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CSU 79/2010: CAUSES OF DEATHS IN <5s, CHINA, 2008

Wednesday, 25th of August 2010

CSU 79/2010:  CAUSES OF DEATHS IN <5s, CHINA, 2008

Has China registered the remarkable gains in under-five survival set down in the summary reproduced below?

See full text of this article at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60060-8/fulltext

See comments by Bhutta at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60352-2/fulltext

 

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outline goes here

The Lancet, Volume 375, Issue 9720, Pages 1083 - 1089, 27 March 2010

 

Causes of deaths in children younger than 5 years in China in 2008

Original Text

Prof Igor Rudan MD a b *, Kit Yee Chan PhD c d *, Jian SF Zhang MSc c, Evropi Theodoratou PhD a, Xing Lin Feng PhD d, Joshua A Salomon PhD e, Joy E Lawn PhD f, Prof Simon Cousens MA g, Prof Robert E Black MD h, Prof Yan Guo PhD d † , Prof Harry Campbell MD a † , on behalf of WHO/UNICEF's Child Health Epidemiology Reference Group (CHERG)

Background

Previous estimates of the global burden of disease for children have not included much information from China, leading to a large gap in data. We identified the main causes of deaths in neonates (<1 month), postneonatal infants (1—11 months), and children (<5 years) in China using information that was available to the public.

Methods

The Child Health Epidemiology Reference Group in collaboration with colleagues from Peking University systematically searched Chinese databases that were available to the public. Information was obtained from the Chinese Ministry of Health and Bureau of Statistics websites, Chinese National Knowledge Infrastructure database, and Chinese Health Statistics yearbooks for 1990—2008. We also obtained information from 206 high-quality community-based longitudinal studies of different causes of deaths in children (<5 years) that were written in the Chinese language. A statistical model was developed to estimate the total number of deaths in children according to provinces, age groups, and main causes.

Findings

During 1990—2008, the mortality rates in neonates, postneonatal infants, and children were reduced by 70% (from 34·0 to 10·2 per 1000 livebirths), 72% (from 53·5 to 14·9 per 1000 livebirths), and 71% (from 64·6 to 18·5 per 1000 livebirths), respectively, meeting the targets set in the Millennium Development Goal 4. The leading causes of deaths in 2008 were pneumonia, birth asphyxia, and preterm birth complications, each accounting for 15—17% of all deaths. Congenital abnormalities and accidents increased in importance during this period, contributing to 11% and 10% of child deaths, respectively. Sudden infant death syndrome contributed to 5% of deaths in children.

Interpretation

Publically available Chinese databases contain much important information that has been underused in the estimation of global and regional burden of disease. On the basis of trends, preterm birth complications are expected to become the leading cause of child mortality in China, whereas deaths from congenital abnormalities, accidents, and sudden infant death syndrome are predicted to continue increasing in importance in the long term.

Funding

Bill & Melinda Gates Foundation.

a Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, UK

b Croatian Centre for Global Health, University of Split Medical School, Split, Croatia

c Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia

d School of Public Health, Peking University, Beijing, China

e Harvard School of Public Health, Boston, MA, USA

f Saving Newborn Lives/Save the Children, Cape Town, South Africa

g London School of Hygiene and Tropical Medicine, London, UK

h Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

Correspondence to: Prof Harry Campbell, Centre for Population Health Sciences, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK

Correspondence to: Prof Yan Guo, School of Public Health, Institute of Global Health, Peking University Health Science Centre, 38 Xueyuan Road, Hai Dian District, Beijing 100083, China

* Joint first authors.

† Joint corresponding authors.