The Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK.
Lancet. 2015 Jan 31;385(9966):430-40. doi: 10.1016/S0140-6736(14)61698-6. Epub 2014 Sep 30.
BACKGROUND: Trend data for causes of child death are crucial to inform priorities for improving child survival by and beyond 2015. We report child mortality by cause estimates in 2000-13, and cause-specific mortality scenarios to 2030 and 2035. METHODS: We estimated the distributions of causes of child mortality separately for neonates and children aged 1-59 months. To generate cause-specific mortality fractions, we included new vital registration and verbal autopsy data. We used vital registration data in countries with adequate registration systems. We applied vital registration-based multicause models for countries with low under-5 mortality but inadequate vital registration, and updated verbal autopsy-based multicause models for high mortality countries. We used updated numbers of child deaths to derive numbers of deaths by causes. We applied two scenarios to derive cause-specific mortality in 2030 and 2035. FINDINGS: Of the 6·3 million children who died before age 5 years in 2013, 51·8% (3·257 million) died of infectious causes and 44% (2·761 million) died in the neonatal period. The three leading causes are preterm birth complications (0·965 million [15·4%, uncertainty range (UR) 9·8-24·5]; UR 0·615-1·537 million), pneumonia (0·935 million [14·9%, 13·0-16·8]; 0·817-1·057 million), and intrapartum-related complications (0·662 million [10·5%, 6·7-16·8]; 0·421-1·054 million). Reductions in pneumonia, diarrhoea, and measles collectively were responsible for half of the 3·6 million fewer deaths recorded in 2013 versus 2000. Causes with the slowest progress were congenital, preterm, neonatal sepsis, injury, and other causes. If present trends continue, 4·4 million children younger than 5 years will still die in 2030. Furthermore, sub-Saharan Africa will have 33% of the births and 60% of the deaths in 2030, compared with 25% and 50% in 2013, respectively. INTERPRETATION: Our projection results provide concrete examples of how the distribution of child causes of deaths could look in 15-20 years to inform priority setting in the post-2015 era. More evidence is needed about shifts in timing, causes, and places of under-5 deaths to inform child survival agendas by and beyond 2015, to end preventable child deaths in a generation, and to count and account for every newborn and every child. FUNDING: Bill & Melinda Gates Foundation.
背景：儿童死亡原因的趋势数据对于明确到 2015 年及之后改善儿童生存的优先事项至关重要。我们报告了 2000-2013 年儿童死亡的死因估计数，以及到 2030 年和 2035 年的特定死因死亡率预测。
方法：我们分别为新生儿和 1-59 月龄儿童估算了儿童死亡的原因分布。为了产生特定死因的死亡率分数，我们纳入了新的生命登记和死因推断数据。在生命登记系统完善的国家，我们使用生命登记数据。对于 5 岁以下儿童死亡率较低但生命登记不完善的国家，我们采用生命登记为基础的多死因模型；对于高死亡率国家，我们采用经更新的死因推断多死因模型。我们利用最新的儿童死亡人数，推算出不同死因的死亡人数。我们采用两种情景，推算出 2030 年和 2035 年的特定死因死亡率。
结果：2013 年，630 万 5 岁以下儿童死亡，其中 51.8%（325.7 万）死于传染性疾病，44%（276.1 万）死于新生儿期。三个主要死因是早产并发症（98-245 万[15.4%]；81.7-105.7 万）、肺炎（93.5 万[14.9%]；13.0-16.8 万）和分娩期相关并发症（66.2 万[10.5%]；42.1-105.4 万）。与 2000 年相比，2013 年记录的 360 万例儿童死亡减少，其中一半以上归因于肺炎、腹泻和麻疹死亡率的降低。进展最慢的病因是先天性、早产、新生儿败血症、伤害和其他病因。如果目前的趋势持续下去，2030 年仍将有 440 万 5 岁以下儿童死亡。此外，到 2030 年，撒哈拉以南非洲将占出生人数的 33%，占死亡人数的 60%，而 2013 年分别为 25%和 50%。
解释：我们的预测结果为 15-20 年后儿童死因的分布情况提供了具体示例，为 2015 年后的优先事项制定提供了信息。为了在 2015 年及之后结束可预防的儿童死亡，并计算和记录每一个新生儿和每一个儿童，我们需要更多关于 5 岁以下儿童死亡时间、原因和地点变化的证据，以指导儿童生存议程。
资助：比尔及梅琳达·盖茨基金会。
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