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1. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

Author

Wang, H, Liddell, CA, Coates, MM, Mooney, MD, Levitz, CE, Schumacher, AE, Apfel, H, Iannarone, M, Phillips, B, Lofgren, KT, Sandar, L, Dorrington, RE, Rakovac, I, Jacobs, TA, Liang, X, Zhou, M, Zhu, J, Yang, G, Wang, Y, Liu, S, Li, Y, Ozgoren, AA, Abera, SF, Abubakar, I, Achoki, T, Adelekan, A, Ademi, Z, Alemu, ZA, Allen, PJ, AlMazroa, MA, Alvarez, E, Amankwaa, AA, Amare, AT, Ammar, W, Anwari, P, Cunningham, SA, Asad, MM, Assadi, R, Banerjee, A, Basu, S, Bedi, N, Bekele, T, Bell, ML, Bhutta, Z, Blore, JD, Basara, BB, Boufous, S, Breitborde, N, Bruce, NG, Bui, LN, Carapetis, JR, Cárdenas, R, Carpenter, DO, Caso, V, Castro, RE, Catalá-Lopéz, F, Cavlin, A, Che, X, Chiang, PP, Chowdhury, R, Christophi, CA, Chuang, TW, Cirillo, M, da Costa Leite, I, Courville, KJ, Dandona, L, Dandona, R, Davis, A, Dayama, A, Deribe, K, Dharmaratne, SD, Dherani, MK, Dilmen, U, Ding, EL, Edmond, KM, Ermakov, SP, Farzadfar, F, Fereshtehnejad, SM, Fijabi, DO, Foigt, N, Forouzanfar, MH, Garcia, AC, Geleijnse, JM, Gessner, BD, Goginashvili, K, Gona, P, Goto, A, Gouda, HN, Green, MA, Greenwell, KF, Gugnani, HC, Gupta, R, Hamadeh, RR, Hammami, M, Harb, HL, Hay, Simon, Hedayati, MT, Hosgood, HD, Hoy, DG, Idrisov, BT, Islami, F, Ismayilova, S, Jha, Vivekanand, Jiang, G, Jonas, JB, Juel, K, Kabagambe, EK, Kazi, DS, Kengne, AP, Kereselidze, M, Khader, YS, Khalifa, SE, Khang, YH, Kim, D, Kinfu, Y, Kinge, JM, Kokubo, Y, Kosen, S, Defo, BK, Kumar, GA, Kumar, K, Kumar, RB, Lai, T, Lan, Q, Larsson, A, Lee, JT, Leinsalu, M, Lim, SS, Lipshultz, SE, Logroscino, G, Lotufo, PA, Lunevicius, R, Lyons, RA, Ma, S, Mahdi, AA, Marzan, MB, Mashal, MT, Mazorodze, TT, McGrath, JJ, Memish, ZA, Mendoza, W, Mensah, GA, Meretoja, A, Miller, TR, Mills, EJ, Mohammad, KA, Mokdad, AH, Monasta, L, Montico, M, Moore, AR, Moschandreas, Joanna, Msemburi, WT, Mueller, UO, Muszynska, MM, Naghavi, M, Naidoo, KS, Narayan, KM, Nejjari, C, Ng, M, de Dieu Ngirabega, J, Nieuwenhuijsen, MJ, Nyakarahuka, L, Ohkubo, T, Omer, SB, Caicedo, AJ, Pillay-van Wyk, V, Pope, D, Pourmalek, F, Prabhakaran, D, Rahman, SU, Rana, SM, Reilly, RQ, Rojas-Rueda, D, Ronfani, L, Rushton, L, Saeedi, MY, Salomon, JA, Sampson, U, Santos, IS, Sawhney, M, Schmidt, JC, Shakh-Nazarova, M, She, J, Sheikhbahaei, S, Shibuya, K, Shin, HH, Shishani, K, Shiue, I, Sigfusdottir, ID, Singh, JA, Skirbekk, V, Sliwa, K, Soshnikov, SS, Sposato, LA, Stathopoulou, VK, Stroumpoulis, K, Tabb, KM, Talongwa, RT, Teixeira, CM, Terkawi, AS, Thomson, AJ, Thorne-Lyman, AL, Toyoshima, H, Dimbuene, ZT, Uwaliraye, P, Uzun, SB, Vasankari, TJ, Vasconcelos, AM, Vlassov, VV, Vollset, SE, Waller, S, Wan, X, Weichenthal, S, Weiderpass, E, Weintraub, RG, Westerman, R, Wilkinson, JD, Williams, HC, Yang, YC, Yentur, GK, Yip, P, Yonemoto, N, Younis, M, Yu, C, Jin, KY, El Sayed Zaki, M, Zhu, S, Vos, T, Lopez, AD, and Murray, CJ

Abstract

Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030.We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone.Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030.Bill & Melinda Gates Foundation, US Agency for International Development.

