Tuesday, 15th of November 2016 |
Child mortality is (estimated to be) falling
Peter Byass
Affiliations
Umeå Centre for Global Health Research, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå 90187, Sweden
Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
Published: The Lancet, 10 November 2016
Elsevier´s open access license policy
© 2016 The Author(s). Published by Elsevier Ltd.
Excerpts below; full text is at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32169-9/fulltext
Undoubtedly child mortality is falling, and the world should be proud of this progress. Within the past 100 years, expectations around child mortality (and subsequently family size) have changed substantially, starting in countries that industrialised earlier and more recently pervading most of the world.
. . .the goal of a two-thirds reduction in under-5 child mortality from 1990 to 2015 did not happen globally, more nuanced consideration needs to be applied to understand changing patterns of child mortality. Global goals and targets tend to be set on a one-size-fits-all basis, as was the case with the MDGs. However, there are notable exceptions. In 1990, South Africa had the lowest under-5 mortality rate in the sub-Saharan region, then encountered a massive HIV pandemic, but subsequently achieved a substantial improvement in child mortality towards the end of the MDG period. Using in-country data to reveal the details, this was dubbed “a successful failure´” in terms of MDG 4.
. . . Additionally, country-level estimates could well obscure major geographical or socioeconomic inequalities in mortality that might well exceed intercountry differences.
In view of the substantial efforts that go into assessing global patterns of childhood mortality, it is important to consider additional creative ways of using and interpreting such findings. As well as the obvious need to monitor levels and trends of mortality over time and hold governments to account, mortality rates might also provide crucial pointers to other health and disease issues at the population level. Early life exposures are critically important and can exert epigenetic changes that affect the whole life-course, as expressed in the Developmental Origins of Health and Disease (DOHaD) hypothesis.
. . .That 6 million under-5 children continue to die every year in our 21st century world is unacceptable, but even worse is that we seem collectively unable to count, and hence be accountable for, most of those individual deaths. . . .Automated verbal autopsy needs deploying as a routine part of CRVS, to track individual cause-of-death and decrease dependence on estimates.
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