Achieving millennium development goal 4 in 2015: are we really on track?

Abstract

INTRODUCTION: Millennium development goal (MDG) 4 aims to reduce under 5 mortality by two thirds from 1990 (22.2 per 1000 live births) to 2015 (7.4 per 1000 live births). In achieving this, proper and accurate description of the causes of deaths is crucial. OBJECTIVES: To describe the timing, causes and distribution of under 5 child deaths in Sri Lanka and to predict the likelihood of achieving MDG 4. DESIGN, SETTING AND METHOD: Information regarding all under 5 child deaths between 2002-2006 was obtained from the Registrar Generals' Department. Place, sex and age at death were retrieved. Causes of deaths documented accordingly to the ICD-10 classification were reclassified into clinically relevant and user-friendly categories. Mortality rates and predictions for 2015 were calculated using Microsoft Excel. RESULTS: A total of 26,273 deaths have occurred during 2002-2006 [55% neonatal, 21% post-neonatal infant and 24% child (l-5year)]. Tsunami wave in 2004 had caused 2,868 (11%) deaths and they were excluded from further analysis. Prematurity had caused 4,603 (31.8%) neonatal deaths; 2389 (16.5%) were due to infections and 1149 (7.9%) were due to birth asphyxia. Congenital anomalies have contributed to 1830 (12.6%) neonatal deaths, of which, the majority [1389 (9.6%)] were heart diseases. Leading causes for post-neonatal infant deaths include congenital anomalies [1772 (35%)], infections [1516 (29.9%)] and trauma [393 (7.7%)]. in children, 910 (23.4%) deaths were due to infections (10.2% respiratory, 2.0% gastroenteritis and 0.9% dengue). One fifth of deaths were due to congenital anomalies of which half were due to heart defects. Trauma/ accidents and malignancies had contributed to 731 (18.8%) and 279 (7.1%) deaths respectively. Colombo district reported the highest number of deaths (24%). More males (54.7%) have died compared to females. Reduction in mortality rates were observed from 2002-2006; neonatal mortality from 8.3 to 7.6, infant mortality from 11.4 to 10.4 and under 5 mortality from 13.7 to 12.3. Projections of data showed that the neonatal, infant and under 5 mortality rates in 2015 would be 4.6, 6.7 and 7.7 per 1000 live births respectively. CONCLUSIONS: Prematurity was the leading cause of neonatal mortality. Congenital heart diseases are an important cause of death throughout childhood. Trauma and accidents contribute to a significant proportion of child deaths. Predictions from data suggest that Sri Lanka may fall marginally short of achieving MDG 4.