, the

number of below age five deaths globally has declined from 12.6 million as of 1990 to 5.7

million in 2015. That represents a reduction 35, 000 children dying each day to 16, 000 during

the subject periods. Thus since 1990 the worldwide below age five mortality rate has fallen to

53% in 2015 from 91% in 1990, per 1,000 live births (MacDorman, Hoyert & Mathews, 2013).

In overall the world has made significant progress in reducing the below age five mortality rate
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as the annual reduction percentage increased from 1.8% in the period of 1990 to 2000 to 3.9% in

2000 to 2015.

Remarkably, the sub-Saharan Africa which is a region widely affected by below age five

mortality rate globally has also reported a substantive acceleration (MacDorman, Hoyert &

Mathews, 2013). The annual rate of reduction of the sub-Saharan Africa rose from 1.6% in the

1990s to 4.1% in 2000 through 2015 (MacDorman, Matthews, Mohangoo & Zeitlin, 2014). It is

this significant decline in below age five mortality since 2000 that as over 48 million lives of

children under age five have been saved. Thus in the absence of efforts to lower child mortality,

these children could not have made beyond five years if the child mortality rate remained as it

were in 2000 (MacDorman, Hoyert & Mathews, 2013). Encouragingly, between 1990 and 2015

and out of 195 countries, 62 of them met the millennium development fourth goal (MacDorman,

Hoyert & Mathews, 2013). The objectives of this goal are to achieve a two-thirds reduction in

the below age five mortality rate between the period of 1990 and 2015 (MacDorman, Hoyert &

Mathews, 2013). Further hope arises from the realization that 24 are low and lower-middle

income countries (MacDorman, Hoyert & Mathews, 2013).

There is the need for more progress is required to attain the fourth-millennium

development goal and in many regions. Notably the most affected areas include sub-Saharan

Africa, Central Asia, Southern Asia and Oceania (MacDorman, Matthews, Mohangoo & Zeitlin,

2014). By giving more attention to ending preventable child deaths in sub-Saharan and Southern

Asia in accelerating progress in the child, survival can be attained. Reports indicate that 1 in

every 12 children in sub-Saharan Africa dies before age five compared to 1 in 147 children in

high-income countries (MacDorman, Matthews, Mohangoo & Zeitlin, 2014). Further analysis of
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the problem suggests that Southern Asia has the second highest below age five mortality rate

globally at one child in 19 dying before age five.

Analysis of Mortality Rate

In 1990 the neonatal mortality rate stood at 36 deaths per 1,000 live births and dropped to

19 in 2015 (Liu et al., 2015). The number of neonatal deaths fell from 5.1 million to 2.7 million

(Liu et al., 2015). Notably, the decline in neonatal mortality from 1990 to 2015 has been gradual

than that of post-neonatal below age five mortality (Liu et al., 2015). As earlier highlighted, most

child deaths arise from diseases that are easily preventable or treatable with proven and quality

delivered interventions (Liu et al., 2015). The vast majority of below age five deaths globally

occur from neonatal complications and infectious diseases. In this regard, attaining sustainable

development goal requires an accelerated pace of progress in enhancing child survival especially

for high mortality countries in sub-Saharan Africa.

For instance, a total of 47 countries needs to hasten their pace of growth so as to achieve

the sustainable development goal target of a below age five mortality rate of not more than 25

per 1,000 live births by 2030 (Liu et al., 2015). So as to achieve these, 30 countries must double

their current rate of reduction while 11 of those 30 countries need to triple their existing rate of

decline (Liu et al., 2015). Acceleration is thus crucial for attaining the sustainable development

goal target. At the moment only 79 countries have a below age five mortality rate above 25 while

47 of them will not reach proposed sustainable development goal target of 25 deaths per 1, 000

live births by 2030 unless they reverse their current approach of addressing under-five mortality

(Liu et al., 2015).

Equally important is the realization that the acceleration required to attain the goals in

those 47 countries is significant. Notably, among these 47 countries, 34 fall in sub-Sahara

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Africa. Should the current trends persist, then many of these countries will not attain the

sustainable development goal target before 2050 (Liu et al., 2015). If all countries meet the

sustainable development goal target as of 2030, a total of 38 million fewer children will die

between 2016 and 2030 (Liu et al., 2015). Should below age five mortality rate remain the same

between 2016 and 2030, a total of 94 million will die (Liu et al., 2015). The challenge arises in

attempts to attain the sustainable development goal target of a neonatal mortality rate of 12% per

1, 000 live births are more substantial (Liu et al., 2015). In this regard, 63 countries need to

hasten their current rates of reduction in an attempt to reach that target.

Furthermore, by focusing on low mortality countries for instance of the 195 countries

with available projections, 116 have already attained the sustainable development goal target

with a below age five mortality rate of 25 per 1, 000 live births (Liu et al., 2015). Within these

low-mortality countries, a third have a below age five mortality rate that is below five while 16

are still above 20 (Liu et al., 2015). In the case that the existing trends persist, 44 of these low-

mortality countries will not attain todays below age five mortality rate of the developed countries

of 6.8 deaths per 1, 000 live births as of 2030 (Liu et al., 2015). That also represents around 6

million children dying in these 116 countries between the periods of 2016 through 2030 (Liu et

al., 2015). In the case that all these affected countries reduced their below age five mortality rate

to the existing lowest level of 23 deaths per 1, 000 live births present among countries with more

than 10, 000 live births as 2015 (Liu et al., 2015).

