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.
| Original language | English |
|---|---|
| Pages (from-to) | 957-979 |
| Number of pages | 23 |
| Journal | The Lancet |
| Volume | 384 |
| Issue number | 9947 |
| DOIs | |
| Publication status | Published - 2014 |
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ASJC Scopus subject areas
- Medicine(all)
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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. / Wang, Haidong; Liddell, Chelsea A.; Coates, Matthew M.; Mooney, Meghan D.; Levitz, Carly E.; Schumacher, Austin E.; Apfel, Henry; Iannarone, Marissa; Phillips, Bryan; Lofgren, Katherine T.; Sandar, Logan; Dorrington, Rob E.; Rakovac, Ivo; Jacobs, Troy A.; Liang, Xiaofeng; Zhou, Maigeng; Zhu, Jun; Yang, Gonghuan; Wang, Yanping; Liu, Shiwei; Li, Yichong; Ozgoren, Ayse Abbasoglu; Abera, Semaw Ferede; Abubakar, Ibrahim; Achoki, Tom; Adelekan, Ademola; Ademi, Zanfina; Alemu, Zewdie Aderaw; Allen, Peter J.; AlMazroa, Mohammad Abdulaziz; Alvarez, Elena; Amankwaa, Adansi A.; Amare, Azmeraw T.; Ammar, Walid; Anwari, Palwasha; Cunningham, Solveig Argeseanu; Asad, Majed Masoud; Assadi, Reza; Banerjee, Amitava; Basu, Sanjay; Bedi, Neeraj; Bekele, Tolesa; Bell, Michelle L.; Bhutta, Zulfiqar; Blore, Jed D.; Basara, Berrak Bora; Boufous, Soufiane; Breitborde, Nicholas; Bruce, Nigel G.; Bui, Linh Ngoc; Carapetis, Jonathan R.; Cárdenas, Rosario; Carpenter, David O.; Caso, Valeria; Castro, Ruben Estanislao; Catalá-Lopéz, Ferrán; Cavlin, Alanur; Che, Xuan; Chiang, Peggy Pei Chia; Chowdhury, Rajiv; Christophi, Costas A.; Chuang, Ting Wu; Cirillo, Massimo; Da Costa Leite, Iuri; Courville, Karen J.; Dandona, Lalit; Dandona, Rakhi; Davis, Adrian; Dayama, Anand; Deribe, Kebede; Dharmaratne, Samath D.; Dherani, Mukesh K.; Dilmen, Uʇur; Ding, Eric L.; Edmond, Karen M.; Ermakov, Sergei Petrovich; Farzadfar, Farshad; Fereshtehnejad, Seyed Mohammad; Fijabi, Daniel Obadare; Foigt, Nataliya; Forouzanfar, Mohammad H.; Garcia, Ana C.; Geleijnse, Johanna M.; Gessner, Bradford D.; Goginashvili, Ketevan; Gona, Philimon; Goto, Atsushi; Gouda, Hebe N.; Green, Mark A.; Greenwell, Karen Fern; Gugnani, Harish Chander; Gupta, Rahul; Hamadeh, Randah Ribhi; Hammami, Mouhanad; Harb, Hilda L.; Hay, Simon; Hedayati, Mohammad T.; Hosgood, H. Dean; Hoy, Damian G.; Idrisov, Bulat T.; Islami, Farhad; Ismayilova, Samaya; Jha, Vivekanand; Jiang, Guohong; Jonas, Jost B.; Juel, Knud; Kabagambe, Edmond Kato; Kazi, Dhruv S.; Kengne, Andre Pascal; Kereselidze, Maia; Khader, Yousef Saleh; Khalifa, Shams Eldin Ali Hassan; Khang, Young Ho; Kim, Daniel; Kinfu, Yohannes; Kinge, Jonas M.; Kokubo, Yoshihiro; Kosen, Soewarta; Defo, Barthelemy Kuate; Kumar, G. Anil; Kumar, Kaushalendra; Kumar, Ravi B.; Lai, Taavi; Lan, Qing; Larsson, Anders; Lee, Jong-Tae; Leinsalu, Mall; Lim, Stephen