USA: For children younger than 2 years of age in low- and middle-income countries, the coverage of potentially life-saving interventions should be ensured during pregnancy, suggests a recent study in JAMA Network Open.
In the study, a large majority of deaths among children younger than 5 years occurred before 2 years of age in all countries among girls and boys and in households with the worst and best living standards in the sample of 77 low- and middle-income countries. The study has highlighted perinatal complications, undernutrition, and infections as primary death causes in children younger than 5 years.

In low- and middle-income countries, the coverage of essential child health and nutrition interventions remains suboptimal. Adverse exposures, such as infections and undernutrition, are harmful specifically during the 1000 days from conception until 2 years of age.
Against the above background, Omar Karlsson, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, and colleagues aimed to examine whether deaths in children younger than 5 years—which also reflect adverse exposures faced by children more broadly—are concentrated in the first 2 years after birth in a cross-sectional study.
The study used a synthetic cohort probability method with Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 77 low- and middle-income countries. The earliest survey started with data collection in March 2010 and the most recent ended data collection in December 2019. The study included 2 827 515 children younger than 5 years at any point 10 years before the survey. Data analysis was done from March 11 to 21, 2022.

Main outcomes and measures included shares of death in children younger than 5 years occurring before 1 month, at 1 to 23 months, and at 24 to 59 months of age.
Salient findings of the study include:
Among the 2 827 515 children included in the analysis, 81.5% of deaths occurred in the first 2 years after birth ranging from 63.7% in Niger to 97.8% in Albania.
An estimated 18.5% of child deaths occurred at 24 to 59 months of age.
Countries with higher mortality rates among children younger than 5 years had a lower share of deaths occurring in the neonatal period.
"These findings highlight interventions at the pregnancy and perinatal stages to decrease neonatal deaths, including addressing maternal malnutrition and infections and providing essential health care services," wrote the authors.
Reference:
Karlsson O, Kim R, Hasman A, Subramanian SV. Age Distribution of All-Cause Mortality Among Children Younger Than 5 Years in Low- and Middle-Income Countries. JAMA Netw Open. 2022;5(5):e2212692. doi:10.1001/jamanetworkopen.2022.12692