Determinants of childhood mortality

Millennium development goal 4 calls for a reduction in the mortality rate in under 5s by two thirds between 1990 and 2015. Despite an impressive 47% drop in the global rate since 1990, the rate of decline is too slow to meet that target, particularly in sub-Saharan Africa and southern Asia.1 It is therefore important to know why some countries are making poor progress. Despite previous studies, there is no strong evidence base defining the determinants of cross country child mortality,2 3 4 5 6 which would be an important step towards developing effective policies to tackle high death rates. In a welcome contribution, the linked study by Hanf and colleagues (doi:10.1136/bmj.f6427) revisits the associations between global factors—such as socioeconomic conditions, health variables, and political contexts—and national rates of death in under 5s.7

The 10 year (2000-2009) longitudinal analysis tests for non-linear associations between the rate of deaths in under 5s and its determinants, allowing for the possibility that these associations are time dependent. As expected, the study confirms immediate associations between death rates among young children and factors such as national income, access to sanitation facilities, and …