Why You Shouldn't Be Totally Depressed By A Report On Child Mortality

Every year, millions of kids and teenagers die around the world, often from preventable and treatable conditions. It is a troubling statistic. But if you look beneath the surface numbers, you'll find signs of hope, says Theo Vos, a professor of global health at the University of Washington in Seattle.

Although progress is slow in some countries, he says, the data show rapid improvements in many others.

"I always fight with my public health colleagues because I have found they are eternal pessimists," Vos says. "They always like to talk about public health problems. Whereas, there are a whole lot of good news stories as well. The sorts of changes we've seen in child mortality are pretty spectacular."

Every year since 1990, in an effort funded mostly by the Gates Foundation, researchers have compiled a massive amount of mortality data from around the globe. Using sophisticated statistical techniques, they can then assess trends across time and place. (Note: The Gates Foundation is also a funder of NPR.)

In one of the latest analyses of data on deaths and disability from more than 300 diseases in 188 countries in 2013, Vos and colleagues report this week in JAMA Pediatrics that deaths among young people up to age 19 totaled 7.7 million. More than 80 percent of those were kids age 5 and younger.

The report offers lots of details about what kills kids most and where. Among the findings:

• Five causes explained more than half of deaths in little kids: lower respiratory tract infections, malaria, diarrheal diseases, preterm birth complications and neonatal encephalopathy — a type of nervous system problem following birth trauma.

• Among adolescents ages 10 to 19, the most frequent cause of death was road injuries, followed by HIV/AIDS, intestinal infectious diseases, drowning and self-harm.

• Five countries accounted for half of all diarrhea-related deaths among children and teens: Democratic Republic of the Congo, Ethiopia, India, Nigeria and Pakistan.

• Iron-deficiency anemia — which can result from malnutrition, malaria, hookworm and other causes — was the top cause of disability, affecting 619 million young people.

While all of that sounds depressing, Vos also found reason to be hopeful. In many places, including Bangladesh, China and Iran, rates of death among kids are dropping by as much as six percent per year.

The biggest improvements, Vos says, show up in statistics for infectious diseases, like diarrhea, malaria and pneumonia. An intensive program in Zambia to provide drugs and bed nets, for example, led to declines in deaths from malaria. But when funding for that program dried up for a year and a half, rates of death increased rapidly. "Those are the sort of anecdotes," Vos says, "where you say, 'Hey, this investment of resources is paying off.'"

Data can help guide policy changes, he says. In Rwanda, the minister of health noticed high rates of illness from air pollution in her country, then rolled out a program to distribute efficient cook stoves.

Still, some places are not doing so well. In 2013, according to the report, 12 percent of the deaths from lower respiratory tract infections occurred in Nigeria, which also accounted for 38 percent of global deaths from malaria. A third of the world's deaths from neonatal encephalopathy happened in India.

Kids are particularly vulnerable to death in countries that are undergoing chronic civil unrest and political instability, wrote two Stanford University researchers in an accompanying editorial.

But the commenters warned against putting too much trust in the numbers because reporting may be incomplete. They also stressed the importance of pushing for better accounting.

"There is something deeply troubling about a death that goes unnoticed," they wrote.