Page last updated at 23:11 GMT, Sunday, 23 May 2010 00:11 UK
UK's child mortality rate falls behind other countries
Child in drought-stricken Bihar, India, Aug 2009
The vast majority of child deaths occur in developing countries
The UK is lagging behind other high income countries on cutting child mortality, international figures show.
Along with the USA, New Zealand and South Korea, child deaths in the UK have not fallen as quickly as expected.
The research confirms the UK has the highest child mortality rate - 5.3 per 1,000 live births - in Western Europe.
But new global estimates published by The Lancet show that in many poorer countries, the decline in deaths in the under-fives is speeding up.
See how the UK compares
The analysis done by a team at the University of Washington in Seattle found stark differences in child deaths between high-income countries.
As well as having the worst child mortality in Western Europe, globally the UK fell from 12th best in 1970 to 33rd best in 2010.
The UK has reduced its mortality by three quarters since 1970, and by almost half since 1990, but Austria, Belgium, Cyprus, Germany, Greece, Ireland, Israel, Italy, Luxembourg, Malta, Portugal and Spain have all overtaken the UK in the past four decades.
Overall, the researchers found that deaths in children under the age of five are actually lower than the latest estimate provided by Unicef.
Worldwide mortality in children younger than five years has dropped from 11·9 million deaths in 1990 to an estimated 7·7 million deaths in 2010.
A third of those deaths occur in south Asia and half occur in sub-Saharan Africa.
The researchers said the latest data show that cuts in child mortality have been faster than projected in many poorer countries.
When you get to these low levels of child mortality seen in high income countries, healthcare probably is an important component in the variation
Dr Christopher Murray, study leader
In 13 regions of the world, including all regions in sub-Saharan Africa, the figures suggested faster declines from 2000 to 2010 compared with the previous decade.
Study leader Dr Christopher Murray said the apparent acceleration of progress in poorer countries was encouraging evidence that it was worth intensifying efforts further.
He said improved education for women, the lessening negative impact of HIV, and expansion in programmes such as bed nets and vaccination had all played a part in the improvements seen in developing countries in the past decade.
Dr Murray agreed that the UK had seen a "big slide" in its ranking in terms of child mortality.
"When you get to these low levels of child mortality seen in high income countries, healthcare probably is an important component in the variation.
"Most of the deaths in places like the UK will be neonatal and you would have to look in more detail at what aspects of healthcare might explain that difference."
A Department of Health spokesman said infant mortality in the UK is at its lowest ever level.
"However, the death of any child is one death too many and we must continue to do all we can to prevent those we can.
"This is why every child death is now subject to a detailed review to understand why children die and what steps can be taken to protect other children."
Global Death Rates Drop for Children 5 or Younger
By DENISE GRADY
Published: May 23, 2010
Death rates in children under 5 are dropping in many countries at a surprisingly fast pace, according to a new report based on data from 187 countries from 1970 to 2010.
Worldwide, 7.7 million children are expected to die this year ― still an enormous number, but a vast improvement over the 1990 figure of 11.9 million.
On average, death rates have dropped by about 2 percent a year from 1990 to 2010, and in many regions, even some of the poorest in Africa, the declines have started to accelerate, according to the report, which is being published online Sunday by The Lancet, a medical journal. Some parts of Latin America, north Africa and the Middle East have had declines as steep as 6 percent a year.
Other reports in recent years have found similar trends, but the new article, based on more detailed information and what its authors say are improved statistical methods, paints the most optimistic picture yet. Health experts say the figures mean that global efforts to save children’s lives have started working, better and faster than expected.
Vaccines, AIDS medicines, vitamin A supplements, better treatment of diarrhea and pneumonia, insecticide-treated bed nets to prevent malaria and more education for women are among the factors that have helped lower death rates, said Dr. Christopher J. L. Murray, an author of the report and the director of the Institute for Health Metrics and Evaluation at the University of Washington, in Seattle. He said the improvements in Africa were especially encouraging. “The very slow progress in Africa has led some people in global health to argue there should be more emphasis on tackling child mortality outside of Africa, especially India,” Dr. Murray said in an interview. “We think it’s important to call out this accelerated progress. The last thing we’d like to see, when at last something is happening, is to pull the plug and move elsewhere.”
The United Nations has set a goal of reducing death rates in children under 5 by two-thirds from 1990 to 2015, but not many countries seem to be on track to reach it.
