Mortality, Infant

doi:10.1016/B978-012370877-9.00084-0

Encyclopedia of Infant and Early Childhood Development

2008, Pages 343-359

https://doi.org/10.1016/B978-012370877-9.00084-0 Get rights and content

Over 10 million infants and children under 5 years of age die each year. Over 99% of these deaths occur in the developing countries and the least developed countries. Under-5 mortality rates range from 3 deaths per 1000 live births in Iceland and Sweden to over 250 deaths per 1000 live births in Afghanistan, Niger, Angola, and Sierra Leone. In 2000, the United Nations Millennium Declaration established a goal of a two-thirds reduction in under-5 mortality rate between 1990 and 2015. With only 10 years left the rate had been reduced from 95 deaths per 1000 live births to 76 deaths per 1000 live births in 2005, a 20% reduction. Latin American and East Asian countries have shown a 43% decline; the Middle East and North African countries and South Asia have had declines of 33–35%; by contrast, sub-Saharan Africa has had a decrease of only 10%.

Most infant and early childhood deaths can be prevented by inexpensive measures such as nutritional support to the pregnant mother, access to clean water, immunization against childhood infectious diseases, provision of a skilled attendant at birth, treatment of diarrhea and dehydration with oral rehydration fluid, and implementation of malarial control measures including insecticide treated bed nets. Improvement in socioeconomic status results in improvement in infant in childhood mortality but just as important is the political will within a nation to provide support for women and children. Conversely, war, sociopolitical deterioration, and the HIV/AIDS epidemic have increased infant and childhood mortality from 1990 to 2005 as exemplified by Iraq, Zimbabwe, and Botswana.

Historically, infant mortality in developed countries first improved when standards of living increased and infectious disease mortality decreased. More recently, advances in obstetric and neonatal care for high-risk pregnancies and premature infants have reduced neonatal mortality rates to as low as 3 per 1000 live births. ‘Back to sleep’ and other risk reduction strategies have cut the incidence of sudden infant death syndrome by 50% and more since 1990. Despite these advances, even in developed countries there remain disadvantaged subgroups and at-risk populations with significantly higher infant and child mortality rates.

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Cited by (18)

Early life environments and cognition in adulthood: New evidence using a semiparametric approach and quantile regression
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Citation Excerpt :
Specifically, we hypothesize that advances in obstetric and neonatal care for high-risk pregnancies and preterm births improved the cognition of adults because the recent decline in infant mortality rates in developed countries is primarily due to the technological development in these medical fields (Andrews et al., 2008). By contrast, an increase in standards of living and a decrease in infectious disease, which are the causes of the decline in infant mortality rate in early stage (Andrews et al., 2008), may be less important for later life cognition. Further, we also investigated how associations between infant mortality rates and later life cognition are contingent upon the level of cognition.
Theories and empirical evidence document the importance of early life environmental factors on later life cognition. A next question is how and in what dimension associations between early life environments and later life cognition vary. Using data from the UK Biobank in conjunction with time-place-specific infant mortality rates, we assessed heterogeneous and non-linear associations between early life conditions and later life cognition. We found that the association between the infant mortality rate and later life cognition increased once the UK achieved very low infant mortality rates, suggesting that additional decreases in infant mortality rates in an industrialized society continue to improve later life cognition. We also found that infant mortality rates have stronger effects at upper quantiles of the cognition distribution. This implies that adverse early life environments may have an important role for an early manifestation of cognitive aging.
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Kathryn Andrews, originally of Portland, Maine, USA, completed a BSc in the ecological determinants of health with the McGill School of Environment in 2006. She has also studied at the Australian National University in the school of resources, environment, and society, where she undertook field research on acid sulfate soils and agricultural techniques. Her most recent work has been on a groundbreaking multimedia instructional CD-ROM on safer sex, contraception, and pregnancy with the McGill Medical Informatics and McGill Health Promotion Office. She is currently in medical school at McGill University, Montréal.

Daniel Brouillette graduated from McGill University with a major in biology in 2006. He has since worked for McGill's Department of Physical and Occupational Therapy conducting systematic reviews on cerebral palsy rehabilitation. In addition, he developed an evidence-based knowledge transfer system titled CP Engine. Presently, Daniel is working at the Douglas Hospital and Research Center in Montréal, Canada where he is studying the effect of sleep on the symptoms of pediatric attention deficit hyperactivity disordered patients.

Robert Brouillette was born in Washington, DC, studied at Providence College, where he obtained a bachelor’s degree in biology; taught fifth grade in Indianapolis; obtained his medical degree at Washington University, St. Louis, 1974; completed pediatric residency, neonatal fellowship and postdoctoral research training in infant apnea and control of breathing at Washington University, 1979; pediatric and neonatal faculty, Northwestern University, 1979–89; he has held various posts at McGill University including division head for neonatology and pediatric respiratory medicine, vice chairman of pediatrics, and currently associate director for Clinical Research, McGill University Health Center, 1989–present. He is director of the Jeremy Rill Center for Sudden Infant Death Syndrome and Respiratory Control Disorders. He has published over 100 peer-reviewed papers and reviews, many relating to obstructive sleep apnea in children, other control of breathing disorders, and neonatal respiratory problems.

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