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Global and National Burden of Diseases and Injuries Among Children and Adolescents Between 1990 and 2013 Findings From the Global Burden of Disease 2013 Study Publisher Pubmed



Vos T1 ; Kyu HH1 ; Pinho C1 ; Wagner JA1 ; Brown JC1 ; Bertozzivilla A1 ; Charlson FJ1, 2, 3 ; Coffeng LE1, 4 ; Dandona L1, 5 ; Erskine HE1, 2, 3 ; Ferrari AJ1, 2, 3 ; Fitzmaurice C1, 6, 7 ; Fleming TD1 ; Forouzanfar MH1 Show All Authors
Authors
  1. Vos T1
  2. Kyu HH1
  3. Pinho C1
  4. Wagner JA1
  5. Brown JC1
  6. Bertozzivilla A1
  7. Charlson FJ1, 2, 3
  8. Coffeng LE1, 4
  9. Dandona L1, 5
  10. Erskine HE1, 2, 3
  11. Ferrari AJ1, 2, 3
  12. Fitzmaurice C1, 6, 7
  13. Fleming TD1
  14. Forouzanfar MH1
  15. Graetz N1
  16. Guinovart C1
  17. Haagsma J1, 4
  18. Higashi H1
  19. Kassebaum NJ1, 8
  20. Larson HJ1, 9
  21. Lim SS1
  22. Mokdad AH1
  23. Moradilakeh M1, 10
  24. Odell SV1, 11, 12, 13
  25. Roth GA1
  26. Serina PT1
  27. Stanaway JD1
  28. Misganaw A1
  29. Whiteford HA1, 2, 3
  30. Wolock TM1
  31. Hanson SW1
  32. Abdallah F14
  33. Abera SF15, 16
  34. Aburaddad LJ17
  35. Al Buhairan FS18, 19
  36. Antonio CAT23
  37. Artaman A24
  38. Barkercollo SL25
  39. Barrero LH26
  40. Benjet C27
  41. Bensenor IM28
  42. Bhutta ZA29, 30
  43. Bikbov B31, 32
  44. Brazinova A33, 34
  45. Camposnonato I35, 36
  46. Castanedaorjuela CA37, 38
  47. Catalalopez F39, 40
  48. Chowdhury R41
  49. Cooper C42, 43, 44
  50. Crump JA45
  51. Dandona R5
  52. Degenhardt L46
  53. Dellavalle RP47
  54. Dharmaratne SD48
  55. Faraon EJA23, 49
  56. Feigin VL50
  57. Furst T51
  58. Geleijnse JM52
  59. Gessner BD53
  60. Gibney KB54, 55
  61. Goto A56
  62. Gunnell D57
  63. Hankey GJ58, 59, 60
  64. Hay RJ61, 62
  65. Hornberger JC63, 64
  66. Hosgood HD65
  67. Hu G66
  68. Jacobsen KH67
  69. Jayaraman SP68
  70. Jeemon P69, 70
  71. Jonas JB71
  72. Karch A72, 73
  73. Kim D74
  74. Kim S75
  75. Kokubo Y76
  76. Defo BK77, 78, 79
  77. Bicer BK80
  78. Kumar GA5
  79. Larsson A81
  80. Leasher JL82
  81. Leung R83
  82. Li Y84
  83. Lipshultz SE85, 86
  84. Lopez AD85, 87
  85. Lotufo PA28
  86. Lunevicius R88, 89
  87. Lyons RA90
  88. Majdan M34
  89. Malekzadeh R91
  90. Mashal T92
  91. Masonjones AJ93
  92. Melaku YA16, 94, 95
  93. Memish ZA96, 97
  94. Mendoza W98
  95. Miller TR99, 100
  96. Mock CN101
  97. Nolte S103, 104
  98. Oh IH105
  99. Olusanya BO106
  100. Ortblad KF107
  101. Park EK108
  102. Caicedo AJP109
  103. Patten SB110
  104. Patton GC111
  105. Pereira DM112
  106. Perico N113
  107. Piel FB114
  108. Polinder S4
  109. Popova S115
  110. Pourmalek F116
  111. Quistberg DA101, 117
  112. Remuzzi G118, 119
  113. Rodriguez A120, 121
  114. Rojasrueda D122
  115. Rothenbacher D123
  116. Rothstein DH124, 125
  117. Sanabria J126, 127
  118. Santos IS128
  119. Schwebel DC129
  120. Sepanlou SG91
  121. Shaheen A130
  122. Shiri R131, 132
  123. Shiue I133, 134
  124. Skirbekk V135
  125. Sliwa K136
  126. Sreeramareddy CT20, 21, 22, 137
  127. Steiner TJ138, 139, 140, 141
  128. Stovner LJ141, 142
  129. Sykes BL143, 144, 145
  130. Tabb KM146
  131. Terkawi AS147, 148, 149
  132. Thomson AJ150
  133. Thornelyman AL151, 152
  134. Towbin JA153, 154, 155
  135. Ukwaja KN156
  136. Vasankari T157
  137. Venketasubramanian N158
  138. Vlassov VV159
  139. Vollset SE160, 161
  140. Weiderpass E162, 163, 164, 165
  141. Weintraub RG166, 167, 168
  142. Werdecker A169
  143. Wilkinson JD85, 86
  144. Woldeyohannes SM170
  145. Wolfe CDA171, 172
  146. Yano Y173
  147. Yip P174, 175
  148. Yonemoto N176
  149. Yoon SJ177
  150. Younis MZ178
  151. Yu C179, 180
  152. El Sayed Zaki M181
  153. Naghavi M1
  154. Murray CJL1, 102
Show Affiliations
Authors Affiliations
  1. 1. Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave, Seattle, 98121, WA, United States
  2. 2. School of Public Health, University of Queensland, Brisbane, Australia
  3. 3. Queensland Centre for Mental Health Research, Brisbane, Australia
  4. 4. Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
  5. 5. Public Health Foundation of India, New Delhi, India
  6. 6. Division of Hematology, Department of Medicine, University of Washington, Seattle, United States
  7. 7. Fred Hutchinson Cancer Research Center, Seattle, WA, United States
  8. 8. Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, WA, United States
  9. 9. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
  10. 10. Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran
  11. 11. University of Washington Medical Center, Seattle, United States
  12. 12. Seattle Children's Hospital, Seattle, WA, United States
  13. 13. Intermountain Healthcare, Salt Lake City, UT, United States
  14. 14. Department of Neurology, Cairo University, Cairo, Egypt
  15. 15. Kilte Awlaelo Health and Demographic Surveillance Site, Mekelle, Ethiopia
