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Child mortality is the
mortality Mortality is the state of being mortal, or susceptible to death; the opposite of immortality. Mortality may also refer to: * Fish mortality, a parameter used in fisheries population dynamics to account for the loss of fish in a fish stock throug ...
of
child A child ( : children) is a human being between the stages of birth and puberty, or between the developmental period of infancy and puberty. The legal definition of ''child'' generally refers to a minor, otherwise known as a person younger ...
ren under the age of five. The child mortality rate, also under-five mortality rate, refers to the probability of dying between birth and exactly five years of age expressed per 1,000 live births. It encompasses
neonatal mortality Perinatal mortality (PNM) refers to the death of a fetus or neonate and is the basis to calculate the perinatal mortality rate. Variations in the precise definition of the perinatal mortality exist, specifically concerning the issue of inclusion o ...
and
infant mortality Infant mortality is the death of young children under the age of 1. This death toll is measured by the infant mortality rate (IMR), which is the probability of deaths of children under one year of age per 1000 live births. The under-five morta ...
(the probability of death in the first year of life). Reduction of child mortality is reflected in several of the
United Nations The United Nations (UN) is an intergovernmental organization whose stated purposes are to maintain international peace and international security, security, develop friendly relations among nations, achieve international cooperation, and be ...
'
Sustainable Development Goals The Sustainable Development Goals (SDGs) or Global Goals are a collection of 17 interlinked objectives designed to serve as a "shared blueprint for peace and prosperity for people and the planet, now and into the future".United Nations (2017) R ...
. Target 3.2 is "by 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce … under‑5 mortality to at least as low as 25 per 1,000 live births." Child mortality rates have decreased in the last 40 years. While in 1990, 12.6 million children under age five died, in 2016 that number fell to 5.6 million children, and then in 2020, the global number fell again to 5 million. Rapid progress has resulted in a significant decline in preventable child deaths since 1990, with the global under-5 mortality rate declining by over half between 1990 and 2016. While in 1990, 12.6 million children under age five died, in 2016 that number fell to 5.6 million children. However, despite advances, there are still 15,000 under-five deaths per day from largely preventable causes. About 80 per cent of these occur in sub-Saharan Africa and South Asia, and just 6 countries account for half of all under-five deaths: China, India, Pakistan, Nigeria, Ethiopia and the Democratic Republic of the Congo. 45% of these children died during the first 28 days of life. Death rates were highest among children under age 1, followed by children ages 15 to 19, 1 to 4, and 5 to 14. Without accurate data on child deaths, we cannot fully discover and combat the greatest risks to a child's life.


Types of Child Mortality

Child mortality refers to number of child deaths under the age of 5 per 1000 live births. More specific terms include: * Perinatal mortality rate: Number of child deaths within first week of birth ÷ total number of births. * Neonatal mortality rate: Number of child deaths within first 28 days of life ÷ total number of births. * Infancy mortality rate: Number of child deaths within first 12 months of life ÷ total number of births. * Under 5 mortality rates: Number of child deaths within 5th birthday ÷ total number of births. * Child Mortality refers to the premature deaths of any child under the age of 5 years old. However, within those 5 years, there are 5 smaller groups. Perinatal refers to a fetus, a living organism, but not yet born. Typically, peri neonate deaths are due to premature birth or birth defects. Neonatal refers to child death within one month, or 28 days, of birth. Neonate deaths are reflected in the type of care the hospital is providing, as well as birth defects and complications. Infant refers to the death of a child before their first birthday or within 12 months of life. Some of the main causes include premature birth, SIDS, low birth weight, malnutrition, and infectious diseases. And lastly, the under-5 mortality rate refers to children who die under the age of 5 years old or within the first 5 years of life.


