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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

Citation

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., et al. (2014). 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. Lancet, 384(9947), 957-979. PMCID: PMC4165626

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.

URL

http://dx.doi.org/10.1016/S0140-6736(14)60497-9

Reference Type

Journal Article

Year Published

2014

Journal Title

Lancet

Author(s)

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
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 A.
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, Uğur
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 I.
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 K.
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.
Caicedo, Angel J. Paternina
Wyk, Victoria Pillay-van
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 Claire
Yentur, Gokalp Kadri
Yip, Paul
Yonemoto, Naohiro
Younis, Mustafa Z.
Yu, Chuanhua
Jin, Kim Yun
El Sayed Zaki, Maysaa
Zhu, Shankuan
Vos, Theo
Lopez, Alan D.
Murray, Christopher J. L.

PMCID

PMC4165626