Who is most at risk?
The probability of dying among children aged 5 to 14 years was 7.1 deaths per 1000 children aged 5 in 2018, roughly 18% of the under-5 mortality rate in the same year. Globally deaths among children aged 5-9 years accounted for 61% of all deaths of children aged 5 to 14 years. However, survival chances for older children and young adolescents vary greatly across the world. In sub-Saharan Africa, the probability of dying among children aged 5–14 years in 2018 was 17.9 deaths per 1,000 children aged 5 years, followed by Oceania (excluding Australia and New Zealand) with 7.8 deaths and Central and Southern Asia with 5.8. More than half (55 per cent) of deaths among children aged 5–14 years occurred in sub-Saharan Africa, followed by Southern Asia with about 24 per cent. The average risk of dying between the fifth and fifteenth birthday was 14 times higher in sub-Saharan Africa than in Northern America and Europe.
At the country level, mortality ranged from 0.4 to 37.3 deaths per 1,000 children aged 5 years. The higher mortality countries are concentrated in sub-Saharan Africa with the 14 countries having a mortality rate for children aged 5–14 years above 20 deaths per 1,000 children aged 5 years in 2018 all in this region. Countries with the highest number of deaths for this age group include India, Nigeria, DR Congo, Pakistan and China.
What are the leading causes of death?
Injuries (including road traffic injuries, drowning, burns, and falls) rank among the top causes of death and lifelong disability among children aged 5-14 years. The patterns of death in older children and young adolescents reflect the underlying risk profiles of the age groups, with a shift away from infectious diseases of childhood and towards accidents and injuries, notably drowning and road traffic injuries for older children and young adolescents.
What can be done to improve older child and young adolescent survival?
The rise of injury deaths, particularly, road traffic injuries and drowning, demonstrate that the risk exposure is different for those over the age of 5 years. As a result, the nature of interventions needed to prevent poor health outcomes have shifted away from health sector actions to prevent and treat the infectious diseases of early childhood towards other sectors needed to take action to prevent mortality from road traffic injuries, violence and mental health problems. Actions across a range of government sectors including education, transportation and road infrastructure, water and sanitation and law enforcement are needed to prevent premature mortality in older children and young adolescents. National governments will need to critically assess their countries’ older child and young adolescent health needs, determine the most appropriate evidence-based intervention to address them and then prioritize these within their national health programming. WHO can help by providing guidance on effective interventions, prioritization, programme planning, monitoring and evaluation and research areas to strengthen the response.