J Compr Ped. 2019 May; 10(2):e86902. Published online 2019 May 12. doi: 10.5812/compreped.86902. Research Article Trend Analysis of Mortality Rates for Leading Causes of Death Among Under-Five Children in Iran, 2000 - 2015 Salman Khazaei 1 , Farid Najafi 2 , Vajihe Armanmehr 3 , Mahmoud Hajipour 4 , Manoochehr Karami 5 and Shahab Rezaeian 6, * 1 Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran 2 Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran 3 Social Determinants of Health Research Center, Gonabad University of Medical Science, Gonabad, Iran 4 Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran 5 Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran 6 Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran * Corresponding author: Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran. Email: shahab.rezayan@gmail.com Received 2018 November 29; Accepted 2019 May 05. Abstract Background: This secondary study is the first to assess the trend of mortality rate and its variations among Iranian children. Methods: The mortality data of under-five children were extracted from the WHO reports. All-cause and cause-specific mortality rates were calculated per 1000 live births and by age groups for each year from 2000 to 2015. The average annual rate of reduction (AARR) was used to determine the changes in mortality rates. Results: Of 21011 under-five children who died in 2015, 52.3% were attributed to infectious causes. The overall mortality rate among children under five years decreased from 35 per 1000 live births in 2000 to 16 per 1000 live births in 2015, representing a decline of 55.5% over the 16-year period with an AARR of 5.5%. There was a significant decreasing trend in the mortality rates of all causes except for HIV/AIDS and pertussis. Conclusions: The overall all-cause mortality rate decreased from 2000 to 2015 in Iran although this pattern varied according to the causes of death. There is still a relatively high proportion of mortality rates among children due to congenital anomalies, prematu- rity, birth asphyxia, sepsis, and acute lower respiratory infections. Keywords: Mortality Rate, Children, Infant, Iran 1. Background Although child mortality has a decreasing trend world- wide (1), it is estimated that more than six million children die before the age of five years (2). This is while most of the death causes are preventable and they predominantly oc- cur in poor countries. There is considerable inequality in the children’s mortality rate between countries so that six countries account for 50% of the under-five deaths world- wide (3). The infant mortality rate (IMR) is one of the most important indices to determine the economic, cultural, so- cial, and public health status of countries (4). Numerous epidemiological studies have been con- ducted around the globe on infant and childhood mortal- ity (2, 5-8), many of which have reported that more than half of the deaths are attributed to infectious causes (2, 6). In addition, based on the global statistics, the lead- ing causes of death include preterm birth complications (14.1%), intrapartum-related complications (9.4%), and sep- sis or meningitis (5.2%), as well as pneumonia (14.1%), diar- rhea (9.9%), and malaria (7.4%) among older children (9). Several studies have used local and national data of infant and children’s mortality rates in Iran (10), all of which have focused on the causes of death and reported a decreasing trend in the children’s mortality rate based on comparisons with other findings. However, it is not well known whether the fourth Millennium Development Goals (MDGs) regarding a reduction in child mortality by two-thirds between 1990 and 2015 have been achieved (11). 2. Objectives Considering the lack of knowledge regarding the trend of mortality among Iranian children, this study aimed to (i) assess the trend of mortality rate and (ii) quantify the Copyright © 2019, Journal of Comprehensive Pediatrics. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.