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Top 10 countries with most improved child mortality rates

BOSTON — Children are living longer, according to a new study that shows global child mortality rates have dropped 35 percent over the past two decades.

Ethnic Dao children from Vietnam's northern Bac Kan province.
Ethnic Dao children from Vietnam’s northern Bac Kan province.

BOSTON — Children are living longer, according to a new study that shows global child mortality rates have dropped 35 percent over the past two decades.

An estimated 11.9 million children under age 5 died in 1990, compared with 7.7 million infant deaths in 2009, according to the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, which released its report Sunday. But where the rest of the world is seeing fast improvements, the United States lags behind in reducing child deaths.

The 2009 total consists of 3.1 million deaths during birth, 2.3 million deaths in the first year, and 2.3 million deaths of children aged 1 year to 4 years. The study includes new data and increased accuracy from past estimates, said Julie Knoll Rajaratnam, the lead author of the study and assistant professor of Global Health.

In 1990, 12 countries had an under-5 mortality rate of more than 200 deaths per 1,000 live births. Today, no country has an under-5 mortality rate that high, according to IHME estimates. In Ethiopia, the under-5 mortality rate in 1990 was 202 per 1,000 live births, one of the highest rates in the world. Over the next two decades that fell by half, to 101 per 1,000.

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Dr. Christopher Murray, IHME director and one of the paper’s co-authors, credited three reasons for the decline in mortality rates: improved maternal education; efforts to curb mother-to-child HIV/AIDS transmission; and increased childhood disease intervention, such as mosquito nets and drugs.

“IHME has found that the amount of spending on global health programs has shot up over the past 20 years to a total of more than $200 billion,” Dr. Murray said in an email response to questions from the Monitor. “The spending has funded childhood immunization programs, bed net distribution programs and antiretroviral drug programs to combat HIV/AIDS.”

The study shows that 31 developing countries are on pace to reduce child deaths by 66 percent in 2015 compared to 1990 levels.

Even countries with low childhood mortality rates to start with have continued to see mortality declines, according to the study. Singapore had a child mortality rate of 8 per 1,000 live births in 1990, but by 2010, that rate had dropped to 2, the lowest in the world.

Only Swaziland, Lesotho, Equatorial Guinea, and Antigua and Barbuda saw increases in child mortality between 1990 and 2010.

The United States had 11.6 deaths per 1,000 children under 5 in 1990. That declined to 6.7 deaths per 1,000 children in 2009. Over 120 other countries saw steeper gains and the US still has a higher infant mortality rate than most of Europe, including Estonia and Croatia.

“Some high-income countries, including the United States, have seen an increase in health disparities across racial and economic groups,” Dr. Murray says. “You can see the effects of this especially in newborns, where high quality obstetrical care is crucial. Globally, about 40 percent of all deaths of children under 5 happen in newborns. In the US, about 60 percent of all child deaths are newborns.”

He adds: “We have to ask whether it’s acceptable that the US, which spends more on health care than any country in the world, has a child mortality rate that is more than three times as high as Singapore and a newborn mortality rate that is four times as high. As federal health reform programs roll out, this is an opportunity for the US to look for ways to improve.”