S.; Lipshultz, Steven E.; Logroscino, Giancarlo; Lotufo, Paulo A.; Lunevicius, Raimundas; Lyons, Ronan Anthony; Ma, Stefan; Mahdi, Abbas Ali; Marzan, Melvin Barrientos; Mashal, Mohammad Taufiq; Mazorodze, Tasara T.; McGrath, John J.; Memish, Ziad A.; Mendoza, Walter; Mensah, George A.; Meretoja, Atte; Miller, Ted R.; Mills, Edward J.; Mohammad, Karzan Abdulmuhsin; Mokdad, Ali H.; Monasta, Lorenzo; Montico, Marcella; Moore, Ami R.; Moschandreas, Joanna; Msemburi, William T.; Mueller, Ulrich O.; Muszynska, Magdalena M.; Naghavi, Mohsen; Naidoo, Kovin S.; Narayan, K. M Venkat; Nejjari, Chakib; Ng, Marie; De Dieu Ngirabega, Jean; Nieuwenhuijsen, Mark J.; Nyakarahuka, Luke; Ohkubo, Takayoshi; Omer, Saad B.; Paternina Caicedo, Angel J.; Pillay-Van Wyk, Victoria; Pope, Dan; Pourmalek, Farshad; Prabhakaran, Dorairaj; Rahman, Sajjad U R; Rana, Saleem M.; Reilly, Robert Quentin; Rojas-Rueda, David; Ronfani, Luca; Rushton, Lesley; Saeedi, Mohammad Yahya; Salomon, Joshua A.; Sampson, Uchechukwu; Santos, Itamar S.; Sawhney, Monika; Schmidt, Jürgen C.; Shakh-Nazarova, Marina; She, Jun; Sheikhbahaei, Sara; Shibuya, Kenji; Shin, Hwashin Hyun; Shishani, Kawkab; Shiue, Ivy; Sigfusdottir, Inga Dora; Singh, Jasvinder A.; Skirbekk, Vegard; Sliwa, Karen; Soshnikov, Sergey S.; Sposato, Luciano A.; Stathopoulou, Vasiliki Kalliopi; Stroumpoulis, Konstantinos; Tabb, Karen M.; Talongwa, Roberto Tchio; Teixeira, Carolina Maria; Terkawi, Abdullah Sulieman; Thomson, Alan J.; Thorne-Lyman, Andrew L.; Toyoshima, Hideaki; Dimbuene, Zacharie Tsala; Uwaliraye, Parfait; Uzun, Selen Begüm; Vasankari, Tommi J.; Vasconcelos, Ana Maria Nogales; Vlassov, Vasiliy Victorovich; Vollset, Stein Emil; Waller, Stephen; Wan, Xia; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G.; Westerman, Ronny; Wilkinson, James D.; Williams, Hywel C.; Yang, Yang C.; Yentur, Gokalp Kadri; Yip, Paul; Yonemoto, Naohiro; Younis, Mustafa; Yu, Chuanhua; Jin, Kim Yun; El Sayed Zaki, Maysaa; Zhu, Shankuan; Vos, Theo; Lopez, Alan D.; Murray, Christopher J L.
In: The Lancet, Vol. 384, No. 9947, 2014, p. 957-979.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013
T2 - A systematic analysis for the Global Burden of Disease Study 2013
AU - Wang, Haidong
AU - Liddell, Chelsea A.
AU - Coates, Matthew M.
AU - Mooney, Meghan D.
AU - Levitz, Carly E.
AU - Schumacher, Austin E.
AU - Apfel, Henry
AU - Iannarone, Marissa
AU - Phillips, Bryan
AU - Lofgren, Katherine T.
AU - Sandar, Logan
AU - Dorrington, Rob E.
AU - Rakovac, Ivo
AU - Jacobs, Troy A.
AU - Liang, Xiaofeng
AU - Zhou, Maigeng
AU - Zhu, Jun
AU - Yang, Gonghuan
AU - Wang, Yanping
AU - Liu, Shiwei
AU - Li, Yichong
AU - Ozgoren, Ayse Abbasoglu
AU - Abera, Semaw Ferede
AU - Abubakar, Ibrahim
AU - Achoki, Tom
AU - Adelekan, Ademola
AU - Ademi, Zanfina
AU - Alemu, Zewdie Aderaw
AU - Allen, Peter J.
