Exploring mortality patterns in Pakistani children and adolescents aged 5-19: evidence from a national verbal and social autopsy study.

Background: While under-five mortality has declined by approximately 50% globally since 2000, mortality among older children and adolescents has fallen by only 31% since 1990. The age group 5-19-year-olds constitute over a third of Pakistan's population, yet estimates of mortality in this population, which are necessary for identifying preventable causes of death and developing interventions to improve health outcomes, have been limited. We aimed to investigate cause-specific mortality in children aged ≥5 years using verbal and social autopsy (VASA) to identify patterns and health risks across these age groups. Methods: We used the multistage stratified cluster sampling frame of the Pakistan National Nutrition Survey 2018, which covered 115,600 households from urban and rural areas. Through retrospective mortality surveillance, we identified 1,322 deaths among 5-19-year-olds in these households in the preceding three years. We then obtained data on their deaths from the household members through VASA interviews, after which a trained paediatrician and two computerised methods assigned specific causes of death to each case. Results: We completed VASA interviews for 1,322 deaths, out of which 29.8% were among children aged 5-9 years, 24.4% among young adolescents (10-14 years), and 45.8% among older adolescents (15-19 years). Overall mortality was higher among males (59%) than females (41%). Infectious diseases, non-communicable diseases (NCDs), and accidents/injuries were the three main causes of death, with the contribution of infectious diseases declining, and that of NCDs and injuries increasing with age. Maternal causes, particularly obstetric complications, contributed significantly to mortality among female adolescents. Conclusions: We found age- and gender-based differences in mortality causes among the 5-19-year population in Pakistan. Targeted efforts are needed to sustain the gains achieved among the under-five population by extending mortality reduction strategies that focus on age-specific risks for older children and adolescents.