Published
2018

2. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Author

Karen Sliwa, Xiaofeng Liang, Vivekanand Jha, Dorairaj Prabhakaran, Rakhi Dandona, Gonghuan Yang, Xuan Che, Soewarta Kosen, Sergei Petrovich Ermakov, Ted R. Miller, Samath D Dharmaratne, Philimon Gona, Sergey Soshnikov, Atsushi Goto, Costas A. Christophi, Zacharie Tsala Dimbuene, Elena Alvarez, Yanping Wang, Peggy Pei-Chia Chiang, Mohammad H. Forouzanfar, Giancarlo Logroscino, Massimo Cirillo, Knud Juel, Johanna M. Geleijnse, Stefan Ma, Samaya Ismayilova, Karen Fern Greenwell, Michelle L. Bell, Saad B. Omer, Ademola Lukman Adelekan, Joshua A. Salomon, Dhruv S. Kazi, Jed D. Blore, Walid Ammar, Carly E Levitz, Kovin Naidoo, Solveig A. Cunningham, Stephen G. Waller, Anand Dayama, James D. Wilkinson, Vasiliki Stathopoulou, Meghan D. Mooney, Mall Leinsalu, Jonathan R. Carapetis, Paul S. F. Yip, Anders Larsson, Abbas Ali Mahdi, Hideaki Toyoshima, Guohong Jiang, Xia Wan, Chuanhua Yu, Soufiane Boufous, Ivy Shiue, Bulat Idrisov, Qing Lan, Chelsea A. Liddell, Austin E Schumacher, Valeria Caso, Nigel Bruce, Paulo A. Lotufo, Ibrahim Abubakar, Roberto Tchio Talongwa, Luke Nyakarahuka, Edward J Mills, Iuri da Costa Leite, Semaw Ferede Abera, Ana C. Garcia, Ayse Abbasoglu Ozgoren, Matthew M Coates, Konstantinos Stroumpoulis, Bradford D. Gessner, Kebede Deribe, Tommi Vasankari, Logan Sandar, Kenji Shibuya, Karen M. Tabb, Troy Jacobs, Christopher J L Murray, Chakib Nejjari, Katherine T. Lofgren, Melvin Barrientos Marzan, Haidong Wang, Joanna Moschandreas, Raimundas Lunevicius, Nataliya Foigt, Rashmi Gupta, Ziad A. Memish, Victoria Pillay-van Wyk, Randah R. Hamadeh, Azmeraw T. Amare, Lalit Dandona, Uchechukwu K.A. Sampson, Monika Sawhney, Vasiliy Victorovich Vlassov, Farhad Islami, Palwasha Anwari, Mustafa Z. Younis, Amitava Banerjee, Ruben Castro, David O. Carpenter, Karzan Abdulmuhsin Mohammad, Taavi Lai, Yousef Khader, Sara Sheikhbahaei, Atte Meretoja, Zanfina Ademi, Ivo Rakovac, Yang Yang, Hilda L Harb, Daniel Pope, Jun She, Yichong Li, Andrew L. Thorne-Lyman, Adrian Davis, Stein Emil Vollset, Andre Pascal Kengne, Henry Apfel, Mark J. Nieuwenhuijsen, John J. McGrath, Yoshihiro Kokubo, Jonas Minet Kinge, Elisabete Weiderpass, Rajiv Chowdhury, Damian G Hoy, Jürgen C Schmidt, Seyed-Mohammad Fereshtehnejad, Harish Chander Gugnani, Hywel C Williams, Karen Edmond, Peter J. Allen, Marina Shakh-Nazarova, Tom Achoki, Edmond K. Kabagambe, Naohiro Yonemoto, Jun Zhu, Simon I. Hay, Karen J. Courville, Ketevan Goginashvili, Theo Vos, Kim Yun Jin, Kawkab Shishani, Lorenzo Monasta, H. Dean Hosgood, Uʇur Dilmen, Marcella Montico, Shankuan Zhu, Ami R. Moore, Marie Ng, Maigeng Zhou, Hebe N. Gouda, Linh N Bui, Sanjay Basu, Mouhanad Hammami, Mohammad T Mashal, Bryan K. Phillips, Marissa Iannarone, Ronan A Lyons, Young-Ho Khang, Robert G. Weintraub, Luca Ronfani, Daniel Kim, Alanur Çavlin, Ferrán Catalá-López, Ronny Westerman, Maia Kereselidze, Itamar S. Santos, Reza Assadi, Hwashin Hyun Shin, Carolina Maria Teixeira, Berrak Bora Basara, David Rojas-Rueda, Abdullah Sulieman Terkawi, Adansi A. Amankwaa, Nicholas J K Breitborde, Gokalp Kadri Yentur, Kaushalendra Kumar, Daniel Obadare Fijabi, Neeraj Bedi, Robert Quentin Reilly, Ana Maria Nogales Vasconcelos, Scott Weichenthal, Mark A. Green, Selen Begüm Uzun, Mukesh Dherani, Shams Eldin Ali Hassan Khalifa, Majed Asad, Jasvinder A. Singh, Angel J Paternina Caicedo, Eric L. Ding, Jost B. Jonas, Tolesa Bekele, Alan J Thomson, Steven