  16. 16. School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
  17. 17. Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar
  18. 18. King Abdullah Specialized Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
  19. 19. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
  20. 20. Department of Epidemiology, University of Groningen, Groningen, Netherlands
  21. 21. College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
  22. 22. Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia
  23. 23. Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, PA, Philippines
  24. 24. Windsor, ON, Canada
  25. 25. School of Psychology, University of Auckland, Auckland, New Zealand
  26. 26. Department of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogota, Colombia
  27. 27. National Institute of Psychiatry Ramon de la Fuente, Mexico City, Mexico
  28. 28. University of Sao Paulo, Sao Paulo, Brazil
  29. 29. Medical Center, Aga Khan University, Karachi, Pakistan
  30. 30. Hospital for Sick Children, Toronto, ON, Canada
  31. 31. A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
  32. 32. Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russian Federation
  33. 33. International Neurotrama Research Organization, Vienna, Austria
  34. 34. Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
  35. 35. National Institute of Public Health, Cuernavaca, Mexico
  36. 36. School of Public Health, Harvard University, Boston, MA, United States
  37. 37. Colombian National Health Observatory, Instituto Nacional de Salud, Bogota, Colombia
  38. 38. Epidemiology and Public Health Evaluation Group, Public Health Department, Universidad Nacional de Colombia, Bogota, Colombia
  39. 39. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
  40. 40. Department of Medicine, University of Valencia, INCLIVA/CIBERSAM, Valencia, Spain
  41. 41. Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
  42. 42. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
  43. 43. National Institute for Health Research Biomedical Research Centre, University of Southampton, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
  44. 44. National Institute for Health Research Musculoskeletal, Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
  45. 45. Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  46. 46. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
  47. 47. University of Colorado School of Medicine, Colorado School of Public Health, Aurora, United States
  48. 48. Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
  49. 49. Office for Technical Services, Department of Health, Manila, Philippines
  50. 50. National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
  51. 51. Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
  52. 52. Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
  53. 53. Agence de Medecine Preventive, Paris, France
  54. 54. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
  55. 55. Melbourne Health, Parkville, Australia
  56. 56. Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
  57. 57. School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
  58. 58. School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
  59. 59. Harry Perkins Institute of Medical Research, Nedlands, Australia
  60. 60. Western Australian Neuroscience Research Institute, Nedlands, Australia
  61. 61. International Foundation for Dermatology, London, United Kingdom
  62. 62. King's College London, London, United Kingdom
  63. 63. Cedar Asso., Menlo Park, CA, United States
  64. 64. Stanford University, Stanford, CA, United States
  65. 65. Albert Einstein College of Medicine, Bronx, NY, United States
  66. 66. Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, China
  67. 67. George Mason University, Fairfax, VA, United States
  68. 68. Department of Surgery, Virginia Commonwealth University, Richmond, United States
  69. 69. Centre for Chronic Disease Control, New Delhi, India
  70. 70. Centre for Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India
  71. 71. Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-Universitat Heidelberg, Mannheim, Germany
  72. 72. Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
  73. 73. Hannover-Braunschweig Site, German Center for Infection Research, Braunschweig, Germany
  74. 74. Department of Health Sciences, Northeastern University, Boston, MA, United States
  75. 75. Soonchunhyang University, Seoul, South Korea
  76. 76. Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
  77. 77. Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
  78. 78. Department of Demography, University of Montreal, Montreal, QC, Canada
  79. 79. Public Health Research Institute, University of Montreal, Montreal, QC, Canada
  80. 80. Institute of Public Health, Hacettepe University, Ankara, Turkey
