Research highlight

Health sciences: Mapping inequality in child deaths

Nature

October 17, 2019

A detailed global map of death rates in children under five years of age from low- and middle-income countries, reported in Nature, estimates that 123 million children died between 2000 and 2017. The study explores how a child’s risk of dying before the age of five varies depending on where they are born. Examining the causes of these inequalities could help to inform policies and public health programmes that aim to end preventable child deaths globally.

Child deaths have decreased globally from 19.6 million in 1950 to 5.4 million in 2017; in 2017, 93% of child deaths occurred in low- and middle-income countries. The United Nations (UN) Sustainable Development Goal (SDG) 3.2 aims to end preventable child deaths by 2030. Although considerable progress has been made to meet this goal there is still variation in death rates at subnational levels, such as within states and provinces or districts and counties.

Pursuing the goal to end preventable deaths requires a good understanding of child mortality rates and trends. To address this need, Simon Hay and colleagues created high-resolution maps of deaths in infants and children under the age of five, from 99 low- and middle-income countries in Africa, Asia, the Middle East, the Americas and Oceania between 2000 and 2017. The authors indicate that, at the national level, child mortality has decreased by 41% between 2000 and 2017, across the countries studied. The largest number of child deaths in 2017 occurred in India, Nigeria, Pakistan and the Democratic Republic of the Congo, although the distribution of these deaths varied within the countries. The authors estimate that, in the absence of geographical inequalities, about two-thirds of child deaths between 2000 and 2017 in these countries could have been prevented. Furthermore, if the areas studied had met the SDG 3.2 target of at least as low as 25 deaths per 1,000, an estimated 2.6 million deaths of children under the age of five may have been averted in 2017, the authors report.

In an accompanying World View, Michelle Bachelet, UN High Commissioner for Human Rights and former President of Chile, argues that reducing child deaths will require broader efforts than making sure sick children can see a doctor. She notes that “the factors that contribute to deaths come down to failures to treat broader ills: poverty, disempowerment, discrimination, and injustice. Hard data, like that published this week, must be followed up by action across the whole spectrum of government and society.”

doi: 10.1038/s41586-019-1545-0

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