E. Lipshultz, Rosario Cárdenas, Sajjad Ur Rahman, George A. Mensah, Jongmin Lee, Inga Dora Sigfusdottir, Mohammad Yahya Saeedi, Magdalena M. Muszyńska, Ulrich O Mueller, Stephen S Lim, Barthelemy Kuate Defo, Alan D. Lopez, Luciano A. Sposato, G Anil Kumar, Farshad Pourmalek, Zulfiqar A Bhutta, Maysaa El Sayed Zaki, Shiwei Liu, K.M. Venkat Narayan, William Msemburi, Ting Wu Chuang, Zewdie Aderaw Alemu, Saleem M Rana, Mohammad Taghi Hedayati, Mohsen Naghavi, Vegard Skirbekk, Walter Mendoza, Ali H. Mokdad, Yohannes Kinfu, Jean de Dieu Ngirabega, Takayoshi Ohkubo, Parfait Uwaliraye, Tasara T. Mazorodze, Farshad Farzadfar, Rob E. Dorrington, Mohammad A. AlMazroa, R. Kumar, Lesley Rushton, Wang, H, Liddell, Ca, Coates, Mm, Mooney, Md, Levitz, Ce, Schumacher, Ae, Apfel, H, Iannarone, M, Phillips, B, Lofgren, Kt, Sandar, L, Dorrington, Re, Rakovac, I, Jacobs, Ta, Liang, X, Zhou, M, Zhu, J, Yang, G, Wang, Y, Liu, S, Li, Y, Ozgoren, Aa, Abera, Sf, Abubakar, I, Achoki, T, Adelekan, A, Ademi, Z, Alemu, Za, Allen, Pj, Almazroa, Ma, Alvarez, E, Amankwaa, Aa, Amare, At, Ammar, W, Anwari, P, Cunningham, Sa, Asad, Mm, Assadi, R, Banerjee, A, Basu, S, Bedi, N, Bekele, T, Bell, Ml, Bhutta, Z, Blore, J, Basara, Bb, Boufous, S, Breitborde, N, Bruce, Ng, Bui, Ln, Carapetis, Jr, Cárdenas, R, Carpenter, Do, Caso, V, Castro, Re, Catalá Lopéz, F, Cavlin, A, Che, X, Chiang, Pp, Chowdhury, R, Christophi, Ca, Chuang, Tw, Cirillo, Massimo, da Costa Leite, I, Courville, Kj, Dandona, L, Dandona, R, Davis, A, Dayama, A, Deribe, K, Dharmaratne, Sd, Dherani, Mk, Dilmen, U, Ding, El, Edmond, Km, Ermakov, Sp, Farzadfar, F, Fereshtehnejad, Sm, Fijabi, Do, Foigt, N, Forouzanfar, Mh, Garcia, Ac, Geleijnse, Jm, Gessner, Bd, Goginashvili, K, Gona, P, Goto, A, Gouda, Hn, Green, Ma, Greenwell, Kf, Gugnani, Hc, Gupta, R, Hamadeh, Rr, Hammami, M, Harb, Hl, Hay, S, Hedayati, Mt, Hosgood, Hd, Hoy, Dg, Idrisov, Bt, Islami, F, Ismayilova, S, Jha, V, Jiang, G, Jonas, Jb, Juel, K, Kabagambe, Ek, Kazi, D, Kengne, Ap, Kereselidze, M, Khader, Y, Khalifa, Se, Khang, Yh, Kim, D, Kinfu, Y, Kinge, Jm, Kokubo, Y, Kosen, S, Defo, Bk, Kumar, Ga, Kumar, K, Kumar, Rb, Lai, T, Lan, Q, Larsson, A, Lee, Jt, Leinsalu, M, Lim, S, Lipshultz, Se, Logroscino, G, Lotufo, Pa, Lunevicius, R, Lyons, Ra, Ma, S, Mahdi, Aa, Marzan, Mb, Mashal, Mt, Mazorodze, Tt, Mcgrath, Jj, Memish, Za, Mendoza, W, Mensah, Ga, Meretoja, A, Miller, Tr, Mills, Ej, Mohammad, Ka, Mokdad, Ah, Monasta, L, Montico, M, Moore, Ar, Moschandreas, J, Msemburi, Wt, Mueller, Uo, Muszynska, Mm, Naghavi, M, Naidoo, K, Narayan, Kv, Nejjari, C, Ng, M, de Dieu Ngirabega, J, Nieuwenhuijsen, Mj, Nyakarahuka, L, Ohkubo, T, Omer, Sb, Caicedo, Aj, Wyk, Vp, Pope, D, Prabhakaran, D, Rahman, Su, Rana, Sm, Reilly, Rq, Rojas Rueda, D, Ronfani, L, Rushton, L, Saeedi, My, Salomon, J, Sampson, U, Santos, I, Sawhney, M, Schmidt, Jc, Shakh Nazarova, M, She, J, Sheikhbahaei, S, Shibuya, K, Shin, Hh, Shishani, K, Shiue, I, Sigfusdottir, Id, Singh, Ja, Skirbekk, V, Sliwa, K, Soshnikov, S, Sposato, La, Stathopoulou, Vk, Stroumpoulis, K, Tabb, Km, Talongwa, Rt, Teixeira, Cm, Terkawi, A, Thomson, Aj, Thorne Lyman, Al, Toyoshima, H, Dimbuene, Zt, Uwaliraye, P, Uzun, Sb, Vasankari, Tj, Vasconcelos, Am, Vlassov, Vv, Vollset, Se, Vos, T, Waller, S, Wan, X, Weichenthal, S, Weiderpass, E, Weintraub, Rg, Westerman, R, Wilkinson, Jd, Williams, Hc, Yang, Yc, Yentur, Gk, Yip, P, Yonemoto, N, Younis, M, Yu, C, Jin, Ky, El Sayed Zaki, M, Zhu, S, Lopez, Ad, and Murray, C. J.

