Causes of child mortality, 2000–2012
Globally, prematurity was the leading cause of under-five deaths in 2012 (17.3% of deaths), followed by pneumonia (15.2%), intrapartum-related complications including birth asphyxia (11.4%), congenital anomalies and other noncommunicable diseases (10.8%) and diarrhoea (9.5%). Malaria was still a major killer in Sub-Saharan Africa, causing about 15% of under-five deaths in the region.
About 44% of under-five deaths in 2012 occurred in the first 28 days of life – the neonatal period. During the neonatal period, 35.2% of deaths were due to prematurity, 23.9% were caused by intrapartum-related complications including birth asphyxia, and 15.2% were caused by sepsis and other infectious conditions of the newborn. For the postneonatal period (ages 1–59 months), pneumonia (23.1%), diarrhoea (16.2%) and malaria (12.9%) were the leading causes of death.
The majority of neonatal deaths can be prevented with quality care during pregnancy, safe and clean delivery by a skilled attendant, and immediate postnatal care, including neonatal resuscitation, extra care of low birth weight babies, attention to baby warmth, treatment of neonatal sepsis and early initiation of breastfeeding. Similarly, most child deaths due to infectious diseases can be prevented by known, simple, affordable and low cost interventions such as exclusive breastfeeding up to 6 months of age, immunization, appropriate use of antibiotics, oral rehydration therapy and zinc, insecticide treated bed nets, and anti-malarials.
In high-income countries, over one half of all child deaths were due to congenital abnormalities (28.5%) and prematurity (26.1%). In low- and middle-income countries, prematurity was also an important cause of death (17.2%), as were pneumonia (15.4%), intrapartum-related complications including birth asphyxia (11.4%), and diarrhoea (9.6%).
Although the African Region had the lowest proportion of under-five deaths occurring in the neonatal period (33.6%), it still had the highest regional neonatal mortality rate (32 deaths per 1000 live births), underscoring the fact that nearly 50% of all under-five child deaths occur in Africa. The African Region accounted for nearly 9 in 10 under-five HIV/AIDS deaths and over 19 in 20 malaria deaths, while WHO South-East Asia Region accounted for 40% of all deaths due to prematurity.
The number of under-five deaths worldwide dropped from 12.6 million in 1990 to 6.6 million in 2012. Between 2000 and 2012, deaths due to measles fell by 80%, and large reductions were seen for HIV/AIDS (- 51%), diarrhoea (-50%), pneumonia (-40%), and malaria (-37%). In contrast, relatively little progress was made in reducing the number of deaths due to prematurity, which had a decline of only 14%. More generally, the proportion of under-five deaths occurring during the neonatal period rose from 37% in 2000 to 44% in 2012.