Deaths of older children: what do the data tell us?

The Millenium Development Goals focused attention on child mortality under age 5 (where it is the highest) and the world has halved the child death rate from 1990 to 2015 (is-the-world-achieving-the-health-related-MDGs). Much less attention has been paid to older children (aged 5-14) where death rates are lower. However, this age group is one of the areas where WHO global mortality estimates differ most from those of the Seattle-based Institute for Health Metrics and Evaluation (IHME), funded by the Bill and Melinda Gates Foundation. IHME estimated that there were 820,000 deaths at ages 5-14 years in 2010, compared to 1,300,000 estimated by WHO and the UN Population Division.

Now Ken Hill, Dean Jamison and Linnea Zimmerman have analysed data from 194 DHS surveys covering 84 countries plus census data for China to estimate directly from data that there were 1,500,000 deaths in 2010 for 5-14 year olds, slightly higher than the WHO and UN estimates, but 87% higher than the estimates of IHME. The IHME relational model life table system, which is fitted to the probability of dying under age 5 and the probability of dying between aged 15 and 60, appears to underestimate for older child deaths.

The IHME has recently published updated mortality estimates for years up to 2013 (Lancet – GBD2013) and continues to estimate substantially lower numbers of deaths in the age range 5-14 than the UN estimates and the new analysis by Ken Hill and colleagues. WHO is part of the UN Interagency Group for Child Mortality Estimation (UN-IGME) which to date has focused on deaths under 5, but is investigating the feasibility to extend their estimates to include older children, using similar data and methods to those of Hill et al.

The paper by Hill et al. is published in the Lancet and available at
I have written a commentary which accompanies the paper and can be accessed at: Lancet – Hill et al 2015

I have written a commentary which accompanies the paper Lancet – Mathers 2015. There has been increasing interest in the older child and adolescent period among the global health agencies, as there is evidence that mortality rates have not declined as fast as for the under-five age range. This age range represents an important period of social and educational development, as well as onset of puberty and the older adolescent age group 15-19 is also the period of transition to adult risk exposures (driving, alcohol and drugs, reproductive risks, workplace risks etc). Both WHO and UNICEF have recently published major reports on adolescent health and mortality:

http://www.who.int/maternal_child_adolescent/topics/adolescence/second-decade/en/

http://www.unicef.org/media/files/PFC2012_A_report_card_on_adolescents.pdf

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