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USA 1 out of 8 nations where child and adolescent health improved, but maternal mortality worsened

SEATTLE – The United States is one of eight countries in the world where reducing child and adolescent mortality over a 27-year period has also not been accompanied by reductions in maternal mortality, according to a new scientific study.

This divergent trend has also been found in American Samoa, Canada, Greece, Guam, Jamaica, Saint Vincent and the Grenadines, and Zimbabwe. Of these countries, the United States had the largest increase in the maternal mortality rate at 67.5%.

"Our findings are particularly alarming because the health of children is closely linked to that of their mothers," said Dr. Nicholas Kassebaum, senior author of the study and associate professor at the Institute for Measuring and Evaluating Health (IHME). University of Washington School of Medicine. "This paradox warrants further investigation in the United States to determine how we can prioritize improvements in the health of mothers along with those of children and adolescents."

Kassebaum emphasized that the study also identifies unequal progress in the health of children and adolescents over the 27-year study period, with inequality increasing among countries with the highest and lowest scores on the Socio-demographic Index (SDI). SDI, a development measure, takes into account per capita income, adult education and the total fertility rate for women under 25 years of age.

For example, the findings show that the gap between the best and the worst performers has increased. Low SDI and low SDI countries experienced 82.2% of all child and adolescent deaths, compared with 70.9% in 1990.

Published today in the international medical journal JAMA Pediatrics, the study covers 1990 to 2017 and 195 countries and territories. A part of the Global Burden of Disease (GBD) study, this new analysis is a comprehensive effort to quantify internationally the health of children and adolescents. The results are presented for the collective age range from birth to age 19, but also separately for neonates, infants, children and adolescents. The authors of the study defined infants less than 28 days old, infants less than 1 year old, children under 10 years of age and adolescents between the ages of 10 and 19 years.

Researchers have found that children today are more likely than ever to reach their 20s as a result of substantial reductions in mortality. Child and adolescent deaths fell by half between 1990 and 2017, dropping from 13.8 million to 6.6 million. These dramatic gains were largely due to the overall decline in deaths from diarrhea, lower respiratory infections, and other common infectious diseases, especially among children 1 to 4 years old, who saw the most rapid reduction in mortality.

Despite this considerable progress, lower respiratory infections, diarrhea and acute malnutrition remained among the top killers of children and adolescents worldwide by 2017. In addition, HIV / AIDS remains an imminent threat to the health and well-being of children and older adolescents. Sub-Saharan Africa, including South Africa, Zimbabwe, Lesotho, Swaziland, Botswana and Zambia.

With the reduction of mortality from communicable diseases, many middle- and upper-income countries have experienced an increase in health loss due to noncommunicable diseases (NCDs), such as birth defects, mental and behavioral disorders, and asthma. Lesions also continue to be a major cause of early mortality and long-term disability among older children and adolescents in all countries.

"An emerging threat is the large and growing burden of mental health and substance use disorders among older children and adolescents around the world," said Dr. Bobby Reiner, lead author of the study and assistant professor at IHME. "As more children survive childhood, overburdened health systems will need to adapt to the challenge of addressing noncommunicable diseases among older children and adolescents."

Reiner also noted that few countries have shown any evidence of health improvements among adolescents over the 27-year period beyond that expected with overall gains in societal development.

Additional results include:

  • More than half of the 6.64 million deaths occurred in 2017 occurred in children under 1 year of age, and of these, 47% occurred in the first week of life.
  • There were a total of 50 countries where the probability of death from self-harm and interpersonal violence increased between 1990 and 2017.
  • All sub-Saharan African countries had neonatal disorders, malaria or HIV / AIDS as the leading cause of disability-adjusted life years (DALYs), with diarrhea or lower respiratory infections often secondarily.
  • In 2017, the 10 leading causes of years of disability (YLDs) worldwide were iron deficiency anemia, vitamin A deficiency, headache, behavioral disorders, neonatal disorders, anxiety, skin disorders, low back pain, disorders congenital and depression.
  • Rates of YLDs decreased only slightly between 1990 and 2017 and increased with age.

The study is entitled "Diseases, Injuries and Risk Factors in Child and Adolescent Health, 1990 to 2017".


Less than 20 years

  1. India: 1,299,265 deaths
  2. Nigeria: 866,170
  3. Pakistan: 421,784
  4. Democratic Republic of the Congo: 286,991
  5. China: 243,609
  6. Ethiopia: 232,389
  7. Indonesia: 147,791
  8. Bangladesh: 143,528
  9. Tanzania: 138,382
  10. Mali: 113,600


Less than 20 years

  1. India: 3,399,581 deaths
  2. China: 1,629,696
  3. Nigeria: 877,069
  4. Bangladesh: 654,730
  5. Pakistan: 601,805
  6. Ethiopia: 471,391
  7. Indonesia: 470,377
  8. Democratic Republic of the Congo: 299,385
  9. Brazil: 267,476
  10. Tanzania: 188,343


Less than 20 years – greater reduction

  1. Serbia: -86.9% (4,839 to 636 deaths)
  2. Armenia: -86.6% (3,836 to 514)
  3. Estonia: -86.5% (611-82)
  4. China: -85.0% (1,629,696 to 243,609)
  5. Maldives: -84.8% (488-74)
  6. Latvia: -84.5% (1,066 to 165)
  7. Albania: -84.0% (4,070 to 651)
  8. Portugal: -83.5% (3,013 to 499)
  9. South Korea: -82.7% (14,748 to 2,545)
  10. Romania: -82.3% (13,607 to 2,411)

Less than 20 years – highest increase

  1. Papua New Guinea: 40.5% (12,624 to 17,736)
  2. Vanuatu: 36.1% (238 to 324)
  3. Chad: 31.0% (67,124 to 87,908)
  4. Central African Republic: 24.3 per cent (21,360 to 26,545)
  5. Zimbabwe: 12.5% ​​(28,549 to 32,117)
  6. Iraq: 10.8% (40,510 to 44,894)
  7. South Sudan: 9.2% (48,460 to 52,897)
  8. Qatar: 4.9% (287 to 301)
  9. Afghanistan: 4.2% (96,809 to 100,823)
  10. United Arab Emirates: 2.8% (1,431 to 1,471)


Media Contacts:

IHME: Kelly Bienhoff, + 1-206-897-2884 (office); + 1-913-302-3817 (mobile);

IHME: Dean Owen, + 1-206-897-2858 (office); + 1-206-434-5630 (mobile);

JAMA: Jim Michalski, + 1-312-464-5786 (office);

Available for review:

Dr. Nicholas Kassebaum, Assistant Professor of Science at Metrics Health, IHME;

Dr. Bobby Reiner, Assistant Professor of Health Metrics Sciences, IHME,

About the Institute for Health Metrics and Evaluation

The Institute of Measurement and Health Assessment (IHME) is an independent global health research organization at the University of Washington that provides rigorous and comparable measures of the world's most important health problems and evaluates the strategies used to address them. The IHME is committed to transparency and makes this information widely available so that policy makers have the evidence they need to make informed decisions about resource allocation to improve the health of the population.

About the Global Burden of Disease

The Global Burden of Disease (GBD) study is the largest and most comprehensive effort to quantify health loss everywhere and over time. It is based on the work of more than 3,600 employees from 146 countries and territories. The Institute of Health Metrics and Evaluation coordinates the study. The GBD 2017 study was published in November 2018 and includes more than 38 billion estimates of 359 diseases and injuries and 84 risk factors in 195 countries and territories.

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