Cause-specific childhood mortality in Africa and Asia: Evidence from INDEPTH health and demographic surveillance system sites

P. Kim Streatfield, Wasif A. Khan, Abbas Bhuiya, Syed M.A. Hanifi, Nurul Alam, Mamadou Ouattara, Aboubakary Sanou, Ali Sié, Bruno Lankoandé, Abdramane B. Soura, Bassirou Bonfoh, Fabienne Jaeger, Eliezer K. Ngoran, Juerg Utzinger, Loko Abreha, Yohannes A. Melaku, Berhe Weldearegawi, Akosua Ansah, Abraham Hodgson, Abraham OduroPaul Welaga, Margaret Gyapong, Clement T. Narh, Solomon A. Narh-Bana, Shashi Kant, Puneet Misra, Sanjay K. Rai, Evasius Bauni, George Mochamah, Carolyne Ndila, Thomas N. Williams, Mary J. Hamel, Emmanuel Ngulukyo, Frank O. Odhiambo, Maquins Sewe, Donatien Beguy, Alex Ezeh, Samuel Oti, Aldiouma Diallo, Laetitia Douillot, Cheikh Sokhna, Valérie Delaunay, Mark A. Collinson, Chodziwadziwa W. Kabudula, Kathleen Kahn, Kobus Herbst, Joël Mossong, Nguyen T.K. Chuc, Martin Bangha, Osman A. Sankoh, Peter Byass

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Background: Childhood mortality, particularly in the first 5 years of life, is a major global concern and the target of Millennium Development Goal 4. Although the majority of childhood deaths occur in Africa and Asia, these are also the regions where such deaths are least likely to be registered. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective: To present a description of cause-specific mortality rates and fractions over the first 15 years of life as documented by INDEPTH Network sites in sub-Saharan Africa and south-east Asia. Design: All childhood deaths at INDEPTH sites are routinely registered and followed up with verbal autopsy (VA) interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provided persontime denominators for mortality rates. Cause-specific mortality rates and cause-specific mortality fractions are presented according to WHO 2012 VA cause groups for neonatal, infant, 1-4 year and 5-14 year age groups. Results: A total of 28,751 childhood deaths were documented during 4,387,824 person-years over 18 sites. Infant mortality ranged from 11 to 78 per 1,000 live births, with under-5 mortality from 15 to 152 per 1,000 live births. Sites in Vietnam and Kenya accounted for the lowest and highest mortality rates reported. Conclusions: Many children continue to die from relatively preventable causes, particularly in areas with high rates of malaria and HIV/AIDS. Neonatal mortality persists at relatively high, and perhaps sometimes underdocumented, rates. External causes of death are a significant childhood problem in some settings.

Original languageEnglish
Article number25363
JournalGlobal Health Action
Issue number1
Publication statusPublished - 1 Jan 2014
Externally publishedYes

Bibliographical note

This is an Open Access article distributed under the terms of the Creative Commons CC-BY 4.0 License (, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.


  • Africa
  • Asia
  • Childhood
  • INDEPTH Network
  • InterVA
  • Mortality
  • Verbal autopsy


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