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Lancet. 2014 Sep 13;384(9947):957-79. doi: 10.1016/S0140-6736(14)60497-9. Epub 2014 May 2.

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 H1, Liddell CA2, Coates MM2, Mooney MD2, Levitz CE2, Schumacher AE2, Apfel H2, Iannarone M2, Phillips B2, Lofgren KT2, Sandar L2, Dorrington RE3, Rakovac I4, Jacobs TA5, Liang X6, Zhou M6, Zhu J7, Yang G8, Wang Y7, Liu S6, Li Y6, Ozgoren AA9, Abera SF10, Abubakar I11, Achoki T12, Adelekan A13, Ademi Z14, Alemu ZA15, Allen PJ16, AlMazroa MA17, Alvarez E18, Amankwaa AA19, Amare AT20, Ammar W21, Anwari P22, Cunningham SA23, Asad MM24, Assadi R25, Banerjee A26, Basu S27, Bedi N28, Bekele T29, Bell ML30, Bhutta Z31, Blore JD14, Basara BB32, Boufous S33, Breitborde N34, Bruce NG35, Bui LN36, Carapetis JR37, Cárdenas R38, Carpenter DO39, Caso V40, Castro RE41, Catalá-Lopéz F42, Cavlin A9, Che X43, Chiang PP44, Chowdhury R45, Christophi CA46, Chuang TW47, Cirillo M48, da Costa Leite I49, Courville KJ50, Dandona L51, Dandona R52, Davis A53, Dayama A54, Deribe K55, Dharmaratne SD56, Dherani MK35, Dilmen U32, Ding EL57, Edmond KM58, Ermakov SP59, Farzadfar F60, Fereshtehnejad SM61, Fijabi DO62, Foigt N63, Forouzanfar MH2, Garcia AC64, Geleijnse JM65, Gessner BD66, Goginashvili K67, Gona P68, Goto A69, Gouda HN70, Green MA71, Greenwell KF72, Gugnani HC73, Gupta R74, Hamadeh RR75, Hammami M76, Harb HL21, Hay S77, Hedayati MT78, Hosgood HD79, Hoy DG80, Idrisov BT81, Islami F82, Ismayilova S83, Jha V84, Jiang G85, Jonas JB86, Juel K87, Kabagambe EK88, Kazi DS89, Kengne AP90, Kereselidze M91, Khader YS92, Khalifa SE93, Khang YH94, Kim D95, Kinfu Y96, Kinge JM97, Kokubo Y98, Kosen S99, Defo BK100, Kumar GA52, Kumar K101, Kumar RB52, Lai T102, Lan Q103, Larsson A104, Lee JT105, Leinsalu M106, Lim SS2, Lipshultz SE107, Logroscino G108, Lotufo PA109, Lunevicius R110, Lyons RA111, Ma S112, Mahdi AA113, Marzan MB114, Mashal MT115, Mazorodze TT116, McGrath JJ70, Memish ZA17, Mendoza W117, Mensah GA118, Meretoja A14, Miller TR119, Mills EJ120, Mohammad KA121, Mokdad AH2, Monasta L122, Montico M122, Moore AR123, Moschandreas J124, Msemburi WT90, Mueller UO125, Muszynska MM126, Naghavi M2, Naidoo KS127, Narayan KM23, Nejjari C128, Ng M2, de Dieu Ngirabega J129, Nieuwenhuijsen MJ130, Nyakarahuka L131, Ohkubo T132, Omer SB23, Caicedo AJ133, Pillay-van Wyk V90, Pope D35, Pourmalek F134, Prabhakaran D135, Rahman SU136, Rana SM137, Reilly RQ138, Rojas-Rueda D130, Ronfani L122, Rushton L139, Saeedi MY17, Salomon JA57, Sampson U88, Santos IS109, Sawhney M140, Schmidt JC53, Shakh-Nazarova M91, She J141, Sheikhbahaei S60, Shibuya K142, Shin HH143, Shishani K144, Shiue I145, Sigfusdottir ID146, Singh JA147, Skirbekk V97, Sliwa K148, Soshnikov SS149, Sposato LA150, Stathopoulou VK151, Stroumpoulis K152, Tabb KM153, Talongwa RT154, Teixeira CM155, Terkawi AS156, Thomson AJ157, Thorne-Lyman AL158, Toyoshima H159, Dimbuene ZT160, Uwaliraye P161, Uzun SB32, Vasankari TJ162, Vasconcelos AM163, Vlassov VV164, Vollset SE97, Waller S165, Wan X166, Weichenthal S143, Weiderpass E167, Weintraub RG168, Westerman R125, Wilkinson JD169, Williams HC170, Yang YC171, Yentur GK32, Yip P172, Yonemoto N173, Younis M174, Yu C175, Jin KY176, El Sayed Zaki M177, Zhu S178, Vos T2, Lopez AD14, Murray CJ2.