Additionally, 3.5 million children would survive beyond five years between 2016 and

2030 (Preston & Haines, 2014). The implication is that there is still work needed in improving

child survival even within this group of countries’ (Rudan, Nair, Marušić & Campbell, 2013).

For instance, significant gaps in infant mortality across sub-groups within countries fall into this
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category of nations (Liu et al., 2015). Perhaps there is the need for an equity-focused approach to

lowering child mortality. A case in point is Brazil which is one of the countries that has

succeeded significantly in reducing child mortality (Rudan, Nair, Marušić & Campbell, 2013).

Notably, the entire country attained the millennium development fourth goal. In detail, the child

mortality rate in Brazil fell from 61% in 1990 to 16% in 2015 (Liu et al., 2015).

Addressing Child Mortality

Notably, the sustainable development goals internalized by the UN aims to promote well-

being for all children as well as ensuring healthy lives. The sustainable development goal 3 aims

to end preventable deaths of infants and below age five children by 2030 (Preston & Haines,

2014). Notably, this gets captured under target 3.2 that is closely connected with target 3.1 to

drive down the global maternal mortality ratio (Preston & Haines, 2014). The aim is to reduce

that rate to 70 per 100 000 live births while target 2.2 focuses on ending all forms of malnutrition

(Preston & Haines, 2014). In particular, malnutrition is a significant and frequent cause of death

for below age five children (Rudan, Nair, Marušić & Campbell, 2013). Subsequently, these have

been incorporated into the new global strategy for children, women and adolescent health with

calls for addressing preventable infant as well as considering the emerging child health priorities.

In this regard, the global community has established goals and targets for tackling gray

areas of child survival agenda so as to attain under-five mortality of 25 per 1000 live births as of

2030 (Preston & Haines, 2014). There are several global initiatives such as ending preventable

maternal mortality as well as every new action plan to popularize universal coverage of quality

newborn and maternal care (Preston & Haines, 2014). Additionally, there is also the global

action plan for treatment and prevention of diarrhea and pneumonia. Other programs include a

detailed implementation plan on infant nutrition to lower obesity and undernutrition (Gruber,
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Hendren & Townsend, 2014). There are also global programs with profound results such as the

global strategy for malaria meant to lower malaria case incidence and mortality by 2030 as well

as the global vaccine plan to prevent infant diseases via vaccination (Preston & Haines, 2014).

At the global stage, member States of World Health Organization need to establish

targets and create specific strategies to lower child mortality and track progress (Rudan, Nair,

Marušić & Campbell, 2013). In this regard, the World Health Organization focuses on attaining

the objectives and vision of the global strategy and the sustainable development goals (Rudan,

Nair, Marušić & Campbell, 2013). It is thus important to assist members in enhancing health

services and creating awareness on appropriate technical assistance. In this regard, members are

required to address health equity via universal health coverage so that all infants and children can

access requisite health services devoid of financial hardship (Rudan, Nair, Marušić & Campbell,

2013). World Health Organization emphasizes on creative and multiple approaches to increase

coverage, access, and quality of infant health services.

The Future

Sustainability of all efforts in stemming childhood mortality requires improving maternal

health care and prevention of diseases through immunization (Liu et al., 2012). There is the need

to create awareness on immunizable diseases as well as empower individuals and the community

on nutrition (Rudan, Nair, Marušić & Campbell, 2013). Vaccination is critical for deadly

childhood diseases such as polio, measles, tetanus and pneumonia among others (Gruber,

Hendren & Townsend, 2014). Immunization from diarrhea and pneumonia is also available. The

vulnerability of children is understandable judging by their developing immunity system and

developing bodies (Rudan, Nair, Marušić & Campbell, 2013). Since global programs addressing
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the issue of infant mortality may scale down or wind up, it is important to empower people so as

to ensure that a reversal of the gains made in fighting high child mortality does not occur.

Planning for emerging priorities for health of children should be taken with the

seriousness it deserves. For instance, injuries, congenital anomalies, and non-communicable

diseases constitute prioritized health matters (Liu et al., 2012). Notably, the global disease

burden as a result of non-communicable diseases affecting children is increasing yet the risk

factors can be summarily addressed (Rudan, Nair, Marušić & Campbell, 2013). Violence and

unintentional harm continue to contribute to children death. There is the need to emphasize more

on the evidence-based estimation of infant mortality as a pillar for tracking progress towards

attaining child survival goals (Gruber, Hendren & Townsend, 2014). Focusing more on

underlying courses such as nutrition, non-hospital births and high prevalence of HIV/AIDS can

significantly help accelerate the reduction of infant mortality rates for children aged below five

years.

In conclusion, it is important the issue and subject of infant mortality continue being

addressed. So far the discussions have focused on the simple statistical aspect of infant mortality

yet there exists tremendous emotional or psychological negative effects on the mother, family

and the community. The most disheartening aspect of child mortality is that the underlying and

direct causes of infant mortality can be addressed. Communicable and non-communicable

diseases that are immunizable, as well as malnutrition, are fully addressable. The combined

efforts at global, local and individual level on proper nutrition, maternal health, infant health and

good child care should continue.

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References

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Liu, L., Oza, S., Hogan, D., Perin, J., Rudan, I., Lawn, J. E., ... & Black, R. E. (2015). Global,

regional, and national causes of child mortality in 2000–13, with projections to inform

post-2015 priorities: an updated systematic analysis. The Lancet, 385(9966), 430-440.

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Rudan, I., Nair, H., Marušić, A., & Campbell, H. (2013). Reducing mortality from childhood

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