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 - PubMed (original) (raw)

Multicenter Study

. 2014 Sep 13;384(9947):957-79.

doi: 10.1016/S0140-6736(14)60497-9. Epub 2014 May 2.

Chelsea A Liddell 2, Matthew M Coates 2, Meghan D Mooney 2, Carly E Levitz 2, Austin E Schumacher 2, Henry Apfel 2, Marissa Iannarone 2, Bryan Phillips 2, Katherine T Lofgren 2, Logan Sandar 2, Rob E Dorrington 3, Ivo Rakovac 4, Troy A Jacobs 5, Xiaofeng Liang 6, Maigeng Zhou 6, Jun Zhu 7, Gonghuan Yang 8, Yanping Wang 7, Shiwei Liu 6, Yichong Li 6, Ayse Abbasoglu Ozgoren 9, Semaw Ferede Abera 10, Ibrahim Abubakar 11, Tom Achoki 12, Ademola Adelekan 13, Zanfina Ademi 14, Zewdie Aderaw Alemu 15, Peter J Allen 16, Mohammad AbdulAziz AlMazroa 17, Elena Alvarez 18, Adansi A Amankwaa 19, Azmeraw T Amare 20, Walid Ammar 21, Palwasha Anwari 22, Solveig Argeseanu Cunningham 23, Majed Masoud Asad 24, Reza Assadi 25, Amitava Banerjee 26, Sanjay Basu 27, Neeraj Bedi 28, Tolesa Bekele 29, Michelle L Bell 30, Zulfiqar Bhutta 31, Jed D Blore 14, Berrak Bora Basara 32, Soufiane Boufous 33, Nicholas Breitborde 34, Nigel G Bruce 35, Linh Ngoc Bui 36, Jonathan R Carapetis 37, Rosario Cárdenas 38, David O Carpenter 39, Valeria Caso 40, Ruben Estanislao Castro 41, Ferrán Catalá-Lopéz 42, Alanur Cavlin 9, Xuan Che 43, Peggy Pei-Chia Chiang 44, Rajiv Chowdhury 45, Costas A Christophi 46, Ting-Wu Chuang 47, Massimo Cirillo 48, Iuri da Costa Leite 49, Karen J Courville 50, Lalit Dandona 51, Rakhi Dandona 52, Adrian Davis 53, Anand Dayama 54, Kebede Deribe 55, Samath D Dharmaratne 56, Mukesh K Dherani 35, Uğur Dilmen 32, Eric L Ding 57, Karen M Edmond 58, Sergei Petrovich Ermakov 59, Farshad Farzadfar 60, Seyed-Mohammad Fereshtehnejad 61, Daniel Obadare Fijabi 62, Nataliya Foigt 63, Mohammad H Forouzanfar 2, Ana C Garcia 64, Johanna M Geleijnse 65, Bradford D Gessner 66, Ketevan Goginashvili 67, Philimon Gona 68, Atsushi Goto 69, Hebe N Gouda 70, Mark A Green 71, Karen Fern Greenwell 72, Harish Chander Gugnani 73, Rahul Gupta 74, Randah Ribhi Hamadeh 75, Mouhanad Hammami 76, Hilda L Harb 21, Simon Hay 77, Mohammad T Hedayati 78, H Dean Hosgood 79, Damian G Hoy 80, Bulat T Idrisov 81, Farhad Islami 82, Samaya Ismayilova 83, Vivekanand Jha 84, Guohong Jiang 85, Jost B Jonas 86, Knud Juel 87, Edmond Kato Kabagambe 88, Dhruv S Kazi 89, Andre Pascal Kengne 90, Maia Kereselidze 91, Yousef Saleh Khader 92, Shams Eldin Ali Hassan Khalifa 93, Young-Ho Khang 94, Daniel Kim 95, Yohannes Kinfu 96, Jonas M Kinge 97, Yoshihiro Kokubo 98, Soewarta Kosen 99, Barthelemy Kuate Defo 100, G Anil Kumar 52, Kaushalendra Kumar 101, Ravi B Kumar 52, Taavi Lai 102, Qing Lan 103, Anders Larsson 104, Jong-Tae Lee 105, Mall Leinsalu 106, Stephen S Lim 2, Steven E Lipshultz 107, Giancarlo Logroscino 108, Paulo A Lotufo 109, Raimundas Lunevicius 110, Ronan Anthony Lyons 111, Stefan Ma 112, Abbas Ali Mahdi 113, Melvin Barrientos Marzan 114, Mohammad Taufiq Mashal 115, Tasara T Mazorodze 116, John J McGrath 70, Ziad A Memish 17, Walter Mendoza 117, George A Mensah 118, Atte Meretoja 14, Ted R Miller 119, Edward J Mills 120, Karzan Abdulmuhsin Mohammad 121, Ali H Mokdad 2, Lorenzo Monasta [ 122](#full-view-affiliation-122 "Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy."), Marcella Montico [ 122](#full-view-affiliation-122 "Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy."), Ami R Moore 123, Joanna Moschandreas 124, William T Msemburi 90, Ulrich O Mueller 125, Magdalena M Muszynska 126, Mohsen Naghavi 2, Kovin S Naidoo 127, K M Venkat Narayan 23, Chakib Nejjari 128, Marie Ng 2, Jean de Dieu Ngirabega 129, Mark J Nieuwenhuijsen 130, Luke Nyakarahuka 131, Takayoshi Ohkubo 132, Saad B Omer 23, Angel J Paternina Caicedo 133, Victoria Pillay-van Wyk 90, Dan Pope 35, Farshad Pourmalek 134, Dorairaj Prabhakaran 135, Sajjad U R Rahman 136, Saleem M Rana 137, Robert Quentin Reilly 138, David Rojas-Rueda 130, Luca Ronfani [ 122](#full-view-affiliation-122 "Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy."), Lesley Rushton 139, Mohammad Yahya Saeedi 17, Joshua A Salomon 57, Uchechukwu Sampson 88, Itamar S Santos 109, Monika Sawhney 140, Jürgen C Schmidt 53, Marina Shakh-Nazarova 91, Jun She 141, Sara Sheikhbahaei 60, Kenji Shibuya 142, Hwashin Hyun Shin 143, Kawkab Shishani 144, Ivy Shiue 145, Inga Dora Sigfusdottir 146, Jasvinder A Singh 147, Vegard Skirbekk 97, Karen Sliwa 148, Sergey S Soshnikov 149, Luciano A Sposato 150, Vasiliki Kalliopi Stathopoulou 151, Konstantinos Stroumpoulis [ 152](#full-view-affiliation-152 "KEELPNO (Center for Disease Control, Greece, dispatched to "Alexandra" General Hospital of Athens), Athens, Greece."), Karen M Tabb 153, Roberto Tchio Talongwa 154, Carolina Maria Teixeira 155, Abdullah Sulieman Terkawi 156, Alan J Thomson 157, Andrew L Thorne-Lyman 158, Hideaki Toyoshima 159, Zacharie Tsala Dimbuene 160, Parfait Uwaliraye 161, Selen Begüm Uzun 32, Tommi J Vasankari 162, Ana Maria Nogales Vasconcelos 163, Vasiliy Victorovich Vlassov 164, Stein Emil Vollset 97, Stephen Waller 165, Xia Wan 166, Scott Weichenthal 143, Elisabete Weiderpass 167, Robert G Weintraub 168, Ronny Westerman 125, James D Wilkinson 169, Hywel C Williams 170, Yang C Yang 171, Gokalp Kadri Yentur 32, Paul Yip 172, Naohiro Yonemoto 173, Mustafa Younis 174, Chuanhua Yu 175, Kim Yun Jin 176, Maysaa El Sayed Zaki 177, Shankuan Zhu 178, Theo Vos 2, Alan D Lopez 14, Christopher J L Murray 2