AU - AlMazroa, Mohammad Abdulaziz
AU - Alvarez, Elena
AU - Amankwaa, Adansi A.
AU - Amare, Azmeraw T.
AU - Ammar, Walid
AU - Anwari, Palwasha
AU - Cunningham, Solveig Argeseanu
AU - Asad, Majed Masoud
AU - Assadi, Reza
AU - Banerjee, Amitava
AU - Basu, Sanjay
AU - Bedi, Neeraj
AU - Bekele, Tolesa
AU - Bell, Michelle L.
AU - Bhutta, Zulfiqar
AU - Blore, Jed D.
AU - Basara, Berrak Bora
AU - Boufous, Soufiane
AU - Breitborde, Nicholas
AU - Bruce, Nigel G.
AU - Bui, Linh Ngoc
AU - Carapetis, Jonathan R.
AU - Cárdenas, Rosario
AU - Carpenter, David O.
AU - Caso, Valeria
AU - Castro, Ruben Estanislao
AU - Catalá-Lopéz, Ferrán
AU - Cavlin, Alanur
AU - Che, Xuan
AU - Chiang, Peggy Pei Chia
AU - Chowdhury, Rajiv
AU - Christophi, Costas A.
AU - Chuang, Ting Wu
AU - Cirillo, Massimo
AU - Da Costa Leite, Iuri
AU - Courville, Karen J.
AU - Dandona, Lalit
AU - Dandona, Rakhi
AU - Davis, Adrian
AU - Dayama, Anand
AU - Deribe, Kebede
AU - Dharmaratne, Samath D.
AU - Dherani, Mukesh K.
AU - Dilmen, Uʇur
AU - Ding, Eric L.
AU - Edmond, Karen M.
AU - Ermakov, Sergei Petrovich
AU - Farzadfar, Farshad
AU - Fereshtehnejad, Seyed Mohammad
AU - Fijabi, Daniel Obadare
AU - Foigt, Nataliya
AU - Forouzanfar, Mohammad H.
AU - Garcia, Ana C.
AU - Geleijnse, Johanna M.
AU - Gessner, Bradford D.
AU - Goginashvili, Ketevan
AU - Gona, Philimon
AU - Goto, Atsushi
AU - Gouda, Hebe N.
AU - Green, Mark A.
AU - Greenwell, Karen Fern
AU - Gugnani, Harish Chander
AU - Gupta, Rahul
AU - Hamadeh, Randah Ribhi
AU - Hammami, Mouhanad
AU - Harb, Hilda L.
AU - Hay, Simon
AU - Hedayati, Mohammad T.
AU - Hosgood, H. Dean
AU - Hoy, Damian G.
AU - Idrisov, Bulat T.
AU - Islami, Farhad
AU - Ismayilova, Samaya
AU - Jha, Vivekanand
AU - Jiang, Guohong
AU - Jonas, Jost B.
AU - Juel, Knud
AU - Kabagambe, Edmond Kato
AU - Kazi, Dhruv S.
AU - Kengne, Andre Pascal
AU - Kereselidze, Maia
AU - Khader, Yousef Saleh
AU - Khalifa, Shams Eldin Ali Hassan
AU - Khang, Young Ho
AU - Kim, Daniel
AU - Kinfu, Yohannes
AU - Kinge, Jonas M.
AU - Kokubo, Yoshihiro
AU - Kosen, Soewarta
AU - Defo, Barthelemy Kuate
AU - Kumar, G. Anil
AU - Kumar, Kaushalendra
AU - Kumar, Ravi B.
AU - Lai, Taavi
AU - Lan, Qing
AU - Larsson, Anders
AU - Lee, Jong-Tae
AU - Leinsalu, Mall
AU - Lim, Stephen S.
AU - Lipshultz, Steven E.
AU - Logroscino, Giancarlo
AU - Lotufo, Paulo A.