Subjects
trends, Pediatrics, medicine.medical_specialty, Nutrition and Disease, democracy, Developing country, coverage, VDP::Medisinske fag: 700::Helsefag: 800::Epidemiologi medisinsk og odontologisk statistikk: 803, millennium development goals, Global Health, survival, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, 030225 pediatrics, Voeding en Ziekte, Infant Mortality, Global health, Humans, Organizational Objectives, Medicine, 030212 general & internal medicine, 10. No inequality, VLAG, business.industry, Mortality rate, Infant, Newborn, 1. No poverty, Infant, health, General Medicine, Millennium Development Goals, Infant mortality, maternal education, 3. Good health, Secular variation, Child mortality, Socioeconomic Factors, income countries, Child, Preschool, Child Mortality, developing-countries, VDP::Midical sciences: 700::Health sciences: 800::Epidemiology, medical and dental statistics: 803, International development, business, Demography, child-mortality
Abstract

Summary Background Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success. Methods We generated updated estimates of child mortality in early neonatal (age 0–6 days), late neonatal (7–28 days), postneonatal (29–364 days), childhood (1–4 years), and under-5 (0–4 years) age groups for 188 countries from 1970 to 2013, with more than 29 000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030. Findings We estimated that 6·3 million (95% UI 6·0–6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1–18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6–177·4) in Guinea-Bissau to 2·3 (1·8–2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from −6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000–13 than during 1990–2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only −1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone. Interpretation Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030. Funding Bill & Melinda Gates Foundation, US Agency for International Development.