  81. 81. Department of Medical Sciences, Uppsala University, Uppsala, Sweden
  82. 82. Nova Southeastern University, College of Optometry, Fort Lauderdale, FL, United States
  83. 83. State University of New York at Albany, Rensselaer, United States
  84. 84. Genentech, South San Francisco, CA, United States
  85. 85. School of Medicine, Wayne State University, Detroit, MI, United States
  86. 86. Children's Hospital of Michigan, Detroit, United States
  87. 87. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
  88. 88. Aintree University Hospital National Health Service Foundation Trust, Liverpool, United Kingdom
  89. 89. School of Medicine, University of Liverpool, Liverpool, United Kingdom
  90. 90. Farr Institute, Swansea University, Swansea, United Kingdom
  91. 91. Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  92. 92. Ministry of Public Health, Kabul, Afghanistan
  93. 93. Department of Health Sciences, University of York, York, United Kingdom
  94. 94. School of Public Health, Mekelle University, Mekelle, Ethiopia
  95. 95. School of Medicine, University of Adelaide, Adelaide, Australia
  96. 96. Saudi Ministry of Health, Riyadh, Saudi Arabia
  97. 97. College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
  98. 98. United Nations Population Fund, P-Lima, Peru
  99. 99. Pacific Institute for Research and Evaluation, Calverton, MD, United States
  100. 100. Centre for Population Health Research, Curtin University, Perth, Australia
  101. 101. Harborview Injury Prevention and Research Center, University of Washington, Seattle, United States
  102. 102. Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
  103. 103. Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charite Universitatsmedizin, Berlin, Germany
  104. 104. Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Melbourne, Australia
  105. 105. Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
  106. 106. Center for Healthy Start Initiative, Ikoyi, Nigeria
  107. 107. Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
  108. 108. Department of Medical Humanities and Social Medicine, College of Medicine, Kosin University, Busan, South Korea
  109. 109. Universidad de Cartagena, Cartagena, Colombia
  110. 110. Department of Community Health Sciences, University of Calgary, Calgary, AL, Canada
  111. 111. Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
  112. 112. REQUIMTE/LAQV, Laboratorio de Farmacognosia, Departamento de Quimica, Faculdade de Farmacia, Universidade do Porto, Porto, Portugal
  113. 113. Istituto di Ricovero e Cura a Carattere Scientifico, Mario Negri Institute for Pharmacological Research, Bergamo, Italy
  114. 114. Department of Zoology, University of Oxford, Oxford, United Kingdom
  115. 115. Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
  116. 116. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
  117. 117. Department of Pediatrics, University of Washington, Seattle, United States
  118. 118. Centro Anna Maria Astori, Istituto di Ricovero e Cura a Carattere Scientifico, Mario Negri Institute for Pharmacological Research, Bergamo, Italy
  119. 119. Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
  120. 120. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
  121. 121. Mid Sweden University, Ostersund, Sweden
  122. 122. Centre for Research in Environmental Epidemiology, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
  123. 123. Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
  124. 124. Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY, United States
  125. 125. Department of Surgery, University at Buffalo, State University of New York, Buffalo, United States
  126. 126. Case Western Reserve University, Cleveland, OH, United States
  127. 127. Chicago Medical School, Rosalind Franklin University of Medicine and Science, Cancer Treatment Centers of America, North Chicago, IL, United States
  128. 128. Internal Medicine Department, University of Sao Paulo, Sao Paulo, Brazil
  129. 129. University of Alabama at Birmingham, Birmingham, United States
  130. 130. Department of Public Health, An-Najah National University, Nablus, Palestine
  131. 131. Finnish Institute of Occupational Health, Helsinki, Finland
  132. 132. School of Health Sciences, University of Tampere, Tampere, Finland
  133. 133. Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
  134. 134. Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom
  135. 135. Columbia University, New York, NY, United States
  136. 136. Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
  137. 137. Department of Community Medicine, International Medical University, Kuala Lumpur, Malaysia
  138. 138. Department of Psychiatry, University of Cape Town, Cape Town, South Africa
  139. 139. South African Medical Research Council Unit on Anxiety and Stress Disorders, Cape Town, South Africa
