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Why do children die?

Infant mortality rate is often used as an indicator of overall national development because it is sensitive to a number of social, economic, and health sector inputs, many of which can be modified in a relatively short period of time. Much the same can be said of child mortality. In 2003, Robert Black et al. wrote "Where and why are 10 million children dying every year?" More recent figures show progress, but 2008 estimates still show that nearly 8 million children die every year, with over 95% of these deaths happening in low- and middle-income countries, and nearly 90% of these deaths attributable to just six conditions: neonatal causes (prematurity and low birth weight, birth trauma and asphyxia, neonatal infections); malnutrition; acute respiratory infections and pneumonia; diarrhea; malaria; and measles and other vaccine-preventable diseases. (WHO Disease and injury regional estimates for 2004).

Mosley and Chen (1984) suggest there are three main categories of factors that cause infant mortality rates to be high in poor countries:

1. distal or upstream factors, e.g. low national income and high poverty rates; inadequate public health, health services, and educational infrastructure;
2. intermediate family and neighborhood-level factors, e.g., access to food, safe water, sanitation, vaccination, electricity, and healthcare services; and social and cultural norms around activities such as breastfeeding;


© 2009 Dr. Divya Pal Singh, Courtesy of Photoshare

3. and proximate or immediate causes, e.g., child nutritional status, existing co-illnesses, caretaker knowledge of danger signs and home-base treatment, indoor cooking fuels, access to effective health services and medications.

According to WHO, “reaching the MDG on reducing child mortality will require universal coverage with key effective, affordable interventions: care for newborns and their mothers; infant and young child feeding [and vitamin supplementation]; vaccines; prevention and case management of diarrhea, pneumonia and sepsis; malaria control; and prevention and care of HIV/AIDS. In countries with high mortality, these interventions could reduce the number of deaths by more than half. These child health strategies are complemented by interventions for maternal health, in particular, skilled care during pregnancy and childbirth” (MDG 4: Reduce child mortality).

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How important a cause of child mortality is HIV/AIDS?

In 2008, 2% of child deaths were attributed to AIDS (See chart).

Chart: Causes of under-five child death in 2008.

Neonates are children aged 0–27 days, and children are those aged 1–59 months.

Data source: RE Black et al. for the Child Health Epidemiology Reference Group of WHO and UNICEF (2010), Global, regional, and national causes of child mortality in 2008: a systematic analysis, The Lancet 375.9730 (5 June 2010): 1969-1987).

Note: Within the WHO Africa region, 5.0% of all child deaths in 2004 were attributed to HIV/AIDS. (Data source: WHO Disease and injury regional estimates for 2004.)

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