Mortality among children aged 5–14 is low, but 1 million children in this age group still died in 2016. The probability of dying among children aged 5–14 was 7.5 deaths per 1,000 children aged 5 in 2016 – substantially lower than the probability of dying among children under age 5 (41 deaths per 1,000 live births).
The world has halved the mortality rate among children aged 5–14 since 1990. From 1990 to 2016, the mortality rate in older children declined by 51 per cent and the number of deaths dropped by 44 per cent from 1.7 million to 1 million. Most of the regions reduced the probability of dying among children aged 5–14 by at least half.
Large disparities exist in the survival chances for children aged 5–14 across regions and countries. In sub-Saharan Africa, the probability of dying among children aged 5–14 was 19 deaths per 1,000 children aged 5, followed by South Asia with 7. The average risk for a child in sub-Saharan Africa to die between age 5 and age 14 is 17 times higher than the average for children in high-income countries (1.1 deaths per 1,000 children aged 5). The highest probability of dying in this age group was found in the Niger, with 40 deaths per 1,000 children aged 5 versus 0.5 in both Denmark and Luxembourg. The top 26 countries with the highest mortality rates are all in sub-Saharan Africa, with 15 of them having mortality rates above 20. More than half (53 per cent) of deaths to children aged 5–14 occurred in sub-Saharan Africa, followed by South Asia with about 25 per cent. Half (52 per cent) of all deaths between age 5–14 occurred in seven countries (India, Nigeria, the Democratic Republic of the Congo, Ethiopia, Pakistan, China and the Niger).
This report presents the group’s latest estimates of under-five, infant and neonatal mortality up to the year 2016, and assesses progress at the country, regional and global levels. Critically, it shows that although the number of children dying before the age of five has reached a new low – 5.6 million in 2016, compared with nearly 9.9 million in 2000 – the proportion of under-five deaths in the newborn period has increased from 41 per cent to 46 per cent during the same period. For the first time, the report also provides mortality estimates for children aged 5 to 14.
DEFINITION OF INDICATORS
Under-five mortality rate: Probability of dying between birth and exactly 5 years of age, expressed per 1,000 live births.
Infant mortality rate: Probability of dying between birth and exactly 1 year of age, expressed per 1,000 live births.
Neonatal mortality rate: Probability of dying during the first 28 days of life, expressed per 1,000 live births.
Probability of dying among children aged 5–14: Probability of dying at age 5–14 years expressed per 1,000 children aged 5.
DATA SOURCES AND METHODOLOGY
If each country had a single source of high-quality data covering the last few decades, reporting on child mortality levels and trends would be straightforward. But few countries do, and the limited availability of high-quality data over time for many countries makes generating accurate estimates of child mortality a considerable challenge.
Nationally representative estimates of child mortality can be derived from several sources, including civil registration, censuses and sample surveys. Demographic surveillance sites and hospital data are excluded because they are rarely nationally representative. The preferred source of data is a civil registration system that records births and deaths on a continuous basis, collects information as events occur and covers the entire population. If registration coverage is complete and the systems function efficiently, the resulting child mortality estimates will be accurate and timely. However, many countries remain without viable or fully functioning vital registration systems that accurately record all births and deaths—only around 60 countries have such systems. Therefore, household surveys, such as the UNICEF-supported Multiple Indicator Cluster Surveys and the US Agency for International Development–supported Demographic and Health Surveys, which ask women about the survival of their children, are the basis of child mortality estimates for most developing countries.
The United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) seeks to compile all available national-level data on child mortality, including data from vital registration systems, population censuses, household surveys and sample registration systems. To estimate the under-five mortality trend series for each country, a statistical model is fitted to data points that meet quality standards established by IGME and then used to predict a trend line that is extrapolated to a common reference year, set at 2016 for the estimates presented here. Infant mortality rates are generated by either applying a statistical model or transforming under-five mortality rates based on model life tables. Neonatal mortality rates are produced using a statistical model that uses national available data and estimated under-five mortality rates as input. Mortality rates among children aged 5–14 were produced by using a similar model as for under-five mortality. These methods provide a transparent and objective way of fitting a smoothed trend to a set of observations and of extrapolating the trend from the earliest available data point to the present. A more detailed explanation is available in the explanatory notes.
An overview on the methodology is available in this year’s UN IGME report.
To increase transparency of UN IGME’s methodology for child mortality estimation a peer-reviewed collection of articles is available through PLoS Medicine. Topics include: an overview of the child mortality estimation methodology developed by UN IGME, methods used to adjust for bias due to AIDS, estimation of sex differences in child mortality, and more. The collection was produced with support from UNICEF and the independent Technical Advisory Group of IGME. Read more.
More details on the data used in deriving estimates are available in CME Info http://www.childmortality.org.
- For a detailed description of the B3 methodology, see Alkema, L. and New, J.R. (2014). ‘Global estimation of child mortality using a Bayesian B-spline bias-reduction method’, Annals of Applied Statistics, Vol. 8, No. 4, 2122-2149. Available at http://arxiv.org/abs/1309.1602 [PDF].
- Full details of the methodology used in the estimation of child mortality for 2015 are available in the PLOS Medicine Collection on Child Mortality Estimation methods (ploscollections.org/childmortalityestimation).
- For changes to methods used for the 2016 estimates, refer to this years report.
Alkema, L. et al., ‘National, regional, and global sex ratios of infant, child, and under-5 mortality and identification of countries with outlying ratios: a systematic assessment’, The Lancet Global Health, vol. 2, 9, 1 September 2014, pp. e521-e530, DOI: 10.1016/S2214-109X(14)70280-3 Available at http://arxiv.org/abs/1309.1602 [PDF].
Alexander, M., and L. Alkema, ‘Global Estimation of Neonatal Mortality Using a Bayesian Hierarchical Splines Regression Model’, 2016, available at <https://arxiv.org/abs/1612.03561>.
You, D. et al. Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. The Lancet. 2015; 386: 2275–2286.
United Nations Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2017.
United Nations Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2015.
United Nations Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2014.
United Nations Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2013.
United Nations Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2012.
United Nations Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2011.
United Nations Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2010.
UNICEF, WHO, The World Bank and UN Population Division, Levels and Trends of Child Mortality in 2006: Estimates developed by the Inter-agency Group for Child Mortality Estimation’, New York, 2007.Working Paper [PDF]