Published
2014

3. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Author

Wang H, Liddell CA, Coates MM, Mooney MD, Levitz CE, Schumacher AE, Apfel H, Iannarone M, Phillips B, Lofgren KT, Sandar L, Dorrington RE, Rakovac I, Jacobs TA, Liang X, Zhou M, Zhu J, Yang G, Wang Y, Liu S, Li Y, Ozgoren AA, Abera SF, Abubakar I, Achoki T, Adelekan A, Ademi Z, Alemu ZA, Allen PJ, AlMazroa MA, Alvarez E, Amankwaa AA, Amare AT, Ammar W, Anwari P, Cunningham SA, Asad MM, Assadi R, Banerjee A, Basu S, Bedi N, Bekele T, Bell ML, Bhutta Z, Blore JD, Basara BB, Boufous S, Breitborde N, Bruce NG, Bui LN, Carapetis JR, Cárdenas R, Carpenter DO, Caso V, Castro RE, Catalá-Lopéz F, Cavlin A, Che X, Chiang PP, Chowdhury R, Christophi CA, Chuang TW, Cirillo M, da Costa Leite I, Courville KJ, Dandona L, Dandona R, Davis A, Dayama A, Deribe K, Dharmaratne SD, Dherani MK, Dilmen U, Ding EL, Edmond KM, Ermakov SP, Farzadfar F, Fereshtehnejad SM, Fijabi DO, Foigt N, Forouzanfar MH, Garcia AC, Geleijnse JM, Gessner BD, Goginashvili K, Gona P, Goto A, Gouda HN, Green MA, Greenwell KF, Gugnani HC, Gupta R, Hamadeh RR, Hammami M, Harb HL, Hay S, Hedayati MT, Hosgood HD, Hoy DG, Idrisov BT, Islami F, Ismayilova S, Jha V, Jiang G, Jonas JB, Juel K, Kabagambe EK, Kazi DS, Kengne AP, Kereselidze M, Khader YS, Khalifa SE, Khang YH, Kim D, Kinfu Y, Kinge JM, Kokubo Y, Kosen S, Defo BK, Kumar GA, Kumar K, Kumar RB, Lai T, Lan Q, Larsson A, Lee JT, Leinsalu M, Lim SS, Lipshultz SE, Logroscino G, Lotufo PA, Lunevicius R, Lyons RA, Ma S, Mahdi AA, Marzan MB, Mashal MT, Mazorodze TT, McGrath JJ, Memish ZA, Mendoza W, Mensah GA, Meretoja A, Miller TR, Mills EJ, Mohammad KA, Mokdad AH, Monasta L, Montico M, Moore AR, Moschandreas J, Msemburi WT, Mueller UO, Muszynska MM, Naghavi M, Naidoo KS, Narayan KM, Nejjari C, Ng M, de Dieu Ngirabega J, Nieuwenhuijsen MJ, Nyakarahuka L, Ohkubo T, Omer SB, Caicedo AJ, Pillay-van Wyk V, Pope D, Pourmalek F, Prabhakaran D, Rahman SU, Rana SM, Reilly RQ, Rojas-Rueda D, Ronfani L, Rushton L, Saeedi MY, Salomon JA, Sampson U, Santos IS, Sawhney M, Schmidt JC, Shakh-Nazarova M, She J, Sheikhbahaei S, Shibuya K, Shin HH, Shishani K, Shiue I, Sigfusdottir ID, Singh JA, Skirbekk V, Sliwa K, Soshnikov SS, Sposato LA, Stathopoulou VK, Stroumpoulis K, Tabb KM, Talongwa RT, Teixeira CM, Terkawi AS, Thomson AJ, Thorne-Lyman AL, Toyoshima H, Dimbuene ZT, Uwaliraye P, Uzun SB, Vasankari TJ, Vasconcelos AM, Vlassov VV, Vollset SE, Waller S, Wan X, Weichenthal S, Weiderpass E, Weintraub RG, Westerman R, Wilkinson JD, Williams HC, Yang YC, Yentur GK, Yip P, Yonemoto N, Younis M, Yu C, Jin KY, El Sayed Zaki M, Zhu S, Vos T, Lopez AD, and Murray CJ

Subjects
Child, Preschool, Global Health statistics & numerical data, Humans, Infant, Infant, Newborn, Organizational Objectives, Risk Factors, Socioeconomic Factors, Child Mortality trends, Global Health trends, Infant Mortality trends
Abstract

Background: Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success., Methods: We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030., Findings: We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone., Interpretation: Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030., Funding: Bill & Melinda Gates Foundation, US Agency for International Development., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Published
2014
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