Causes

The leading causes of death of children under five include: *
Preterm birth Preterm birth, also known as premature birth, is the Childbirth, birth of a baby at fewer than 37 weeks Gestational age (obstetrics), gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 we ...
complications (18%) *
Pneumonia Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity ...
(16%) * Interpartum-related events (12%) *
Neonatal sepsis Neonatal sepsis is a type of neonatal infection and specifically refers to the presence in a newborn baby of a bacterial blood stream infection (BSI) (such as meningitis, pneumonia, pyelonephritis, or gastroenteritis) in the setting of fever. Old ...
(7%) *
Diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...
(8%) *
Malaria Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. S ...
(5%) *
Malnutrition Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues a ...
(34%) There is variation of child mortality around the world. Countries that are in the second or third stage of the Demographic Transition Mode (
DTM DTM may refer to: Sport * Deutsche Tourenwagen Masters, a motor-racing series staged annually in Germany since 2000 * Deutsche Tourenwagen Meisterschaft, a motor-racing championship staged in Germany from 1984 to 1995 Computing * Deterministic T ...
) have higher rates of child mortality than countries in the fourth or fifth stage.
Chad Chad (; ar, تشاد , ; french: Tchad, ), officially the Republic of Chad, '; ) is a landlocked country at the crossroads of North and Central Africa. It is bordered by Libya to the north, Sudan to the east, the Central African Republic ...
infant mortality is about 96 per 1,000 live births, compared to only 2.2 per 1,000 live births in
Japan Japan ( ja, 日本, or , and formally , ''Nihonkoku'') is an island country in East Asia. It is situated in the northwest Pacific Ocean, and is bordered on the west by the Sea of Japan, while extending from the Sea of Okhotsk in the north ...
. In 2010, there was a global estimate of 7.6 million child deaths with most occurring in
less developed countries A developing country is a sovereign state with a lesser developed industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreem ...
. Among those, 4.7 million died from infection and disorder. Child mortality is not only caused by infection and disorder: it is also caused by premature birth; birth defect; new born infection; birth complication; and diseases like
malaria Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. S ...
, sepsis, and diarrhea. In less developed countries,
malnutrition Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues a ...
is the main cause of child mortality. Pneumonia, diarrhea, and malaria together are the cause of 1 out of every 3 deaths before the age of 5 while nearly half of under-five deaths globally are attributable to under-nutrition.


Prevention

Child survival is a field of
public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...
concerned with reducing child mortality. Child survival interventions are designed to address the most common causes of child deaths that occur, which include
diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...
,
pneumonia Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity ...
,
malaria Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. S ...
, and neonatal conditions. Of the portion of children under the age of 5 alone, an estimated 5.6 million children die each year mostly from such preventable causes. The child survival strategies and interventions are in line with the fourth
Millennium Development Goals The Millennium Development Goals (MDGs) were eight international development goals for the year 2015 that had been established following the Millennium Summit of the United Nations in 2000, following the adoption of the United Nations Millenniu ...
(MDGs) which focused on reducing child mortality by 2/3 of children under five before the year 2015. In 2015, the MDGs were replaced with the
Sustainable Development Goals The Sustainable Development Goals (SDGs) or Global Goals are a collection of 17 interlinked objectives designed to serve as a "shared blueprint for peace and prosperity for people and the planet, now and into the future".United Nations (2017) R ...
(SDGs), which aim to end these deaths by 2030. In order to achieve SDG targets, progress must be accelerated in more than 1/4 of all countries (most of which are in sub-Saharan Africa) in order to achieve targets for under-5 mortality, and in 60 countries (many in sub-Saharan Africa and South Asia) to achieve targets for neonatal mortality. Without accelerated progress, 60 million children under age five will die between 2017 and 2030, about half of which would be newborns. China achieved its target of reduction in under-5 mortality rates well ahead of schedule.


