For children under five, Pakistan’s third most dangerous… health-wise


Preventable infectious diseases were responsible for almost two-thirds of the 7.6 million deaths of children under five worldwide, according to new estimates published in The Lancet.
Although child deaths have declined by 26 percent since 2000, and despite major reductions in some of the leading causes of death – diarrhoea, pneumonia, and measles – few countries are going to achieve international targets for improving child survival with less than 3 years before the 2015 deadline for Millennium Development Goal (MDG) 4.
“In the past decade, the country-specific under-5 mortality rate reduced at an average rate of 2.6 per cent per year, which is less than 4.4 per cent of the annual rate of decrease needed to reach MDG4”, explains Professor Robert Black from John Hopkins Bloomberg School of Public Health in the USA, lead author of the study.
“The attainment of MDG4 is possible only if life-saving maternal, newborn, and child health interventions are rapidly scaled up in high-burden regions and countries and across major causes in the next few years.”
With a total of 424,377 under-5 deaths in 2010, Pakistan was third among five countries, including India, Nigeria, Congo, and China that accounted for almost half (3.754 million) of deaths in children under 5 worldwide, and contributed to half the deaths from infections (2.440 million) and more than half (1.636 million) the deaths due to neonatal causes. For pneumonia and diarrhoea, the five countries with the most deaths were India, Nigeria, Congo, Pakistan and Ethiopia.
“But besides ranking, understanding both the trends and determinants of change is important. Too much emphasis has been placed in recent years on global numbers and mortality, and less on understanding the determinants and direction of trends…such as distribution of deaths by residence or indeed place of death.
Annual diarrhoeal deaths in children might well have fallen to less than 800 000 during the past two decades, but these trends are mostly indicative of gains in large countries such as China, Brazil, and India…and the overall incidence of diarrhoeal disorders has hardly changed,” says Dr Zulfiqar Bhutta, Founding Chair of Division of Women and Child Health, Aga Khan University, in an accompanying Comment to the piece in The Lancet.
He adds: “Do mere numbers and proportions give sufficient detail about the causes of mortality…such as distribution of deaths by residence or indeed place of death? Estimations from a national mortality survey in 2006–07 in Pakistan suggest that more than two-thirds of all deaths in children younger than 5 years took place at home, the majority after seeing a health professional.”
In this study, Black and colleagues found that two-fifths of deaths occurred within the first month of life, with preterm birth second only to pneumonia as the leading cause of child death in 2010, “indicating the crucial importance of the reduction of neonatal deaths if countries are to achieve MDG4.”
In 2010, a third of deaths in children younger than 5 years occurred in southeast Asia and half in Africa. A striking 73 per cent (2.6 million) of all child deaths in Africa were due to infectious causes, including 96 per cent of all deaths due to malaria and 90 per cent due to AIDS. In comparison, neonatal causes were the leading cause of death (1.096 million deaths) in southeast Asia.
The authors conclude: “Africa and southeast Asia are repeatedly the regions with the most deaths in children younger than 5 years. Our trend analysis shows that accelerated reductions are needed in the two major causes and in the two high-burden regions to achieve MDG4 by 2015.”