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While cause-specific mortality may be difficult to accurately ascertain, many childhood deaths in developing countries can be attributed to five main causes, or a combination of the causes: acute respiratory infection, diarrhoea, measles, malaria and malnutrition.


WHO - Multicountry Evaluation

An Uncertain Divide: Under-five deaths by cause
Estimates of under-five deaths by cause are important for targeting interventions to reduce child mortality and to monitor progress. Although the total of under-five deaths is relatively well known, the proportion related to each cause is much more uncertain and hence no numbers are used on the chart. There are several reasons. First, vital registration systems that provide cause of death data in industrialised countries do not exist in most developing countries. Second, children often die from multiple causes, and deciding which is the primary cause can be difficult. In addition, malnutrition is associated with half the deaths. Third, small-scale studies must be used to estimate cause for the majority of under-five deaths. Most of these studies refer to the first half of the 1990s and earlier, and hence provide no data on changes in the last half of the decade. As an example of the uncertainty, estimates for measles deaths vary between 1% and 8%

Acute Respiratory Infection (ARI)
ARI is a leading cause of mortality in children under the age of five in developing countries. Respiratory infections caused by viruses or bacteria, can manifest in any area of the respiratory tract, including the nose, middle ear, throat, voice box, air passage, and lungs. Respiratory syncytial virus (RSV) and parainfluenza virus type 3 are the main causes of acute respiratory infection in early childhood. Pneumonia, an infection of the lungs, is the most serious respiratory infection and often can be treated with affordable oral antibiotics since the primary cause of infection is bacteria. Children suffering from other conditions, such as malnutrition or measles, are particularly susceptible to pneumonia. To prevent deaths when children develop ARI, it is crucial that the signs are recognised - a cough accompanied by difficult or short, rapid breathing - and that appropriate health care is sought immediately.

Diarrhoeal Disease
Diarrhoea remains one of the major causes of death among the world's children. Most die of dehydration - the loss of large quantities of water and salt from the body. Many of these deaths can be prevented with the use of oral rehydration therapy (ORT) at first onset of diarrhoea. Diarrhoea is caused by ingesting certain bacteria, viruses or parasites found in faecal matter which may be spread through water, food, hands, eating and drinking utensils, flies, and dirt under fingernails. Diarrhoea may present in different forms and have various treatment protocols: persistent diarrhoea (more than 14 days), acute watery diarrhoea, or dysentery (blood in stool). Other diseases that can occur concurrently with diarrhoea include measles and malaria. Malnutrition also often accompanies diarrhoea.

Measles is a highly contagious disease caused by a virus which is spread easily from one person to another through the air when an infected person coughs or sneezes and a susceptible person inhales the organism. Symptoms include fever, runny nose, cough, and sore eyes, followed by a blotchy rash usually starting on the face and spreading down the body. Children with measles are susceptible to pneumonia. The best protection against measles is immunisation. In addition, vitamin A supplements have been found to reduce the severity of both measles and diarrhoea.

Malaria is a widespread tropical disease caused by a parasite transmitted to humans by mosquitoes. Young children are particularly vulnerable because they have not developed the partial immunity that results from surviving repeated infections. The disease may occur year-round or seasonally. Symptoms of malaria include fever with shivering and sweating, headache, and pain in the back, joints, or body. There may also be loss of appetite, cough, vomiting, and diarrhoea, however fever may be the only sign of malaria, making it difficult to distinguish. Malaria may cause several weeks or months of poor health due to repeated attacks of fever, anaemia, and general weakness. Children can deteriorate rapidly over 1-2 days, becoming very ill, going into coma (cerebral malaria) or shock, or manifesting convulsions, severe anaemia and acidosis. Malnutrition should be recognised as possible co-existing condition. Prevention methods for malaria include the use of insecticide-impregnated bednets in endemic areas. In most cases, children with malaria can be quickly and effectively treated with a course of inexpensive, oral anti-malarial tablets that are appropriate for the area (i.e. without parasitic drug resistance).

Malnutrition contributes to about half of all childhood deaths. Poor feeding practices - inadequate breastfeeding, offering the wrong foods at the wrong age, and giving food in insufficient quantities - contribute to malnutrition. Infection, particularly frequent or persistent diarrhoea, pneumonia, measles and malaria, also undermines nutritional status, leaving malnourished children even more vulnerable to disease. Efforts to prevent malnutrition include the promotion of breastfeeding, the improvement of feeding practices, and the provision of routine micronutrient supplements for children who need them.

Data sources

Childinfo: UNICEF's statistics.
Macrointernational, for DHS surveys

World bank data sources (includes MDGs) - specifically on childhood development , health Documentation