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.

Authors:
Mr Tasara T Mazorodze, Masters in Psycholody By Research
Mr Tasara T Mazorodze, Masters in Psycholody By Research
Rhodes
MR
HIV/AIS in the workplace
Port elizabeth, Eastern Cape | Afghanistan
Dr. Luke Nyakarahuka, DVM, MPH, PhD
Dr. Luke Nyakarahuka, DVM, MPH, PhD
Makerere University
Lecturer
Epidemiology
Kampala, Uganda | Uganda
Karzan Abdulmuhsin Mohammad
Karzan Abdulmuhsin Mohammad
University of Salahaddin
Xuan Che
Xuan Che
National Institute of Health
United States
Dr. Nataliya Foigt, PhD
Dr. Nataliya Foigt, PhD
Institute of Gerontology
Head of Lab.
demography, epidemiology
Kyiv | Ukraine
Prof. Abbas Mahdi, PhD
Prof. Abbas Mahdi, PhD
King George's Medical University
Professor
Medical Biochemistry
Lucknow, Uttar Pradesh | India
Mr. Gokalp Kadri Yentur
Mr. Gokalp Kadri Yentur
Applied Statistics, Biostatistics
Ankara | Turkey
Dr. Lorenzo Monasta, DSc Epidemiology, MSc Health Sciences, MSc+BSc Statistics & Demography
Dr. Lorenzo Monasta, DSc Epidemiology, MSc Health Sciences, MSc+BSc Statistics & Demography
Institute for Maternal and Child Health -
Epidemiology and Biostatistics
Trieste, TS | Italy
Dr.  Berrak Bora Basara, MD, PhD
Dr. Berrak Bora Basara, MD, PhD
Ministry of Health of Turkey
Head of Department of Health Statistics
Ankara | Turkey
Dr Ademola Adelekan, DrPH
Dr Ademola Adelekan, DrPH
Public Health
Ibadan
Chuanhua Yu, PhD
Chuanhua Yu, PhD
Wuhan University
Prof.
Wuhan, Hubei | China
Haidong Wang Chelsea A Liddell Matthew M Coates Meghan D Mooney Carly E Levitz Austin E Schumacher Henry Apfel Marissa Iannarone Bryan Phillips Katherine T Lofgren Logan Sandar Rob E Dorrington Ivo Rakovac Troy A Jacobs Xiaofeng Liang Maigeng Zhou Jun Zhu Gonghuan Yang Yanping Wang Shiwei Liu Yichong Li Ayse Abbasoglu Ozgoren Semaw Ferede Abera Ibrahim Abubakar Tom Achoki Zanfina Ademi Zewdie Aderaw Alemu Peter J Allen Mohammad AbdulAziz AlMazroa Elena Alvarez Adansi A Amankwaa Azmeraw T Amare Walid Ammar Palwasha Anwari Solveig Argeseanu Cunningham Majed Masoud Asad Reza Assadi Amitava Banerjee Sanjay Basu Neeraj Bedi Tolesa Bekele Michelle L Bell Zulfiqar Bhutta Jed D Blore Soufiane Boufous Nicholas Breitborde Nigel G Bruce Linh Ngoc Bui Jonathan R Carapetis Rosario Cárdenas David O Carpenter Valeria Caso Ruben Estanislao Castro Ferrán Catalá-Lopéz Alanur Cavlin Peggy Pei-Chia Chiang Rajiv Chowdhury Costas A Christophi Ting-Wu Chuang Massimo Cirillo Iuri da Costa Leite Karen J Courville Lalit Dandona Rakhi Dandona Adrian Davis Anand Dayama Kebede Deribe Samath D Dharmaratne Mukesh K Dherani Uğur Dilmen Eric L Ding Karen M Edmond Sergei Petrovich Ermakov Farshad Farzadfar Seyed-Mohammad Fereshtehnejad Daniel Obadare Fijabi Mohammad H Forouzanfar Ana C Garcia Johanna M Geleijnse Bradford D Gessner Ketevan Goginashvili Philimon Gona Atsushi Goto Hebe N Gouda Mark A Green Karen Fern Greenwell Harish Chander Gugnani Rahul Gupta Randah Ribhi Hamadeh Mouhanad Hammami Hilda L Harb Simon Hay Mohammad T Hedayati H Dean Hosgood Damian G Hoy Bulat T Idrisov Farhad Islami Samaya Ismayilova Vivekanand Jha Guohong Jiang Jost B Jonas Knud Juel Edmond Kato Kabagambe Dhruv S Kazi Andre Pascal Kengne Maia Kereselidze Yousef Saleh Khader Shams Eldin Ali Hassan Khalifa Young-Ho Khang Daniel Kim Yohannes Kinfu Jonas M Kinge Yoshihiro Kokubo Soewarta Kosen Barthelemy Kuate Defo G Anil Kumar Kaushalendra Kumar Ravi B Kumar Taavi Lai Qing Lan Anders Larsson Jong-Tae Lee Mall Leinsalu Stephen S Lim Steven E Lipshultz Giancarlo Logroscino Paulo A Lotufo Raimundas Lunevicius Ronan Anthony Lyons Stefan Ma Abbas Ali Mahdi Melvin Barrientos Marzan Mohammad Taufiq Mashal John J McGrath Ziad A Memish Walter Mendoza George A Mensah Atte Meretoja Ted R Miller Edward J Mills Ali H Mokdad Marcella Montico Ami R Moore Joanna Moschandreas William T Msemburi Ulrich O Mueller Magdalena M Muszynska Mohsen Naghavi Kovin S Naidoo K M Venkat Narayan Chakib Nejjari Marie Ng Jean de Dieu Ngirabega Mark J Nieuwenhuijsen Takayoshi Ohkubo Saad B Omer Angel J Paternina Caicedo Victoria Pillay-van Wyk Dan Pope Farshad Pourmalek Dorairaj Prabhakaran Sajjad U R Rahman Saleem M Rana Robert Quentin Reilly David Rojas-Rueda Luca Ronfani Lesley Rushton Mohammad Yahya Saeedi Joshua A Salomon Uchechukwu Sampson Itamar S Santos Monika Sawhney Jürgen C Schmidt Marina Shakh-Nazarova Jun She Sara Sheikhbahaei Kenji Shibuya Hwashin Hyun Shin Kawkab Shishani Ivy Shiue Inga Dora Sigfusdottir Jasvinder A Singh Vegard Skirbekk Karen Sliwa Sergey S Soshnikov Luciano A Sposato Vasiliki Kalliopi Stathopoulou Konstantinos Stroumpoulis Karen M Tabb Roberto Tchio Talongwa Carolina Maria Teixeira Abdullah Sulieman Terkawi Alan J Thomson Andrew L Thorne-Lyman Hideaki Toyoshima Zacharie Tsala Dimbuene Parfait Uwaliraye Selen Begüm Uzun Tommi J Vasankari Ana Maria Nogales Vasconcelos Vasiliy Victorovich Vlassov Stein Emil Vollset Stephen Waller Xia Wan Scott Weichenthal Elisabete Weiderpass Robert G Weintraub Ronny Westerman James D Wilkinson Hywel C Williams Yang C Yang Paul Yip Naohiro Yonemoto Mustafa Younis Kim Yun Jin Maysaa El Sayed Zaki Shankuan Zhu Theo Vos Alan D Lopez Christopher J L Murray

Lancet 2014 Sep 2;384(9947):957-79. Epub 2014 May 2.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

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.

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http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(
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http://linkinghub.elsevier.com/retrieve/pii/S014067361460497
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September 2014
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