Analyzing Cause-of-death In Children Under-five And Evaluating Local Child Mortality Surveillance System Of Chengmai County In Hainan Province During2000to2008

Background:Millennium Development Goal (MDG)4is to reduce under-five mortality by two-thirds between1990and2015. The under-five mortality in China has decreased by almost60%during1991to2004with substantial variation in death rates and cause-of-death among different regions. Therefore, local health facilities need to assess local epidemiological profiles of child death for planning sound programs. Neonatal death is related to maternal health and many other factors, which can be better understood through linking data of child death to situations at birth. Child and Maternal Surveillance System (CMSS) is the main source of under-five mortality data in China and it is necessary to evaluate the quality of local mortality data before use.Objective:To describe local epidemiological profile of under-five child death in Chengmai County of Hainan, evaluate quality of local mortality data and search for risk factors of local neonatal death.Method:This paper describes the distribution, mortality rate change and cause-of-death of under-five child death in Chengmai County of Hainan Province, and evaluates the quality of mortality data through analyzing the surveillance data of under-five child death from local CMSS during2000to2008. Also this paper researches on risk factors at birth of neonatal death through matching individual neonatal death to birth data during October1st,2006to September30th,2008.Results:During2000to2008,77.7%of under-five death in Chengmai occurred in the first year of life,55.7%in the first28days. Under-five mortality rate, infant mortality rate and neonatal mortality rate in Chengmai are13.6%。,10.6%o and7.4%o respectively in2008, which were reduced by25.3%、25.4%、32.7%from2000. The main causes of under-five death are neonatal diseases (about40%), pneumonia (33.3%in2000to11.6%in2008), accidents (about10%) and congenital diseases (about8%). The reduction of under-five mortality rate was attributed to the reduction of pneumonia and neonatal disease cause-specific mortality rates. The main cause-of-death during neonates, post-neonates (28day-llmonth) and l-4year old children are neonatal disorders, pneumonia and accidents. Proportion of household death and outpatient treatment were higher among death during28day-4year old child death than that of neonatal death. Also more received diagnosis in provincial and village health facilities during28day-4year old child death. Mortality rate varied among different towns and was correlated to death location, treatment before death and diagnosing facilities. The incidence of cause-of-death mistake was4.7%. Gestational age and birth weight were related to neonatal death.Conclusions:Under-five death has been reduced in Chengmai during2000to2008. Local facilities should pay more attention on family health education should be paid more attention to further reduce the mortality rate of neonatal disorders, pneumonia, diarrhea and other common causes of death. The coverage of exclusive breastfeeding should be increased. The completeness of under-five death data in Chengmai might be low before2003, which affects the reliability of results during2000to2003. Local health workers need training on data collection and cause-of-death classification to improve the quality of under-five death surveillance data.