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.

中文翻译：

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2000-19 年全球、区域和国家 5 岁以下儿童死亡率的原因：更新的系统分析及其对可持续发展目标的影响

 背景

死亡原因是卫生系统确定儿童生存适当干预措施的重要输入。我们提供了 2000 年至 2019 年新生儿和 5 岁以下儿童特定原因死亡率的更新系列。

 方法

我们更新了新生儿和 1-59 月龄儿童的特定原因死亡率估计值，按死亡率水平（低、中或高）分层。我们对先前估计所使用的统计方法进行了重大改变，过渡到贝叶斯框架，其中包括一个结构来解释口头尸检研究中未报告的原因。我们还在多项式框架中使用了系统协变量选择，更加重视使用随机效应模型的全国代表性口头尸检研究，并纳入了结核病死亡率。

 发现

2019年，5岁以下儿童中有5·3000万人死亡（95%不确定性范围4·92–5·68），主要是由于早产并发症（17·7%，16·1–19·5） 、下呼吸道感染（13·9%、12·0–15·1）、产时相关事件（11·6%、10·6–12·5）和腹泻（9·1%、7·9– 9·9)，其中 49·2% (47·3–51·9) 是由于感染原因。疫苗可预防的死亡，例如下呼吸道感染、脑膜炎和麻疹，占 5 岁以下死亡人数的 21·7% (20·4–25·6)，而许多其他原因，例如腹泻，是可以通过低疫苗接种来预防的。 -成本干预。自 2000 年以来，5 岁以下儿童死亡率大幅下降，主要是因为下呼吸道感染、腹泻、早产并发症、产时相关事件、疟疾和麻疹导致的死亡率下降。不同地区和不同阶层的 5 岁以下全因死亡率的具体原因死亡率的程度和趋势存在很大差异。

 解释

需要在改善儿童健康和消除 5 岁以下儿童可预防的死亡方面取得进展。各国应制定战略，如何利用与其具体死因相关的干预措施来降低该年龄组的死亡率。

 资金

比尔及梅琳达·盖茨基金会； WHO。