Mortality risks in children aged 5-14 years in low-income and middle-income countries: a systematic empirical analysis.

Abstract

Health priorities since the UN Millennium Declaration have focused strongly on children younger than 5 years. The health of older children (age 5-9 years) and younger adolescents (age 10-14 years) has been neglected until recently, especially in low-income and middle-income countries, and mortality measures for these age groups have often been derived from overly flexible models. We report global and regional empirical mortality estimates for children aged 5-14 years in low-income and middle-income countries, and compare them with ones from existing models. For this empirical analysis, we obtained birth-history data from surveys done over a 25-year period from 1986 by the Demographic and Health Surveys programme for 84 World Bank low-income and middle-income countries, and data about household deaths in China from their 1990 and 2010 censuses. We used these data to calculate mortality risks for children aged 5-14 years, and compare these risks to corresponding estimates of mortality in children younger than 5 years in the same countries. We used regression analysis to model these associations, generate estimates of the risks, and derive estimates of the numbers of deaths for 1990 and 2010 by applying those risks to population estimates from the UN World Population Prospects (WPP) 2012 Revision. We then compared the numbers of deaths with those given by the UN WPP itself and by the Institute for Health Metrics and Evaluation's Global Burden of Disease (GBD) 2010 study. The mean risk of a child dying at age 5-14 years in low-income and middle-income countries is about 19% of the risk of dying between birth and age 5 years (12% at age 5-9 plus 7% at age 10-14). According to our estimates, the total number of deaths at ages 5-14 years in low-income and middle-income regions fell from about 2·4 million (95% CI 1·9-2·7) in 1990 to about 1·5 million (1·2-1·8) in 2010. From our estimates we concluded there to have been 200,000 (16%) more deaths at ages 5-14 than in the UN report; however, our estimates exceeded GBD estimates by more than 700,000 (87%). The average annual rate of decline in mortality at age 5-9 years (about 3%) slightly exceeded that for ages 0-4 years (2·8%), but progress has been slower for age 10-14 years (about 2%). Our analysis suggests that mortality risks nowadays in the age range 5-14 years in low-income and middle-income countries are rather higher (relative to mortality in children younger than 5 years) than would be expected on the basis of historical evidence. Our findings broadly lend support for the UN WPP mortality estimates, but are almost double those underpinning GBD 2010. Global policy emphasis on reduction of mortality in children younger than 5 years should be broadened to include older children and adolescents. The Lancet Commission on Investing in Health and the Bill & Melinda Gates Foundation.