Child Health Epidemiology
Current Estimates for Children Under Five Years of Age
The past three years have seen an increased demand for evidence-based priority setting and impact evaluations, both within WHO and among member states and partners.
In an effort to respond to this demand, the department of Child and Adolescent Health and Development (CAH) established a cross-organization working group on child health epidemiology with the aim of improving the availability and quality of data. Epidemiologic reviews were conducted for acute respiratory infections (ARI) and diarrhoea. Technical experts were contracted to provide inputs and address specific measurement issues. The work resulted in a recognition that existing data on child health indicators are poor and scarce, and that technically sound estimation methods have not yet been developed, reviewed and agreed upon. WHO is now taking the lead in this task with the aim of entering the next decade with baseline estimates against which to measure future progress.
Addressing the Need
Over the past three years, CAH has taken the lead within WHO in advocating for stronger child health epidemiology, and in defining and addressing some of the most urgent technical challenges.
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In collaboration with the Department of Vaccines and Biologicals (VAB), CAH established a working group on “Improving ARI Estimates” in 1999. This was a technical group, composed of ARI disease experts and individuals responsible for estimation and modelling within CAH, VAB and the Global Programme for Evidence in Health Policy (GPE).
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In 2000, CAH commissioned an epidemiologic review of diarrhoea, and collaborated in the preparation of the third in a series of decade reviews of published articles on diarrhoea-related morbidity and mortality among children under five.
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In June 2001 the Child Health Epidemiology Reference Group was formally established to review and comment on current WHO cause-specific mortality estimates for children under five; to recommend region-specific estimates to be used at the global level in the immediate future; and to report on progress in addressing issues of co-morbidity, and agree on next steps.
Achievements
As a result of the joint effort among CAH, VAB and GPE, a database of ARI best available estimates will be soon available for public use and consultation. Additionally, a database on the best available estimates of diarrhoea for different regions of the world will also be available for public consultation in 2002.
Overlap among Diseases of Childhood
The overlap among diseases is currently known as co-morbidity, which may be defined as the “simultaneous overlap of diseases that may cause death”. It is important to capture this overlap when estimating under fives cause-specific mortality in order to have the complete understanding of the complex status that leads to the death of a child. This will avoid double counting and reflect the correct importance and/or weight of specific causes of death. Moreover, when more than one disease is present at the moment of death, deciding on the primary cause of death may be difficult or even impossible.
However, this has not been a simple task as many mortality studies code only a single cause of death. An ongoing review of studies that address co-morbidity has been sponsored by CAH and will be available within the next few months. At the same time, some methodological approaches to address co-morbidity have been developed and should be incorporated in the global estimates of child indicators.
Public Health Challenges and Opportunities among Children Five to Nine
There has been a gap in identifying and addressing the health issues of children who survive the early childhood health challenges, and reach the age group five to nine. Some areas, such as that of helminths, have already carried out an extensive and thorough work, but most other areas are lacking information for this age-group. In general, not much is known about the health problems of children in the five to nine age group.
