Winifred Bosa, Lagos.

Undoubtedly child mortality is falling, and the world should be proud of this progress said the Lancet, in detailed findings on the latest state of global child mortality.

Within the past 100 years, expectations around child mortality (and susequently family size) have changed substantially, starting in countries that industrialised earlier and more recently pervading most of the world.

According to Li Liu and colleagues who lead the findings , in 2015, among the 5·9 million under 5 deaths, 2·7 million are now estimated to occur in the narrow time window of the neonatal period (first 28 days of life), mainly around delivery or due to subsequent infections.

They report that the leading under-5 causes of death were preterm birth complications (1·055 million), pneumonia (0·921 million), and intrapartum related events (0·691 million).

Sub-Saharan Africa and Asia account for more than 80% of all under-5 deaths, with post-neonatal deaths mainly attributable to childhood infections and injuries. Reductions in mortality from pneumonia, diarrhoea, neonatal intrapartum related events, malaria, and measles were responsible for 61% of the total reduction of 35 per 1000 livebirths in under-5 mortality rates in 2000–15.

They also observed that estimated numbers of child deaths are important, but are not very useful unless they are continually probed, interpreted, and applied into health policy solutions.

The UN Millennium Development Goals (MDGs), specifically MDG 4, have rightly focused considerable attention on child mortality in recent years. Although Liu and colleagues acknowledge that the goal of a two-thirds reduction in under-5 child mortality from 1990 to 2015 did not happen globally, more nuanced consideration needs to be applied to understand changing patterns of child mortality.

Global goals and targets tend to be set on a one-size-fits-all basis, as was the case with the MDGs. However, there are notable exceptions. In 1990, South Africa had the lowest under-5 mortality rate in the sub-Saharan region, then encountered a massive HIV pandemic, but subsequently achieved a substantial improvement in child mortality towards the end of the MDG period. Using in-country data to reveal the details, this was dubbed “a successful failure’” in terms of MDG 4.4 Additionally, country-level estimates could well obscure major geographical or socioeconomic inequalities in mortality that might well exceed intercountry differences.

In view of the substantial efforts that go into assessing global patterns of childhood mortality, it is important to consider additional creative ways of using and interpreting such findings. As well as the obvious need to monitor levels and trends of mortality over time and hold governments to account, mortality rates might also provide crucial pointers to other health and disease issues at the population level.