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Patterns and trends in causes of child and adolescent mortality 2000–2016: setting the scene for child health redesign
  1. Kathleen L Strong1,
  2. Jon Pedersen2,
  3. Emily White Johansson3,
  4. Bochen Cao4,
  5. Theresa Diaz1,
  6. Regina Guthold1,
  7. Danzhen You5,
  8. Jennifer Requejo5,
  9. Li Liu6
  1. 1 Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
  2. 2 Lead Consultant, !Mikro Consulting, Oslo, Norway
  3. 3 Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
  4. 4 Data Analytics and Delivery, World Health Organization, Geneve, Switzerland
  5. 5 Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, New York, USA
  6. 6 Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Kathleen L Strong; strongk{at}


The under-5 mortality rate has declined from 93 deaths per 1000 live births in 1990 to 39 per 1000 live births in 2018. This improvement in child survival warrants an examination of age-specific trends and causes of death over time and across regions and an extension of the survival focus to older children and adolescents. We examine patterns and trends in mortality for neonates, postneonatal infants, young children, older children, young adolescents and older adolescents from 2000 to 2016. Levels and trends in causes of death for children and adolescents under 20 years of age are based on United Nations Inter-agency Group for Child Mortality Estimation for all-cause mortality, the Maternal and Child Epidemiology Estimation group for cause of death among children under-5 and WHO Global Health Estimates for 5–19 year-olds. From 2000 to 2016, the proportion of deaths in young children aged 1–4 years declined in most regions while neonatal deaths became over 25% of all deaths under 20 years in all regions and over 50% of all under-5 deaths in all regions except for sub-Saharan Africa which remains the region with the highest under-5 mortality in the world. Although these estimates have great variability at the country level, the overall regional patterns show that mortality in children under the age of 5 is increasingly concentrated in the neonatal period and in some regions, in older adolescents. The leading causes of disease for children under-5 remain preterm birth and infectious diseases, pneumonia, diarrhoea and malaria. For older children and adolescents, injuries become important causes of death as do interpersonal violence and self-harm. Causes of death vary by region.

  • child health
  • epidemiology
  • public health

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  • Handling editor Seye Abimbola

  • Contributors All authors contributed to the overall concept of the paper. JP and KLS performed the analysis. EWJ and KLS wrote the initial draft of the manuscript. KLS, JP, EWJ, TD, RG, BC, JR, DY and LL revised the manuscript and accepted in final form.

  • Funding Analyses and initial manuscript were funded by the Bill & Melinda Gates Foundation.

  • Disclaimer The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Data are available upon request. Data are published on the WHO Global Health Observatory. Further disaggregated data are available upon request to the corresponding author.