The United States is one of 8 countries where child and adolescent health has improved but maternal mortality has worsened

The United States is one of eight countries in the world where the decline in infant and adolescent mortality over a 27-year period has not been accompanied by a reduction in maternal mortality, according to a new scientific study.

This divergent trend was also seen in American Samoa, Canada, Greece, Guam, Jamaica, Saint Vincent and the Grenadines and Zimbabwe. Among these countries, the United States recorded the highest increase in the maternal mortality rate at 67.5%.

“Our findings are particularly alarming because the health of children is very closely linked to that of their mothers,” said Dr Nicholas Kassebaum, lead author of the study and adjunct associate professor at the Institute for Health Metrics and Evaluation (IHME ) at the University of Washington School of Medicine. “This paradox warrants further investigation in the United States to determine how we can prioritize improvements in maternal health alongside those of children and adolescents.”

Kassebaum pointed out that the study also identifies uneven progress in child and adolescent health over the 27-year study period, with inequalities increasing between countries with the lowest socio-demographic index (SDI) scores. highest and lowest. The IDS, a measure of development, takes into account per capita income, adult education and the synthetic fertility index of women under 25 years of age.

For example, the results show that the gap between top and bottom performers has widened. Low and medium SDI countries recorded 82.2% of all child and adolescent deaths, up from 70.9% in 1990.

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

Researchers have found that children today are more likely than ever to reach their 20th birthday due to substantial reductions in mortality. Child and adolescent deaths have been halved between 1990 and 2017, from 13.8 million to 6.6 million. These dramatic gains were largely due to global declines in deaths from diarrhea, lower respiratory tract infections and other common infectious diseases, particularly among children aged 1 to 4, who experienced the fastest reduction in mortality.

Despite this considerable progress, lower respiratory tract infections, diarrhea and acute malnutrition remained among the leading causes of death of children and adolescents worldwide in 2017. In addition, HIV/AIDS remains an imminent threat. for the health and well-being of older children and adolescents in many countries. countries in sub-Saharan Africa, including South Africa, Zimbabwe, Lesotho, Swaziland, Botswana and Zambia.

With the reduction in mortality from communicable diseases, many middle- and high-income countries have experienced increased health losses from non-communicable diseases (NCDs) such as congenital birth defects, mental and behavioral disorders and asthma. Injuries also continue to be a leading cause of early mortality and long-term disability in older children and adolescents in all countries.

“An emerging threat is the large and growing burden of mental health and substance use disorders in older children and adolescents around the world,” said Dr. Bobby Reiner, lead author of the study and assistant professor at the IHME. “As more children survive infancy, already overstretched health systems will have to adapt to the challenge of tackling non-communicable diseases in older children and adolescents.”

Reiner also noted that few countries showed evidence of improvements in adolescent health over the 27-year period beyond what was expected with overall gains in societal development.

Additional findings include:

  • More than half of the 6.64 million deaths in 2017 occurred in infants under the age of one, and of these, 47% occurred in the first week of life.
  • There were a total of 50 countries where the likelihood of death from self-harm and interpersonal violence increased between 1990 and 2017.
  • In all countries in sub-Saharan Africa, neonatal disorders, malaria or HIV/AIDS were the leading cause of disability-adjusted life years (DALYs), with diarrhea or lower respiratory tract infections often occurring in second position.
  • In 2017, the top 10 causes of years lived with disability (YLD) worldwide were iron deficiency anemia, vitamin A deficiency, headache, conduct disorder, neonatal disorder, anxiety disorder, skin diseases, lower back pain, congenital disorders and depression.
  • YLD rates decreased only slightly between 1990 and 2017 and increased with age.


Under 20

  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


Under 20

  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


Under 20 – biggest drop

  1. Serbia: -86.9% (4,839 to 636 deaths)
  2. Armenia: -86.6% (3,836 to 514)
  3. Estonia: -86.5% (611 to 82)
  4. China: -85.0% (1,629,696 to 243,609)
  5. Maldives: -84.8% (488 to 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)

Under 20: biggest 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% (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 versus 301)
  9. Afghanistan: 4.2% (96,809 to 100,823)
  10. United Arab Emirates: 2.8% (1,431 to 1,471)

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