International differences in child mortality and the impact of malnutrition.

In the industrialized countries, 1-4 year mortality continues to decline even though levels are already low, in most cases being below one per 1000. Rates of decline in child and infant mortalities are similar. The main causes of child death are accidents and congenital anomalies which are difficult to control. Indications are that 1-4 year mortality in the majority of less-developed countries is still very high. Limited data suggest that 1-4 year mortality is declining more rapidly than infant mortality and that rates of decline are faster than in industrialized countries. Diarrhoeal disease and measles are the main causes of 1-4 year mortality with malnutrition being a contributory cause in 60 per cent of cases. The majority of child deaths occur in the second year of life. Health planning and evaluation, particulary in Africa and Asia, are severely hampered by totally inadequate death registration data.