Information to guide child health policy is lacking in the poorest countries with the highest rates of childhood mortality

Information to guide child health policy is lacking in the poorest countries with the highest rates of childhood mortality, concludes a study in this week’s issue of The Lancet.

Around 10.8 million children die worldwide each year. Credible global and national estimates of the burden of disease in childhood are essential for the development of appropriate health policy and implementation of health interventions to prevent these deaths.

Harry Campbell (University of Edinburgh Medical School, Edinburgh, UK) and colleagues undertook a review of published and unpublished data on the major causes of illness and death (pneumonia, diarrhoea, malaria, and neonatal disorders) in children younger than 5years published between 1980 and 2001. The investigators only included studies likely to provide unbiased estimates of the burden childhood disease in the community. They found 17 000 relevant reports. Only 232 studies on mortality and illness had sufficiently reliable data to form the basis for producing global estimates of the burden of child illness and mortality by cause. The investigators found that information was lacking in large areas of the world, including southern and central Africa, some regions of southeast Asia, and countries of the eastern Mediterranean region, despite these areas having a large proportion of the world’s child population. They found no relevant information in nine of the 25 countries with the highest numbers of deaths in children younger than 5 in the year 2000. The also found that the number of new studies diminished over the last 10 years investigated, suggesting that less money was being spent on this area of research.

Professor Campbell states: “Our review draws attention to striking gaps in information about the burden of childhood disease, especially in the poorest countries with the highest rates of child mortality. Our findings also highlight the need to invest in health research to obtain data for burden of disease (both mortality and morbidity) from regions of the world where such information does not exist...If investment is not targeted at plugging gaps in knowledge about the burden of childhood disease in less developed countries for the long term, one is forced to pose the question - do poor children count?"

In an accompanying Editorial The Lancet comments: “Identifying and tracking trends in morbidity and mortality and other health indicators are essential functions if the health of people living in the developing world is to be improved. Without such data, we will continue to stumble around in the dark, making bad decisions on the basis of bad information."