News

Missing in the middle

Tracy Parish

08 January, 2019

588 missing

Young boys in Mozambique.

Below is an extract from Burnet’s latest IMPACT magazine by Professor George Patton, Murdoch Children’s Research Institute and Dr Pete Azzopardi, Burnet Institute.

In summary:

  • Premature death remains pivotal in health measurement
  • Despite its importance, we measure mortality poorly in most places
  • Half of all deaths in children aged 5–14 now occur in seven countries
  • Global coverage by civil registration and vital statistics (CRVS) systems is only 38 per cent
  • Deaths in older children and younger adolescents continue to receive little attention.

Premature death remains pivotal in health measurement. Mortality measures attract political attention as indicators of social and economic progress and figure prominently in the United Nations’ (UN) Millennium Development Goals (MDGs).

Despite its importance, we measure mortality poorly in most places; global coverage by civil registration and vital statistics (CRVS) systems is only 38 per cent, and around a third of these deaths are captured on poor-quality systems. Progress in CRVS systems has been glacial. The global coverage of deaths registered in 2015 increased by only two per cent from 2000. Deaths in older children and younger adolescents continue to receive little attention.

Globally, economic development and demographic change has been accompanied by an epidemiological transition that has brought mortality improvements in children younger than five years relative to those of older children. The resulting reversal in age-related mortality patterns in many countries means that it is timely to focus greater attention on mortality in older children and younger adolescents.

In their study in The Lancet Global Health, Professor Bruno Masquelier and colleagues from the UN Interagency Group for Child Mortality Estimation provided valuable new estimates of mortality in children aged 5–14 years from 1990 to 2016. Mortality during these middle years of childhood is considered to be low relative to that of younger children and older adolescents. Global measurement systems have therefore been focused elsewhere, resulting in weak primary data at a point in life where there is a developmental shift in causes of death.

Puberty is a time when gender and socioeconomic differences in mortality emerge. These social determinants are likely to affect mortality differently in different places, meaning that sound primary data are essential, instead of relying on extrapolation from mortality estimates in younger children or adults.

Notably, more than half of all deaths in children aged 5–14 now occur in seven countries, with the overall burden moving over time to sub-Saharan Africa; both slower decreases in mortality and demographic shifts have contributed to this excess in mid-childhood mortality in Africa.

Further progress will require better primary data on all-cause mortality and causes of death, on which good data are even scarcer. Masquelier and colleagues suggest greater sharing of microdata, extending the use of sibling histories (on the survival of brothers and sisters), and greater use of censuses.

The number of deaths from maternal causes or due to violence or road traffic injuries is also likely to differ from those at older ages, suggesting value in extending observational efforts to these younger groups.

The improved use of existing data in the study by Masquelier and colleagues brings us a step forward in understanding mortality in these neglected middle years of childhood.

  • Extract from The Lancet Global Health, Vol 6, Issue 10, Oct 1, 2018

  • Click here for the full Summer 2018 edition of IMPACT

Contact Details

For more information in relation to this news article, please contact:

Associate Professor Peter Azzopardi

Co-Head of Adolescent Health

Email

peter.azzopardi@burnet.edu.au

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