National and sub-national under-five mortality profiles in Peru: a basis for informed policy decisions.
BACKGROUND
Information on profiles for under-five causes of death is important to guide choice of child-survival interventions. Global level data have been published, but information at country level is scarce. We aimed at defining national and departmental trends and profiles of under-five mortality in Peru from 1996 through 2000.


METHODS
We used the Ministry of Health registered under-five mortality data. For correction of under-registration, a model life-table that fitted the age distribution of the population and of registered deaths was identified for each year. The mortality rates corresponding to these model life-tables were then assigned to each department in each particular year. Cumulative reduction in under-five mortality rate in the 1996-2000 period was estimated calculating the annual reduction slope for each department. Departmental level mortality profiles were constructed. Differences in mortality profiles and in mortality reduction between coastal, andean and jungle regions were also assessed.


RESULTS
At country level, only 4 causes (pneumonia, diarrhoea, neonatal diseases and injuries) accounted for 68% of all deaths in 1996, and for 62% in 2000. There was 32.7% of under-five death reduction from 1996 to 2000. Diarrhoea and pneumonia deaths decreased by 84.5% and 41.8%, respectively, mainly in the andean region, whereas deaths due to neonatal causes and injuries decreased by 37.2% and 21.7%. For 1996-2000 period, the andean, coast and jungle regions accounted for 52.4%, 33.1% and 14.4% of deaths, respectively. These regions represent 41.0%, 46.4% and 12.6% of under-five population. Both diarrhoea and pneumonia constitute 30.6% of under-five deaths in the andean region. As a proportion, neonatal deaths remained stable in the country from 1996 to 2000, accounting for about 30% of under-five deaths, whereas injuries and "other" causes, including congenital anomalies, increased by about 5%.


CONCLUSIONS
Under-five mortality declined substantially in all departments from 1996 to 2000, which is explained mostly by reduction in diarrhoea and pneumonia deaths, particularly in the andean region. There is the need to emphasize interventions to reduce neonatal deaths and emerging causes of death such as injuries and congenital anomalies.
Huicho
Luis
L
Department of Paediatrics, School of Medicine, Universidad Nacional Mayor de San Marcos and Instituto de Salud del Niño, LI 05, Lima, Peru. lhuicho@viabcp.com
Trelles
Miguel
M
Gonzales
Fernando
F
D002423:Cause of Death / Q000639:trends*; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000401:mortality; D003967:Diarrhea / Q000401:mortality; D005260:Female; D005843:Geography; D006291:Health Policy; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D015993:Life Tables; D008297:Male; D010568:Peru / Q000453:epidemiology; D011014:Pneumonia / Q000401:mortality; D011635:Public Health Administration; D012042:Registries; D014947:Wounds and Injuries / Q000401:mortality