Low-cost interventions

Two-thirds of child deaths are preventable. Most of the children who die each year could be saved by low-tech, evidence-based, cost-effective measures such as
vaccine A vaccine is a biological Dosage form, preparation that provides active acquired immunity to a particular infectious disease, infectious or cancer, malignant disease. The safety and effectiveness of vaccines has been widely studied and verifie ...
s,
antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...
s, micronutrient supplementation, insecticide-treated bed nets, improved family care and
breastfeeding Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be expressed by hand or pumped and fed to the infant. The World Health Organization (WHO) recommends that br ...
practices, and
oral rehydration therapy Oral rehydration therapy (ORT) is a type of fluid replacement used to prevent and treat dehydration, especially due to diarrhea. It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium. Oral rehydrati ...
. Empowering women, removing financial and social barriers to accessing basic services, developing innovations that make the supply of critical services more available to the poor and increasing local accountability of health systems are policy interventions that have allowed health systems to improve equity and reduce mortality. In developing countries, child mortality rates related to respiratory and
diarrheal diseases Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...
can be reduced by introducing simple behavioral changes, such as
handwashing Hand washing (or handwashing), also known as hand hygiene, is the act of cleaning one's hands with soap or handwash and water to remove viruses/bacteria/microorganisms, dirt, grease, or other harmful and unwanted substances stuck to the hands ...
with soap. This simple action can reduce the rate of mortality from these diseases by almost 50 per cent. Proven, cost-effective interventions can save the lives of millions of children per year. The UN Vaccine division as of 2014 supported 36% of the world's children in order to best improve their survival chances, yet still, low-cost immunization interventions do not reach 30 million children despite success in reducing
polio Poliomyelitis, commonly shortened to polio, is an infectious disease caused by the poliovirus. Approximately 70% of cases are asymptomatic; mild symptoms which can occur include sore throat and fever; in a proportion of cases more severe s ...
,
tetanus Tetanus, also known as lockjaw, is a bacterial infection caused by ''Clostridium tetani'', and is characterized by muscle spasms. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Each spasm usually ...
, and
measles Measles is a highly contagious infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than , cough, ...
. Measles and tetanus still kill more than 1 million children under 5 each year. Vitamin A supplementation costs only $0.02 for each capsule and given 2–3 times a year will prevent blindness and death. Although vitamin A supplementation has been shown to reduce all-cause mortality by 12 to 24 per cent, only 70 per cent of targeted children were reached in 2015. Between 250,000 and 500,000 children become blind every year, with 70 percent of them dying within 12 months.
Oral rehydration therapy Oral rehydration therapy (ORT) is a type of fluid replacement used to prevent and treat dehydration, especially due to diarrhea. It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium. Oral rehydrati ...
(ORT) is an effective treatment for lost liquids through diarrhea; yet only 4 in 10 (44 per cent) of children ill with diarrhea are treated with ORT. Essential newborn care - including immunizing mothers against tetanus, ensuring clean delivery practices in a hygienic birthing environment, drying and wrapping the baby immediately after birth, providing necessary warmth, and promoting immediate and continued breastfeeding, immunization, and treatment of infections with antibiotics - could save the lives of 3 million newborns annually.
Improved sanitation Improved sanitation (related to but distinct from a " safely managed sanitation service") is a term used to categorize types of sanitation for monitoring purposes. It refers to the management of human feces at the household level. The term was co ...
and access to clean
drinking water Drinking water is water that is used in drink or food preparation; potable water is water that is safe to be used as drinking water. The amount of drinking water required to maintain good health varies, and depends on physical activity level, a ...
can reduce childhood infections and diarrhea. approximately 26% of the world's population does not have access to basic
sanitation Sanitation refers to public health conditions related to clean drinking water and treatment and disposal of human excreta and sewage. Preventing human contact with feces is part of sanitation, as is hand washing with soap. Sanitation systems ...
, and 785 million people use unsafe sources of drinking water.