  140. 140. Division of Brain Sciences, Imperial College London, London, United Kingdom
  141. 141. Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
  142. 142. Norwegian Advisory Unit on Headache, St. Olavs Hospital, Trondheim, Norway
  143. 143. Department of Criminology, Law and Society, University of California, Irvine, United States
  144. 144. Department of Sociology, University of California, Irvine, United States
  145. 145. Department of Public Health, University of California, Irvine, United States
  146. 146. School of Social Work, University of Illinois at Urbana-Champaign, Champaign, United States
  147. 147. Department of Anesthesiology, University of Virginia, Charlottesville, United States
  148. 148. Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, United States
  149. 149. Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia
  150. 150. Adaptive Knowledge Management, Victoria, BC, Canada
  151. 151. Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
  152. 152. WorldFish, Penang, Malaysia
  153. 153. Le Bonheur Children's Hospital, Memphis, TN, United States
  154. 154. University of Tennessee Health Science Center, Memphis, United States
  155. 155. St. Jude Children's Research Hospital, Memphis, TN, United States
  156. 156. Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria
  157. 157. UKK Institute for Health Promotion Research, Tampere, Finland
  158. 158. Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
  159. 159. National Research University Higher School of Economics, Moscow, Russian Federation
  160. 160. Norwegian Institute of Public Health, Oslo, Norway
  161. 161. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
  162. 162. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
  163. 163. Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
  164. 164. Department of Community Medicine, Faculty of Health Sciences, University of Tromso, Arctic University of Norway, Tromso, Norway
  165. 165. Genetic Epidemiology Group, Folkhalsan Research Center, Helsinki, Finland
  166. 166. University of Melbourne, Melbourne, Australia
  167. 167. Royal Children's Hospital, Melbourne, Australia
  168. 168. Murdoch Childrens Research Institute, Melbourne, Australia
  169. 169. Competence Center Mortality Follow-up of the German National Cohort, Federal Institute for Population Research, Wiesbaden, Germany
  170. 170. Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
  171. 171. Division of Health and Social Care Research, King's College London, London, United Kingdom
  172. 172. National Institute for Health Research Comprehensive Biomedical Research Centre, Guy's and St. Thomas' National Health Service Foundation Trust, King's College London, London, United Kingdom
  173. 173. Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
  174. 174. Social Work and Social Administration Department, University of Hong Kong, Hong Kong, Hong Kong
  175. 175. Hong Kong Jockey Club Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, Hong Kong
  176. 176. National Center of Neurology and Psychiatry, Kodaira, Japan
  177. 177. Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
  178. 178. Jackson State University, Jackson, MS, United States
  179. 179. Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
  180. 180. Global Health Institute, Wuhan University, Wuhan, China
  181. 181. Mansoura Faculty of Medicine, Mansoura, Egypt

Source: JAMA Pediatrics Published:2016


Abstract

IMPORTANCE: The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce. OBJECTIVE: To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged < 5 years), older children (aged 5-9 years), and adolescents (aged 10-19 years) between 1990 and 2013 in 188 countries from the Global Burden of Disease (GBD) 2013 study. EVIDENCE REVIEW: Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14 244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35 620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIVinfection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates. FINDINGS: Of the 7.7 (95% uncertainty interval [UI], 7.4-8.1) million deaths among children and adolescents globally in 2013,6.28 million occurred amongyounger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections amongyounger children (905 059 deaths; 95% UI, 810 304-998125), diarrheal diseases among older children (38 325 deaths; 95% UI, 30 365-47 678), and road injuries among adolescents (115186 deaths; 95% UI, 105185-124 870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world's deaths from neonatal encephalopathy. Half of the world's diarrheal deaths among children and adolescents occurred injust 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia. CONCLUSIONS AND RELEVANCE: Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed. Copyright 2016 American Medical Association. All rights reserved.
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