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, Chelsea Liddell, Matthew Coates, Meghan Mooney, Carly Levitz, Austin Schumacher, Henry Apfel, Marissa Iannarone, Bryan Phillips, Katherine Lofgren, Logan Sandar, Rob Dorrington, Ivo Rakovac, Troy Jacobs, Xiaofeng Liang, Maigeng Zhou, Jun Zhu, Gonghuan Yang, Yanping Wang, Shiwei LiuYichong Li, Ayse Abbasoglu Ozgoren, Semaw Ferede Abera, Ibrahim Abubakar, Tom Achoki, Ademola Adelekan, Zanfina Ademi, Zewdie Aderaw Alemu, Peter Allen, Mohammad AlMazroa, Elena Alvarez, Adansi Amankwaa, Azmeraw Amare, Walid Ammar, Palwasha Anwari, Solveig Cunningham, Majed Masoud Asad, Reza Assadi, Amitava Banerjee, Sanjay Basu, Neeraj Bedi, Tolesa Bekele, Michelle Bell, Zulfiqar Bhutta, Jed Blore, Berrak Basara, Soufiane Boufous, Nicholas Breitborde, Nigel Bruce, Linh Ngoc Bui, Jonathan Carapetis, Rosario Cárdenas, David Carpenter, Valeria Caso, Ruben Castro, Ferrán Catalá-Lopéz, Alanur Cavlin, Xuan Che, Peggy Chiang, Rajiv Chowdhury, Costas Christophi, Ting-Wu Chuang, Massimo Cirillo, Iuri da Leite, Karen Courville, Lalit Dandona, Rakhi Dandona, Adrian Davis, Anand Dayama, Kebede Deribe, Samath Dharmaratne, Mukesh Dherani, Ugur Dilmen, Eric Ding, Karen Edmond, Sergei Ermakov, Farshad Farzadfar, Seyed-Mohammad Fereshtehnejad, Daniel Obadare Fijabi, Nataliya Foigt, Mohammad Forouzanfar, Ana Garcia, Johanna Geleijnse, Bradford Gessner, Ketevan Goginashvili, Philimon Gona, Atsushi Goto, Hebe Gouda, Mark Green, Karen Greenwell, Harish Chander Gugnani, Rahul Gupta, Randah Hamadeh, Mouhanad Hammami, Hilda Harb, Simon Hay, Mohammad Hedayati, HDean Hosgood, Damian Hoy, Bulat Idrisov, Farhad Islami, Samaya Ismayilova, Vivekanand Jha, Guohong Jiang, Jost Jonas, Knud Juel, Edmond Kabagambe, Dhruv Kazi, Andre Kengne, Maia Kereselidze, Yousef Khader, Shams Hassan Khalif, Young-Ho Khang, Daniel Kim, Yohannes KINFU, Jonas Kinge, Yoshihiro Kokubo, Soewarta Kosen, Barthelemy Defo, GAnil Kumar, Kaushalendra Kumar, Ravi Kumar, Taavi Lai, Qing Lan, Anders Larsson, Jong-Tae Lee, Mall Leinsalu, Stephen Lim, Steven Lipshultz, Giancarlo Logroscino, Paulo Lotufo, Raimundas Lunevicius, Ronan Lyons, Stefan Ma, Abbas Mahdi, Melvin Marzan, Mohammad Mashal, Tasara Mazorodze, John McGrath, Ziad Memish, Walter Mendoza, George Mensah, Atte Meretoja, Ted Miller, Edward Mills, Karzan Mohammad, Ali Mokdad, Lorenzo Monasta, Marcella Montico, Ami Moore, Joanna Moschandreas, William Msemburi, Ulrich Mueller, Magdalena Muszynska, Mohsen Naghavi, Kovin Naidoo, KM Narayan, Chakib Nejjari, Marie Ng, Jean de Dieu Ngirabega, Mark Nieuwenhuijsen, Luke Nyakarahuka, Takayoshi Ohkubo, Saad Omer, Angel Caicedo, Victoria Wyk, Dan Pope, Farshad Pourmalek, Dorairaj Prabhakaran, Sajjad Rahman, Saleem Rana, Robert Quentin Reilly, David Rojas-Rueda, Luca Ronfani, Lesley Rushton, Mohammad Saeedi, Joshua Salomon, Uchechukwu Sampson, Itamar Santos, Monika Sawhney, Jürgen Schmidt, Marina Shakh-Nazarova, Jun She, Sara Sheikhbahaei, Kenji Shibuya, Hwashin Shin, Kawkab Shishani, Ivy Shiue, Inga Sigfusdottir, Jasvinder Singh, Vegard Skirbekk, Karen Sliwa, Sergey Soshnikov, Luciano Sposato, Vasiliki Kalliopi Stathopoulo, Konstantinos Stroumpoulis, Karen Tabb, Roberto Talongwa, Carolina Teixeira, Abdullah Terkawi, Alan Thomson, Andrew Thorne-Lyman, Hideaki Toyoshima, Zacharie Dimbuene, Parfait Uwaliraye, Selen Uzun, Tommi Vasankari, Ana Vasconcelos, Vasiliy Vlassov, Stein Vollset, Stephen Waller, Xia Wan, Scott Weichenthal, Elisabete Weiderpass, Robert Weintraub, Ronny Westerman, James Wilkinson, Hywel Williams, Yang Yang, Gokalp Yentur, Paul Yip, Naohiro Yonemoto, Mustafa Younis, Chuanhua Yu, Kim Jin, Maysaa Zaki, Shankuan Zhu, Theo Vos, Alan Lopez, Christopher Murray, et al.,

    Research output: Contribution to journalArticle

    436 Citations (Scopus)

    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.

    Original languageEnglish
    Pages (from-to)957-979
    Number of pages23
    JournalLancet
    Volume384
    Issue number9947
    DOIs
    Publication statusPublished - 2014

    Fingerprint Dive into the research topics of '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'. Together they form a unique fingerprint.

    Cite this