Bangladesh among few countries to reach internationally agreed child mortality target

Worldwide mortality among children aged 5 years and younger fell by 53% over the past 25 years, resulting in 3.8 million averted deaths, says a new analysis. But most countries have missed the United Nations’ millennium development goal (MDG) to reduce child deaths by two thirds. Bangladesh is among only 62 of 195 countries to have met the target to reduce under-5 mortality by two thirds over these 25 years.

The United Nations Inter-agency Group for Child Mortality Estimation reported that overall the death rate among children under 5 has fallen from 91 deaths per 1000 live births in 1990 to 43 per 1000 in 2015. The absolute number of deaths of under 5s worldwide dropped from 12.7 million to 5.9 million.  Still, an estimated 236.3 million children under age 5 died between 1990 and 2015.

Photo © icddr,b / Shumon Ahmed

The analysis, undertaken by Danzhen You and coauthors on behalf of the UN agency and published in The Lancet, is the first to include mortality ratios for children under 5 years of age up to the MDG target year (2015) and to estimate the burden of under 5 mortality in the next 15 years in relation to the newly proposed sustainable development goal target of 25 or fewer deaths of under 5s per 1000 live births by 2030.

To achieve the sustainable development goal, 47 countries need to accelerate their progress in reducing child death rates, including 34 countries in sub-Saharan Africa and two countries in south Asia (Afghanistan and Pakistan), the authors said.

Progress in other low and middle income countries is notable. Two regions—East Asia and the Pacific, and Latin America and the Caribbean—achieved the 2015 millennium development goal target. Of the 62 countries that met the goal, 24 were low- or lower-middle income countries, including Ethiopia, Eritrea, Bangladesh, Georgia, El Salvador, Bolivia, Egypt, Cambodia, Nepal, and Yemen. Ten of the 12 low-income countries that have reduced under 5 mortality by at least two thirds are in Africa.  However, in absolute numbers, five in 10 under 5 deaths still occur in sub-Saharan Africa and another three in 10 in South Asia.

Dr Shams el Arifeen, director of icddr,b’s Centre for Child and Adolescent Health says that the decline in child death rates in Bangladesh, from 143.7 to 37.6 deaths per 1000 live births in the past 25 years, an annual rate of decline of over 5%, has been driven mostly by underlying changes in economic growth and development.

“Bangladesh has done very well with providing many of the necessary interventions, such as diarrhoeal treatment and immunisations,” he said. “But the most influential drivers have been the remarkable improvements in the status of women, education, and literacy as well as extreme poverty, which have resulted in increased purchasing power of families.”

The new analysis shows that global progress is accelerating: the annual rate of reduction rose from 1.8% over 1990-2000 to 3.9% over 2000-2015.

But much improvement is needed, especially around the time of birth. Nearly half (45%) of deaths of under 5s occur in the first 28 days of life. Prematurity, pneumonia, complications during labour and delivery, diarrhoea, sepsis, and malaria are the leading causes of deaths of children under 5. Nearly half of all deaths of under 5s are associated with poor nutrition.

The authors concluded, “Countries and the international community must take immediate action to further accelerate the pace of progress to fulfil children’s rights to health and development.”