By A Staff Reporter

Kathmandu, Oct. 18

An unprecedented study mapping child deaths over almost two decades has found that the likelihood of a child reaching age 5 varies more than two-fold among districts in Nepal.

According to the study conducted by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine, 18,698 children died before their fifth birthdays in 2017, as compared to 58,633 in 2000.

The highest mortality rate in 2017 was 57.2 per cent in Karnali. The lowest was 21.3 per cent in Bagmati. Neonatal disorders were the biggest cause of deaths before age 5 in both 2000 and 2017, according to the Global Burden of Disease study, but the total number of deaths from these disorders halved during the study period. 

The study is the first of its kind, mapping child deaths in 99 low- and middle-income countries at the level of individual districts. Published on October 16 today in the journal Nature, the findings included precision maps illuminating health disparities within countries and regions often obscured by national-level analyses.

Dr. Meghnath Dhimal of Nepal is a co-author of the report.

The research looks at countries where more than 90 per cent of child deaths occurred in 2017. Across all countries studied, the likelihood of a child dying before age 5 varied more than 40-fold at the district level, read a statement of the IHME.

Researchers estimated that if every district in the low- and middle-income countries studied had met the Sustainable Development Goal (SDG) target of at least as low as 25 child deaths per 1,000 live births, 2.6 million fewer children would have died.

The vast majority of the 17,554 districts among the 99 nations studied saw improvement in lowering child deaths, but levels of inequality between districts were more variable over the study period. Despite major gains in reducing child deaths over the past 20 years, the highest rates of death in 2017 were still largely concentrated where rates were highest in 2000.

“It is as reprehensible as it is tragic that, on average, nearly 15,000 children under age 5 die every day,” said Dr. Simon I. Hay, the senior author on the study and Director of the Local Burden of Disease (LBD) group at IHME.

The study, funded by the Bill & Melinda Gates Foundation, reveals areas of success where strategies could be replicated across and within countries, according to Dr. Hay.

For example, in Rwanda, the highest district-level rate of child deaths in 2017 was less than half that of the lowest district-level death rate in 2000 – gains partially attributed to investments in children’s health in the poorest communities, expansion of health insurance, and increasing numbers of community health workers.

Nepal significantly decreased inequalities among its districts over the study period. And Peru made major strides in reducing child mortality and inequality after implementing sustained, cross-cutting antipoverty and health programmes.

The Institute for Health Metrics and Evaluation (IHME) is an independent global health research organisation at the University Of Washington School Of Medicine that provides rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them.