More than 10 million children per year die before their fifth birthday, and six conditions — many of which are preventable — cause most of those child deaths.

That’s according to the World Health Organization. In 2001, the WHO launched a major effort to find out how many of the world’s children were dying, and why. The goal was to create the most accurate account ever. Now, the results are in for 2000-2003.

The numbers are an improvement over past records, says the WHO. The results clearly show the stark reality of global child deaths.

“In today’s world, an Ethiopian child is over 30 times more likely than a western European to die before his or her fifth birthday,” says an editorial in The Lancet.

MainCauses of Child Deaths

Out of 10.6 million child deaths, nearly three out of four (73 percent) are due to six main causes, says the WHO. Those problems are:

—Pneumonia: 19 percent

—Diarrhea: 18 percent

—Malaria: 8 percent

—Infection of the blood or pneumonia in newborns: 10 percent

—Preterm delivery: 10 percent

—Asphyxia at birth: 8 percent

The four communicable disease categories account for more than half (54 percent) of all deaths of children under age 5, says the report.

Poor nutrition is also a major problem. “Undernutrition is an underlying cause of 53 percent of all deaths in children younger than age 5 years,” write the researchers.

Regional Differences

Africa was extremely hard hit. Overall, it had 42 percent of all global child deaths. Southeast Asia had another 29 percent, the report details.

Of all child deaths worldwide, Africa had 94 percent of those caused by malaria deaths, 89 percent from HIV/AIDS, 46 percent due to pneumonia, 40 percent from diarrhea, and 5 percent from measles, says the WHO.

The numbers are based on published or publicly available records. Those aren’t perfect, the report notes.

Many Deaths Preventable

Many child deaths might have been preventable.

“WHO attributes almost half (48 percent) of deaths under the age of 5 to diarrhea, pneumonia, malaria, and measles, which would mostly be preventable given appropriate care and treatment,” says an editorial in The Lancet.

“A further 37 percent reflect neonatal causes, many of which might be avoidable, and a third of which are infection related,” it continues.

“Thus, probably two-thirds of global deaths under the age of 5 could be relatively easily averted, if the necessary resources for basic health care were in place and accessible,” the editorial explains.

Poverty’s Toll

Poverty is the most important single determinant of childhood death, says the editorial. It notes that per capita health spending is strongly related to childhood death rates. That is, higher health spending tends to bring lower childhood death rates.

The review and editorial appear in The Lancet’s March 26 edition.

The editorial was written by Peter Byass and Tedros Ghebreyesus. Byass works at Sweden’s Umea International School of Public Health. Ghebreyesus is Minister of State in Ethiopia’s federal ministry of health.

The review of the WHO’s data was written by researchers including Robert Black, MD, of the international health department at Johns Hopkins Bloomberg School of Public Health.

By Miranda Hitti, reviewed by Brunilda Nazario, MD

SOURCES: Bryce, J. The Lancet, March 26, 2005; vol 365: pp 1147-1152. Byass, The Lancet, March 26, 2005; vol 365: pp 1115-1116.