Different extent in decline of infant mortality by region and cause in Shenyang, China

The report “A Promise Renewed: 2015 Progress Report” from the United Nations Children’s Fund (UNICEF) noted that the number of children who die from mostly preventable causes before they turn five years old now stands at 5.9 million a year, decreased from 12.7 million 25 years ago1. Additionally, since 2000, the lives of 48 million children under the age of five have been saved after governments committed to achieving the Millennium Development Goals (MDGs), which are a set of development goals agreed upon by world leaders in 20001. Despite the progress that has been made, one of the most prominent goals for 2015 (MDG-4), which aims to reduce the child mortality by two-thirds from the level in 1990, has not been satisfactorily met. Infant mortality rate is an important indicator for the effectiveness of public health issues including maternal and child health care services, as well as for comparing countries with respect to welfare2. In the last two decades, China has made great progress in child health. For example, according to the report from UNICEF, the infant mortality in China declined from 42 per 1,000 live births in 1990 to 11 per 1,000 live births in 20133. However, compared with developed countries (e.g. 2 and 5 per live births in Sweden and Canada in 2013, respectively), the infant mortality of China has not yet decreased to an acceptable level. Furthermore, besides effective medical technology, better access to pre- and postnatal care for all socioeconomic groups, and better nutrition4, factors contributing to the international variation in neonatal mortality rates largely stem from differences in the development of these countries. Similarly, in China, a huge gap exists in terms of people’s income and health status between urban and rural areas, and the gap may explain the regional differences in children’s health status and survival between urban and rural areas5. For example, although the average infant mortality rate was 15.3 per 1,000 live births in 2007 in China, the infant mortality rates in urban areas were much lower than those in rural areas (7.7 versus 18.6 per 1,000 live births). Therefore, the purpose of this study was to compare the pattern of cause of death of infant mortality rates by urban/rural areas as well as to generate knowledge for potential strategies to reduce infant deaths in the future on the basis of data collected through a relatively long observational period (1997–2014).