Cause-specific childhood mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

Abstract

Background

Childhood mortality, particularly in the first 5 years of life, is a major global concern and the target of Millennium Development Goal 4. Although the majority of childhood deaths occur in Africa and Asia, these are also the regions where such deaths are least likely to be registered. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available.

Objective

To present a description of cause-specific mortality rates and fractions over the first 15 years of life as documented by INDEPTH Network sites in sub-Saharan Africa and south-east Asia.

Design

All childhood deaths at INDEPTH sites are routinely registered and followed up with verbal autopsy (VA) interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provided person-time denominators for mortality rates. Cause-specific mortality rates and cause-specific mortality fractions are presented according to WHO 2012 VA cause groups for neonatal, infant, 1–4 year and 5–14 year age groups.

Results

A total of 28,751 childhood deaths were documented during 4,387,824 person-years over 18 sites. Infant mortality ranged from 11 to 78 per 1,000 live births, with under-5 mortality from 15 to 152 per 1,000 live births. Sites in Vietnam and Kenya accounted for the lowest and highest mortality rates reported.

Conclusions

Many children continue to die from relatively preventable causes, particularly in areas with high rates of malaria and HIV/AIDS. Neonatal mortality persists at relatively high, and perhaps sometimes under-documented, rates. External causes of death are a significant childhood problem in some settings.

• Childhood
• Africa
• Asia
• mortality
• INDEPTH Network
• verbal autopsy
• InterVA

This paper is part of the Special Issue: INDEPTH Network Cause-Specific Mortality. More papers from this issue can be found at http://www.globalhealthaction.net

This paper is part of the Special Issue: INDEPTH Network Cause-Specific Mortality. More papers from this issue can be found at http://www.globalhealthaction.net

Acknowledgements

We are grateful to all the residents of INDEPTH HDSS sites who have contributed personal information to this mortality dataset, and to the field staff who undertook so many verbal autopsy interviews and data management staff who handled the data at every participating site. INDEPTH acknowledges all the site scientists who have participated in bringing this work together, and who variously participated in analysis workshops in Ghana, Belgium, Thailand and the United Kingdom. The INDEPTH Network is grateful for core funding from Sida, the Wellcome Trust, and the William & Flora Hewlett Foundation. The Umeå Centre for Global Health Research is core funded by Forte, the Swedish Research Council for Health, Working Life and Welfare (grant 2006-1512). PB's residency at the University of the Witwatersrand Rural Knowledge Hub to analyse and draft these results was supported by the European Community Marie Curie Actions IPHTRE project (no. 295168). icddr,b is thankful to the Governments of Australia, Bangladesh, Canada, Sweden and the UK for providing core/unrestricted support. The Ouagadougou site acknowledges the Wellcome Trust for its financial support to the Ouagadougou HDSS (grant number WT081993MA). The Kilite Awlaelo HDSS is supported by the US Centers for Disease Control and Prevention (CDC) and the Ethiopian Public Health Association (EPHA), in accordance with the EPHA-CDC Cooperative Agreement No.5U22/PS022179_10 and Mekelle University, though these findings do not necessarily represent the funders' official views. The Kilifi site is supported through core support to the KEMRI-Wellcome Trust Major Overseas Programme from the Wellcome Trust. TNW is supported by a Senior Fellowship (091758) and CN through a Strategic Award (084538) from the Wellcome Trust. This paper is published with permission from the Director of KEMRI. The Kisumu site wishes to acknowledge the contribution of the late Dr. Kubaje Adazu to the development of KEMRI/CDC HDSS, which was implemented and continues to be supported through a cooperative agreement between KEMRI and CDC. The Nairobi Urban Health and Demographic Surveillance System (NUHDSS), Kenya, since its inception has received support from the Rockefeller Foundation (USA), the Wellcome Trust (UK), the William and Flora Hewlett Foundation (USA), Comic Relief (UK), the Swedish International Development Cooperation Agency (SIDA) and the Bill and Melinda Gates Foundation (USA). The Agincourt site acknowledges that the School of Public Health and Faculty of Health Sciences, University of the Witwatersrand, and the Medical Research Council, South Africa, have provided vital support since inception of the Agincourt HDSS. Core funding has been provided by the Wellcome Trust, UK (Grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z) with contributions from the National Institute on Aging (NIA) of the NIH, William and Flora Hewlett Foundation, and Andrew W Mellon Foundation, USA.

Conflict of interest and funding

The authors have not received any funding or benefits from industry or elsewhere to conduct this study.

Notes

This paper is part of the Special Issue: INDEPTH Network Cause-Specific Mortality. More papers from this issue can be found at http://www.globalhealthaction.net

Authors are listed arbitrarily in order of their site code, and alphabetically within each site.