The leading causes of child death are remarkably similar across the 20 countries. Neonatal causes, principally due to preterm birth, birth trauma, and sepsis, dominate across all countries. Congenital birth defects, especially heart defects, are also among the top five causes of child death in all countries. Infectious diseases, especially pneumonia and diarrhea, are major child killers in most countries, followed by malaria in six countries (India, Nigeria, Democratic Republic of Congo, Tanzania, Mozambique, and Mali), and meningitis in three (Nigeria, Pakistan, and Philippines). HIV/AIDS remains a leading child killer in Russia and South Africa, and congenital syphilis in Brazil and Indonesia. Injuries, especially drowning, choking, and road traffic accidents cause many child deaths in China, USA, Mexico, Egypt, and Iran.
In contrast, among working-age adults, the leading causes of death vary across the 20 countries and between men and women. Among working-age men, injuries are a leading cause of death in all countries, especially road traffic accidents which is among the top five killers of young men in all 20 countries. Self-harm is a major killer in eleven (India, China, Brazil, USA, Russia, Bangladesh, South Africa, Mexico, Egypt, Viet Nam, and Iran), while interpersonal violence is a problem in seven (Ethiopia, Brazil, USA, South Africa, Philippines, Tanzania, and Mexico). Heart disease, cirrhosis, and/or stroke are leading non-communicable disease killers, while tuberculosis and HIV/AIDS are the leading communicable killers of young men. In contrast, malaria is a leading killer in just five of the 20 countries, (Nigeria, Democratic Republic of Congo, Tanzania, Mozambique, and Mali). Every country except Ethiopia, South Africa, and Tanzania have communicable and non-communicable diseases among the top five causes of early death.
Among working-age women, heart disease is the leading killer in eleven of the 20 countries, followed closely by tuberculosis, breast cancer, and road traffic accidents. Deaths in pregnancy and childbirth remain major killers of young women in nine countries (India, Nigeria, Pakistan, Democratic Republic of Congo, Ethiopia, Bangladesh, Tanzania, Mozambique, and Mali) and HIV/AIDs remains a threat in eight countries, all of them in Africa with the exception of Russia. Other leading non-communicable killers of working-age women include stroke, cirrhosis, diabetes, and chronic kidney disease. Injuries, especially road traffic accidents, self-harm, and interpersonal violence are leading killers of working age women in 13 countries. The six countries where self-harm is a major problem among young women include India, China, USA, Russia, Bangladesh, and Iran. Interpersonal violence is a major killer of women in Brazil, South Africa, and Mexico.
Specific risk factors drive early deaths across the 20 countries. Among children under five years, the top two risk factors across all countries are low birth weight and short gestation (preterm birth) followed by child growth failure (principally child wasting, stunting, and underweight). Unsafe water and air pollution are leading risk factors in 14 countries, followed by suboptimal breastfeeding in ten of the higher income countries (China, Indonesia, Brazil, USA, Russia, South Africa, Mexico, Egypt, Viet Nam, and Iran). Lack of access to handwashing is a major risk for child death in six countries (Nigeria, Democratic Republic of Congo, Ethiopia, Bangladesh, Tanzania, and Mali), and Vitamin A deficiency in five, including India, Indonesia, Brazil, Philippines, and Mexico (Chart 8).
Among men aged 15 to 49, the leading risk factor for early death across the 20 countries is high blood pressure. Only China, Ethiopia, and Mali do not have high blood pressure among the top five risks for early death for this group. Alcohol and smoking are the second and third leading risk factors and no country manages to avoid one or both. High cholesterol and obesity are also major problems in more than half of the 20 countries, only one of them in Africa (India, China, Pakistan, Indonesia, Brazil, USA, Russia, Bangladesh, Egypt, South Africa, and Iran). All eight of the countries where unsafe sex is a major risk for early death are in Africa with the exception of Viet Nam. Of note, diabetes is already a leading risk for early death in two African countries – Democratic Republic of Congo and Mozambique – as well as in Indonesia, Philippines, Mexico, and Egypt).
High blood pressure is also the leading risk factor for early death among women aged 15 to 49 years across the 20 countries. Only Ethiopia does not have high blood pressure among the top five causes of early death. Obesity is the second leading risk factor but is not yet a major problem in African countries, with the exception of South Africa. In contrast, unsafe sex is a major risk in ten countries, most of them in Africa, but also in Brazil, Mexico, and Viet Nam. Diabetes is a problem in nine countries (Pakistan, Democratic Republic of Congo, Indonesia, Bangladesh, Philippines, Mexico, Egypt, Viet Nam, and Iran. Air pollution is still a leading risk for death among young women in India, China, Ethiopia, Bangladesh, Mozambique, Egypt, and Mali due to their higher exposure to household cooking smoke. Diets low in whole grains and fruits and impaired kidney function also feature in the top five risk factors for early death among working-age women.