Analysis On Death Surveillance For Children Under 5 Years Old From 2004～2009 In Hunan Province

Objective:To understand the prevalence and tendency of mortality rate, and analyze the leading causes of death based on death surveillance data of children under 5 years old in Hunan province from 2004 to 2009. The study aims to provide scientific evidences for mortality controlling programs for children under 5 years old in Hunan province.Methods:The death surveillance data of children under 5 years old in Hunan province from 2004 to 2009 was collected and database was established by Epidata 3.0. Descriptive statistic methods were used to analyze the distribution of age and causes of death. Tend chi-square test was used to analyze the mortality rate trend of children under 5 years. Differences of health service utilization before children death between urban and rural areas were analyzed by chi-square test.Results:Mortality in neonates, infants, children aged 1 to 4 years old and under 5 years old was 8.2‰,11.3‰,3.3‰,14.2‰in 2004 and 4.4‰, 7.2‰,2.6‰,9.8‰in 2009, and the decrease amplitude was 46.2%,36.6%, 21.2% and 31.0% respectively. In urban areas, it declined from 5.6%o, 6.5‰,1.8‰,8.3‰to 2.7‰,4.9‰,1.79‰,6.6‰, and the decrease amplitude was 50.8%,24.8%,5.5%,20.6% respectively. In rural areas, it declined from 9.3‰,12.8‰,4.0‰,16.7‰to 5.2‰,8.3‰,3.1‰,11.4‰, and the decrease amplitude was 44.0%,34.9%,22.7%,32.0% respectively. Among the children died under 5 years old,52.2% of them were neonates, 76.3% were infants and 23.7% were children aged 1 to 4 years old. The leading death causes were neonate asphyxia, premature delivery and low birth weight, pneumonia, congenital heart disease, drowning and accidental suffocation. The ranks of death causes were different in different years. Congenital heart disease rose from the fifth place in 2004 to the first place in 2009. And the proportion of death caused by neonate asphyxia descended year by year though it was still one of the main death causes in newborns, infants, and children under 5 years old. For an average,73.2% of children under 5 years old obtained treatment before death with 26.8% did not. The ultimate diagnoses before death were given in county (region) level health institutes (59.4%), township health centers or village clinics (20.8%). And there were no diagnoses for 19.6% of them. The proportion of children died in hospital, on the way and at home was 57.0%,8.2% and 34.8% respectively. The proportion of children untreated, undiagnosed before death and died at home were significantly higher in rural areas than that in urban areas. Children with older age, untreated and undiagnosed before death, and died at home, received worse health services.Conclusion:The mortality of neonate, infant, children aged 1 to 4 years old and children under 5 years old had a trend of decline from 2004 to 2009 in Hunan province. The mortality was lower than the national average level. The mortality was higher in rural than in urban areas. To decrease the mortality of children under 5 years old in Hunan, more attention are needed to improve health service quality in rural areas and to reduce the infant mortality, especially the neonatal mortality.