AU - Lunevicius, Raimundas
AU - Lyons, Ronan Anthony
AU - Ma, Stefan
AU - Mahdi, Abbas Ali
AU - Marzan, Melvin Barrientos
AU - Mashal, Mohammad Taufiq
AU - Mazorodze, Tasara T.
AU - McGrath, John J.
AU - Memish, Ziad A.
AU - Mendoza, Walter
AU - Mensah, George A.
AU - Meretoja, Atte
AU - Miller, Ted R.
AU - Mills, Edward J.
AU - Mohammad, Karzan Abdulmuhsin
AU - Mokdad, Ali H.
AU - Monasta, Lorenzo
AU - Montico, Marcella
AU - Moore, Ami R.
AU - Moschandreas, Joanna
AU - Msemburi, William T.
AU - Mueller, Ulrich O.
AU - Muszynska, Magdalena M.
AU - Naghavi, Mohsen
AU - Naidoo, Kovin S.
AU - Narayan, K. M Venkat
AU - Nejjari, Chakib
AU - Ng, Marie
AU - De Dieu Ngirabega, Jean
AU - Nieuwenhuijsen, Mark J.
AU - Nyakarahuka, Luke
AU - Ohkubo, Takayoshi
AU - Omer, Saad B.
AU - Paternina Caicedo, Angel J.
AU - Pillay-Van Wyk, Victoria
AU - Pope, Dan
AU - Pourmalek, Farshad
AU - Prabhakaran, Dorairaj
AU - Rahman, Sajjad U R
AU - Rana, Saleem M.
AU - Reilly, Robert Quentin
AU - Rojas-Rueda, David
AU - Ronfani, Luca
AU - Rushton, Lesley
AU - Saeedi, Mohammad Yahya
AU - Salomon, Joshua A.
AU - Sampson, Uchechukwu
AU - Santos, Itamar S.
AU - Sawhney, Monika
AU - Schmidt, Jürgen C.
AU - Shakh-Nazarova, Marina
AU - She, Jun
AU - Sheikhbahaei, Sara
AU - Shibuya, Kenji
AU - Shin, Hwashin Hyun
AU - Shishani, Kawkab
AU - Shiue, Ivy
AU - Sigfusdottir, Inga Dora
AU - Singh, Jasvinder A.
AU - Skirbekk, Vegard
AU - Sliwa, Karen
AU - Soshnikov, Sergey S.
AU - Sposato, Luciano A.
AU - Stathopoulou, Vasiliki Kalliopi
AU - Stroumpoulis, Konstantinos
AU - Tabb, Karen M.
AU - Talongwa, Roberto Tchio
AU - Teixeira, Carolina Maria
AU - Terkawi, Abdullah Sulieman
AU - Thomson, Alan J.
AU - Thorne-Lyman, Andrew L.
AU - Toyoshima, Hideaki
AU - Dimbuene, Zacharie Tsala
AU - Uwaliraye, Parfait
AU - Uzun, Selen Begüm
AU - Vasankari, Tommi J.
AU - Vasconcelos, Ana Maria Nogales
AU - Vlassov, Vasiliy Victorovich
AU - Vollset, Stein Emil
AU - Waller, Stephen
AU - Wan, Xia
AU - Weichenthal, Scott
AU - Weiderpass, Elisabete
AU - Weintraub, Robert G.
AU - Westerman, Ronny
AU - Wilkinson, James D.
AU - Williams, Hywel C.
AU - Yang, Yang C.
AU - Yentur, Gokalp Kadri
AU - Yip, Paul
AU - Yonemoto, Naohiro
AU - Younis, Mustafa
AU - Yu, Chuanhua
AU - Jin, Kim Yun
AU - El Sayed Zaki, Maysaa
AU - Zhu, Shankuan
AU - Vos, Theo
AU - Lopez, Alan D.
AU - Murray, Christopher J L
PY - 2014
Y1 - 2014
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84904972811&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84904972811&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(14)60497-9
DO - 10.1016/S0140-6736(14)60497-9
M3 - Article
C2 - 24797572
AN - SCOPUS:84904972811
VL - 384
SP - 957
EP - 979
JO - The Lancet
JF - The Lancet
SN - 0140-6736
IS - 9947
ER -