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Multicenter Study

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

Haidong Wang et al. Lancet. 2014.

Erratum in

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.

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Figures

Figure 1

Figure 1

Child mortality estimation process for the Global Burden of Diseases, Injuries, and Risk Factors Study 2013

Figure 2

Figure 2. Global under-5 mortality rate and rate of change, 1970–2013

(A) Global under-5 mortality, 1970–2013. (B) Annualised rate of change in global child mortality, 1970–2013.

Figure 3

Figure 3. Global annualised rate of change in under-5 mortality rate (%) from 1990–2000, and 2000–13

Solid line shows the equivalence line between the two periods. Dashed lines show the Millenium Development Goal 4 target rate of 4·4% per year. We excluded North Korea from the figure because of substantially higher rates of change that distort the scales in the figure.CHN=China. EST=Estonia. IDN=Indonesia. GUY=Guyana. ETH=Ethiopia. TLS=Timor-Leste. IND=India. NER=Niger. PAK=Pakistan. NGA=Nigeria. MNE=Montenegro. ZAF=South Africa. COG=Congo. TON=Tonga. SWZ =Swaziland. BWA=Botswana. BHS=The Bahamas. MLT=Malta. FJI=Fiji.

Figure 4

Figure 4. Change in the number of deaths comparing 2013 with 1990

Change due to income per person, maternal education, HIV child death rate, shift in secular trend, births, and unexplained factors for seven Global Burden of Disease super-regions.

Figure 5

Figure 5. Countries with statistically significant differences between the observed rate of decline in under-5 mortality between 2000 and 2013, compared with the expected rate of decline on the basis of income, education, shift in secular trend, and HIV death rates in the absence of intervention

ATG=Antigua and Barbuda. LCA=Saint Lucia. VCT=Saint Vincent and the Grenadines. TTO=Trinidad and Tobago. TLS=Timor-Leste. FSM=Federated States of Micronesia.

Figure 6

Figure 6. Projected global under-5 deaths for four scenarios, 2013–30

Scenarios have been defined by the distribution of observed rates of change 2000 to 2013.

Figure 7

Figure 7. Projected under-5 mortality rate in 2030, on the basis of the observed rate of change for each country, 2000–13

ATG=Antigua and Barbuda. LCA=Saint Lucia. VCT=Saint Vincent and the Grenadines. TTO=Trinidad and Tobago. TLS=Timor-Leste. FSM=Federated States of Micronesia.

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