A third of all deaths in children occur in south Asia, and half in sub-Saharan Africa. Newborns account for 41 percent of those who die. The lowest death rates, per 1,000 births, are in Singapore (2.5) and Iceland (2.6); the highest are in Equatorial Guinea (180.1) and Chad (168.7). In rich countries, some of the worst rates are in the United States (6.7) and Britain (5.3).
Dr. Mickey Chopra, the chief of health for Unicef, said countries with governments that had “fully supported child survival and primary care” had improved quickly, and he cited Malawi, Ethiopia, Tanzania and Rwanda. In addition, he said Botswana had scaled up treatment for H.I.V. and for preventing mother-to-child transmission, and was seeing child mortality rates decline as a result. Zambia also had significant declines, he said, because 75 percent of families had received bed nets to prevent malaria.
But he said the improvements could easily be reversed, because the underlying poverty in many countries had not changed. “If we don’t continue to do these interventions and fund these interventions, we’ll start to see an increase again,” Dr. Chopra warned.
In addition, he said, “There are places where we’re very worried because of conflict, such as Chad, where the immunization rates are too low, less than 20 percent, and also parts of the Democratic Republic of Congo.”
Dr. Flavia Bustreo, director of the Partnership for Maternal, Newborn and Child Health, a group administered by the World Health Organization, said that an important factor in the improvements was “reduced fertility” ― women having fewer children, and leaving more than two years between pregnancies, which both increase their children’s odds for survival. Dr. Bustreo noted that nearly a million babies a year died from asphyxia at birth, for lack of simple, routine resuscitation measures. Focusing on those techniques could save many lives, she said.
Dr. Murray’s report was based on official birth and death records, census data and information from detailed surveys in many countries. The research was paid for by the Bill and Melinda Gates Foundation.
The Lancet, Early Online Publication, 24 May 2010
doi:10.1016/S0140-6736(10)60703-9Cite or Link Using DOI
Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970―2010: a systematic analysis of progress towards Millennium Development Goal 4
Julie Knoll Rajaratnam PhD a, Jake R Marcus BA a, Abraham D Flaxman PhD a, Haidong Wang PhD a, Alison Levin-Rector BSPH a, Laura Dwyer BA a, Megan Costa BA a, Prof Alan D Lopez PhD b, Prof Christopher JL Murray MD a Corresponding AuthorEmail Address
Previous assessments have highlighted that less than a quarter of countries are on track to achieve Millennium Development Goal 4 (MDG 4), which calls for a two-thirds reduction in mortality in children younger than 5 years between 1990 and 2015. In view of policy initiatives and investments made since 2000, it is important to see if there is acceleration towards the MDG 4 target. We assessed levels and trends in child mortality for 187 countries from 1970 to 2010.
We compiled a database of 16 174 measurements of mortality in children younger than 5 years for 187 countries from 1970 to 2009, by use of data from all available sources, including vital registration systems, summary birth histories in censuses and surveys, and complete birth histories. We used Gaussian process regression to generate estimates of the probability of death between birth and age 5 years. This is the first study that uses Gaussian process regression to estimate child mortality, and this technique has better out-of-sample predictive validity than do previous methods and captures uncertainty caused by sampling and non-sampling error across data types. Neonatal, postneonatal, and childhood mortality was estimated from mortality in children younger than 5 years by use of the 1760 measurements from vital registration systems and complete birth histories that contained specific information about neonatal and postneonatal mortality.
Worldwide mortality in children younger than 5 years has dropped from 11?9 million deaths in 1990 to 7?7 million deaths in 2010, consisting of 3?1 million neonatal deaths, 2?3 million postneonatal deaths, and 2?3 million childhood deaths (deaths in children aged 1―4 years). 33?0% of deaths in children younger than 5 years occur in south Asia and 49?6% occur in sub-Saharan Africa, with less than 1% of deaths occurring in high-income countries. Across 21 regions of the world, rates of neonatal, postneonatal, and childhood mortality are declining. The global decline from 1990 to 2010 is 2?1% per year for neonatal mortality, 2?3% for postneonatal mortality, and 2?2% for childhood mortality. In 13 regions of the world, including all regions in sub-Saharan Africa, there is evidence of accelerating declines from 2000 to 2010 compared with 1990 to 2000. Within sub-Saharan Africa, rates of decline have increased by more than 1% in Angola, Botswana, Cameroon, Congo, Democratic Republic of the Congo, Kenya, Lesotho, Liberia, Rwanda, Senegal, Sierra Leone, Swaziland, and The Gambia.
Robust measurement of mortality in children younger than 5 years shows that accelerating declines are occurring in several low-income countries. These positive developments deserve attention and might need enhanced policy attention and resources.
Bill & Melinda Gates Foundation.
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