Efforts

Agencies promoting and implementing child survival activities worldwide include
UNICEF UNICEF (), originally called the United Nations International Children's Emergency Fund in full, now officially United Nations Children's Fund, is an agency of the United Nations responsible for providing Humanitarianism, humanitarian and Devel ...
and
non-governmental organization A non-governmental organization (NGO) or non-governmental organisation (see spelling differences) is an organization that generally is formed independent from government. They are typically nonprofit entities, and many of them are active in h ...
s; major child survival donors worldwide include the
World Bank The World Bank is an international financial institution that provides loans and grants to the governments of low- and middle-income countries for the purpose of pursuing capital projects. The World Bank is the collective name for the Interna ...
, the British Government's
Department for International Development , type = Department , logo = DfID.svg , logo_width = 180px , logo_caption = , picture = File:Admiralty Screen (411824276).jpg , picture_width = 180px , picture_caption = Department for International Development (London office) (far right ...
, the
Canadian International Development Agency The Canadian International Development Agency (CIDA) was a federal Canadian organization that administered foreign aid programs in developing countries. The agency was merged into the Department of Foreign Affairs in 2013 by the federal governmen ...
and the
United States Agency for International Development The United States Agency for International Development (USAID) is an independent agency of the U.S. federal government that is primarily responsible for administering civilian foreign aid and development assistance. With a budget of over $27 bi ...
. In the United States, most non-governmental child survival agencies belong to the
CORE Group Core or cores may refer to: Science and technology * Core (anatomy), everything except the appendages * Core (manufacturing), used in casting and molding * Core (optical fiber), the signal-carrying portion of an optical fiber * Core, the central ...
, a coalition working, through collaborative action, to save the lives of young children in the world's poorest countries. Substantial global progress has been made in reducing child deaths since 1990. The total number of under-5 deaths worldwide has declined from 12.6 million in 1990 to approximately 5.5 million in 2020. Since 1990, the global under-5 mortality rate has dropped by 59%, from 93 deaths per 1000 live births in 1990 to 36 in 2020. This is equivalent to 1 in 11 children dying before reaching age 5 in 1990, compared to 1 in 27 in 2019. The Sustainable Development Goals has set 2 new goals to reduce under-5 and newborn mortality. The goals set newborn mortality for 12 per 1,000 live births in every country and for under 5 mortality 25 per 1,000 livebirths in every country. In 2019, 122 countries met this and every 10 years, 20 more are expected to follow. WHO states they support health equity and universal health care so that all countries may have proper health care with no finances involved.


Epidemiology

Child mortality has been dropping as each country reaches a high stage of DTM. From 2000 to 2010, child mortality has dropped from 9.6 million to 7.6 million. In order to reduce child mortality rates, there needs to be better education, higher standards of healthcare and more caution in childbearing. Child mortality could be reduced by attendance of professionals at birth and by breastfeeding and through access to clean water, sanitation, and immunization. In 2016, the world average was 41 (4.1%), down from 93 (9.3%) in 1990. This is equivalent to 5.6 million children less than five years old dying in 2016. File:Global child mortality over time.png, Global child mortality over time File:Child Mortality vs Fertility Rate.svg, Child mortality is high in countries where women have many children (high
fertility rates The total fertility rate (TFR) of a population is the average number of children that would be born to a woman over her lifetime if: # she were to experience the exact current age-specific fertility rates (ASFRs) through her lifetime # she were t ...
). Wealthy countries have lower child mortality rates than poor ones.


