Child survival is up, but according to a new publication in The Lancet this week, the leading killers of children remain the same. You guessed it: pneumonia and diarrhea. According to WHO and Johns Hopkins Bloomberg School of Public Health, 8.8 million children died in 2008 and two-thirds were due to infectious disease, with pneumonia (18%), diarrhea (15%) and malaria (8%) as the leading causes. Researchers estimate that 41% of all child deaths occurred during the first month of life, when newborn children are vulnerable to birth complications and infections.
The report is full of important findings for global health leaders around the world that can help them target their investments and interventions more accurately. First, it shows them where to focus, by revealing that about one-half of all child deaths occur in just five big countries: India, Nigeria, Democratic Republic of the Congo, Pakistan, and China.
By giving death estimates for every country, these data highlight some striking disparities. Consider the following comparison of two oil exporting countries: Canada - host to this year's G8 meeting - where in 2008 they project that exactly 1 child died of diarrhea and 30 died of pneumonia, and Nigeria, where roughly 200,000 died of diarrhea and 177,000 died of pneumonia.
Second, the report emphasizes the conditions to focus on: pneumonia, diarrhea, malaria, and for newborns, birth complications and infections. Also, for the first time, these estimates explicitly highlight the role of meningitis and pertussis, by allocating individual "pie slices" of two percent to each cause. Until this year, the methods used to estimate causes of child death have lumped these important vaccine-preventable illnesses (both which also affect adults) in the catch-all category of "other".
This year's report provides the most accurate and comprehensive picture today of the causes of child death around the world. It includes more data from more countries and made use of the most accurate and sophisticated statistical methods of any estimates produced to date. And in these new, sophisticated methods lie both the strength of the estimates for 2008 and the potential for problems in comparing the results to previous years.
A simple comparison finds that, in children over age 1 month, about 35% fewer pneumonia and diarrhea deaths are estimated in 2008 than in 2000. Based on that comparison, the world's health ministers might draw a line between the two numbers, pat themselves on the back for this rate of decline, extend the line into the future, and conclude, "let's just keep doing whatever we're doing".
But that conclusion would be premature, and likely inaccurate. Child mortality in 2008 is truly lower than it was in 2000 and so are the number of pneumonia and diarrhea deaths. But because the methods for estimating the causes of death changed, a simple comparison of the number of pneumonia and diarrhea deaths will overestimate the amount of the decline. It is likely that if these latest methods are applied to both year 2000 and 2008, a direct comparison would still show declines, albeit ones smaller than the apparent declines of ~35%.
With nearly 3 million children still dying annually from these diseases, you and I should be just as sick of pneumonia and diarrhea as are the children and parents in Nigeria and other highly affected countries. These two diseases have been the leading infectious killers of children for at least 10 years running and very little has been done to specifically combat them in that time.
So, as the world's health ministers gather in Geneva next week for the World Health Assembly, I hope they read the latest report for what it is: a reminder that too many children die each year and that infectious diseases, especially pneumonia and diarrhea, are the main causes. And maybe they (and you) will join me as I resolve for the year ahead (now for the 10th straight time): to make sure that pneumonia and diarrhea are not the leading causes of child death next year.