Despite remarkable progress in the improvement of child survival between 1990 and 2015, the Millennium Development Goal (MDG) 4 target of a two-thirds reduction of under-5 mortality rate (U5MR) was not achieved globally. A paper published last week examined updated estimates of causes of child death, the cause-specific contributions to progress toward the MDG 4 and considered implications for the Sustainable Development Goals (SDG) target for child survival:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31593-8/fulltext

This work is part of a collaboration between WHO and  an academic research group on Maternal and Child Epidemiology Estimation (MCEE) funded under by a grant from the Bill and Melinda Gates Foundation.

The causes of the 5.9 million deaths of children under 5 is summarized in the following Figure 1 from the paper.

Reductions in mortality rates for pneumonia, diarrhoea, neonatal intrapartum-related events, malaria, and measles were responsible for 61% of the total reduction of 35 per 1000 livebirths in U5MR between 2000 and 2015 (see Figure 2 below, from the Lancet paper). Most of these causes relate mainly to the period 1-59 months after the neonatal period. The faster decline in these “post-neonatal” causes over the last 15 years has resulted in preterm birth complications now being the leading cause of under 5 deaths in 2015.

However, pneumonia remains the leading cause in countries with very high U5MR. Preterm birth complications and pneumonia are both important in high, medium high, and medium child mortality countries; whereas congenital abnormalities was the most important cause in countries with low and very low U5MR.

This year, 2016, marks the beginning of the UN implementation of the Sustainable Development Goals (SDGs). The SDGs target an U5MR of no more than 25 per 1000 livebirths in every country of the world in 2030.

Achievement of the SDG target, would require a 58% reduction in U5MR between 2015 and 2030, higher than the 55% reduction achieved between 2000 and 2015.  This will require substantial progress for countries in sub-Saharan Africa and Southern Asia, with a particular focus on preventing preterm births and preterm birth complications, as well as continued focus on infectious causes such as pneumonia, diarrhoea, malaria, meningitis and sepsis.