Counting every life makes every child’s life count

When a baby is born in Ontario, the parents receive a birth certificate, a social insurance number, Canada child benefits and the baby receives a name. Though many of us living in high-income countries like Canada might take this as a given, many parents around the world may never experience the same record-keeping system, or any system at all, when bringing a new life into the world. In low- and middle-income countries, many births are not recorded. Sometimes the baby may not be given a name for weeks, as the mother doesn’t want to get attached knowing that the baby’s death may be imminent. The implications inherent in not collecting and monitoring such data means there is a ripple effect in management of health and ultimately, outcomes.

A new report published in JAMA Pediatrics this week assesses youth death and injury data from 188 countries in 2013. As a member of the Global Burden of Disease Paediatrics Collaboration who authored the report, my colleagues and I assessed data to estimate cause-specific mortality of children and adolescents (encompassing the 0-19 age group). We counted a total of 7.7 million deaths globally in 2013, 6.28 million of which were in children under age five. However, children’s lives in countries with the highest burden of childhood illness and disease still go uncounted.

Globally, only about half of all births are registered and fewer than half of all deaths are actually captured by well-functioning civil registration and vital statistics. We, therefore, had to rely on a series of alternative sources of data for the study. These data were collated and analyzed using representative data and modelling strategies to generate estimates across the continuum of birth to the beginning of adulthood.

What did we find?

Overall, child deaths have decreased from 1990 to 2013, but significant variations in both levels and trends exist across countries. Importantly, the vast majority of causes of child deaths are still preventable. Many of these childhood deaths can therefore be considered unnecessary.

In Canada, we sometimes take simply being counted for granted. However, detailed information on causes of death and non-fatal health outcomes in children and adolescents is critical to informing policy decision-making on resource allocation to disease prevention and treatment programs.

The leading causes of death among children under age 5 globally in 2013 were:

• Lower respiratory tract infections (0.9 million deaths)
• Preterm birth complications (0.7 million deaths)
• Neonatal encephalopathy following birth trauma and asphyxia (0.6 million deaths)
• Malaria (0.6 million deaths)
• Diarrheal diseases (0.5 million deaths)

The leading causes of death among adolescents (aged 10-19 years) globally in 2013 were:

• Road injuries (0.1 million deaths)
• HIV/AIDS (0.07 million deaths)
• Self-harm (0.06 million)
• Drowning (0.05 million deaths)
• Intestinal infectious diseases (0.04 million deaths).

The data suggest that general improvements in health services and public health interventions for a wide range of health problems, rather than single-disease programs, are a determining factor for mortality decline. Declines in poverty levels and conflict, and improvements in living conditions over time, may have also contributed to declines in mortality.

The Centre for Global Child Health is a dedicated hub at SickKids that aims to address global child health challenges through our research, capacity building and knowledge translation programs.