Variation

Huge disparities in under-5 mortality rates exist. Globally, the risk of a child dying in the country with the highest under-5 mortality rate is about 60 times higher than in the country with the lowest under-5 mortality rate. Sub-Saharan Africa remains the region with the highest under-5 mortality rates in the world: All six countries with rates above 100 deaths per 1,000 live births are in sub-Saharan Africa, with
Somalia Somalia, , Osmanya script: 𐒈𐒝𐒑𐒛𐒐𐒘𐒕𐒖; ar, الصومال, aṣ-Ṣūmāl officially the Federal Republic of SomaliaThe ''Federal Republic of Somalia'' is the country's name per Article 1 of thProvisional Constituti ...
having the highest under-5 mortality rates. Furthermore, approximately 80% of under-5 deaths occur in only two regions: sub-Saharan Africa and South Asia. 6 countries account for half of the global under-5 deaths, namely,
India India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...
,
Nigeria Nigeria ( ), , ig, Naìjíríyà, yo, Nàìjíríà, pcm, Naijá , ff, Naajeeriya, kcg, Naijeriya officially the Federal Republic of Nigeria, is a country in West Africa. It is situated between the Sahel to the north and the Gulf o ...
,
Pakistan Pakistan ( ur, ), officially the Islamic Republic of Pakistan ( ur, , label=none), is a country in South Asia. It is the world's List of countries and dependencies by population, fifth-most populous country, with a population of almost 24 ...
, the
Democratic Republic of the Congo The Democratic Republic of the Congo (french: République démocratique du Congo (RDC), colloquially "La RDC" ), informally Congo-Kinshasa, DR Congo, the DRC, the DROC, or the Congo, and formerly and also colloquially Zaire, is a country in ...
,
Ethiopia Ethiopia, , om, Itiyoophiyaa, so, Itoobiya, ti, ኢትዮጵያ, Ítiyop'iya, aa, Itiyoppiya officially the Federal Democratic Republic of Ethiopia, is a landlocked country in the Horn of Africa. It shares borders with Eritrea to the ...
and
China China, officially the People's Republic of China (PRC), is a country in East Asia. It is the world's most populous country, with a population exceeding 1.4 billion, slightly ahead of India. China spans the equivalent of five time zones and ...
. India and Nigeria alone account for almost a third (32 per cent) of the global under-five deaths. Within low- and middle-income countries, there is also substantial variation in child mortality rates across
administrative division Administrative division, administrative unit,Article 3(1). country subdivision, administrative region, subnational entity, constituent state, as well as many similar terms, are generic names for geographical areas into which a particular, ind ...
s. Likewise, there are disparities between wealthy and poor households in developing countries. According to a
Save the Children The Save the Children Fund, commonly known as Save the Children, is an international non-governmental organization established in the United Kingdom in 1919 to improve the lives of children through better education, health care, and economic ...
paper, children from the poorest households in
India India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...
are three times more likely to die before their fifth birthday than those from the richest households. A systematic study reports for all the low- and middle-income countries (not including China), the children among the poorest households are twice as likely to die before the age of 5 years old compare to those in the richest household. A large team of researchers published a major study on the global distribution of child mortality in
Nature Nature, in the broadest sense, is the physics, physical world or universe. "Nature" can refer to the phenomenon, phenomena of the physical world, and also to life in general. The study of nature is a large, if not the only, part of science. ...
in October 2019. It was the first global study that mapped child death on the level of subnational district (17,554 units). The study was described as an important step to make action possible that further reduces child mortality. The child survival rate of nations varies with factors such as
fertility rate The total fertility rate (TFR) of a population is the average number of children that would be born to a woman over her lifetime if: # she were to experience the exact current age-specific fertility rates (ASFRs) through her lifetime # she were t ...
and
income distribution In economics, income distribution covers how a country's total GDP is distributed amongst its population. Economic theory and economic policy have long seen income and its distribution as a central concern. Unequal distribution of income causes eco ...
; the change in distribution shows a strong correlation between child survival and income distribution as well as fertility rate, where increasing child survival allows the average income to increase as well as the average fertility rate to decrease.


Covid-19 and Child Mortality

Child mortality, unlike mortality throughout other ages, actually dropped in 2020 when the
Covid-19 pandemic The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identif ...
hit the world. Children were among the lowest group of deaths in the world due to Covid-19. About 3.7 million deaths occurred and only 0.4 of them occurred in adolescents under 20 years of age, making about 13,400 deaths in adolescents. Of that small proportion, 42% occurred in children under the age of 9 years old.


See also

*
List of countries by infant mortality rate The under-five mortality rate (U5MR) is the number of deaths of infants and children under five years old per 1000 live births. The under-five mortality rate for the world is 39 deaths according to the World Bank and the World Health Organization ...


References


External links

* * {{DEFAULTSORT:Child Mortality Global health Hygiene Demography
Mortality Mortality is the state of being mortal, or susceptible to death; the opposite of immortality. Mortality may also refer to: * Fish mortality, a parameter used in fisheries population dynamics to account for the loss of fish in a fish stock throug ...
Sanitation Public health