Author information

1
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: haidong@uw.edu.
2
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
3
University of Cape Town, Cape Town, South Africa.
4
WHO Regional Office for Europe, Copenhagen, Denmark.
5
MCH Division, USAID - Global Health Bureau, HIDN, Washington, DC, USA.
6
National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
7
National Office for Maternal and Child's Health Surveillance, Chengdu, China.
8
Peking Union Medical College, Beijing, China; Peking Union Medical College, Beijing, China.
9
Hacettepe University Institute of Population Studies, Ankara, Turkey.
10
Mekelle University, Tigray, Ethiopia.
11
University College London, London, United Kingdom.
12
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Ministry of Health, Gaborone, Botswana.
13
Public Health Promotion Alliance, Osogpb, Nigeria.
14
University of Melbourne, Melbourne, VIC, Australia.
15
Debre Markos Univerity, Debre Markos, Ethiopia.
16
Ministry of Health, Belmopan, Cayo, Belize.
17
Saudi Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
18
Government, Madrid, Spain.
19
Albany State University, Albany, GA, USA.
20
Department of Epidemiology, University of Groningen, Groningen, Netherlands.
21
Ministry of Public Health, Beirut, Lebanon.
22
UNFPA, Kabul, Afghanistan.
23
Emory University, Atlanta, GA, USA.
24
Ministry of Health, Amman, Jordan.
25
Mashhad University of Medical Sciences, Mashhad, Khorasan, Iran.
26
University of Birmingham, Birmingham, West Midlands, United Kingdom.
27
Stanford University, Stanford, CA, USA.
28
College of Public Health and Tropical Medicine, Jazan, Saudi Arabia.
29
Madawalabu University, Bale Goba, Oromia, Ethiopia.
30
Yale University, New Haven, CT, USA.
31
Aga Khan University Medical Center, Karachi, Pakistan.
32
Ministry of Health, General Directorate of Health Research, Ankara, Turkey.
33
Transport and Road Safety (TARS) Research, University of New South Wales, Sydney, NSW, Australia.
34
University of Arizona, Tucson, AZ, USA.
35
University of Liverpool, Merseyside, United Kingdom.
36
Hanoi School of Public Health, Hanoi, Vietnam.
37
Telethon Institute for Child Health Research, Subiaco, WA, Australia.
38
Universidad Autonoma Metropolitana, Mexico, DF, Mexico.
39
University at Albany, Rensselaer, NY, USA.
40
Stroke Unit, University of Perugia, Perugia, Italy.
41
Universidad Diego Portales, Santiago, Chile.
42
Division of Pharmacology and Pharmacovigilance, Spanish Medicines and Healthcare Products Agency (AEMPS), Ministry of Health, Madrid, Spain.
43
National Institutes of Health, Bethesda, MD, USA.
44
General Practice and Primary Health Care Academic Centre, Melbourne, VIC, Australia.
45
University of Cambridge, Cambridge, United Kingdom.
46
Cyprus University of Technology, Limassol, Cyprus.
47
Taipei Medical University, Taipei, Taiwan.
48
University of Salerno, Baronissi, SA, Italy.
49
National School of Public Health (ENSP/Fiocruz), Rio De Janeiro, Brazil.
50
Hospital Dr. Gustavo N. Collado, Chitre, Herrera, Panama.
51
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Public Health Foundation of India, New Delhi, India.
52
Public Health Foundation of India, New Delhi, India.
53
Public Health England, London, United Kingdom.
54
School of Medicine, Atlanta, GA, USA.
55
Addis Ababa University, Addis Ababa, Ethiopia.
56
University of Peradeniya, Peradeniya, Sri Lanka.
57
Harvard School of Public Health, Harvard University, Boston, MA, USA.
58
University of Western Australia, Perth, WA, Australia.
59
The Institute of Social and Economic Studies of Population at the Russian Academy of Sciences, Moscow, Russia.
60
Non-Communicable Diseases Research Center, Endocrine and Metabolic Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
61
Karolinska Institutet, Stockholm, Sweden.
62
Heller Graduate School, Waltham, MA, USA.
63
Institute of Gerontology, Academy of Medical Sciences, Kyiv, Ukraine.
64
Public Health Unit of Primary Health Care Group of Almada-Seixal (region of Lisbon), Almada, Portugal.
65
Wageningen University, Division of Human Nutrition, Wageningen, the Netherlands.
66
Agence de Medecine Preventive, Paris, France.
67
Ministry of Labour, Health, and Social Affairs, Tbilisi, Georgia.
68
University of Massachusetts Medical School, Worcester, MA, USA.
69
Department of Diabetes Research, National Center for Global Health and Medicine, Tokyo, Japan.
70
University of Queensland, Brisbane, QLD, Australia.
71
University of Sheffield, Sheffield, South York, United Kingdom.
72
Stattis LLC, Chisinau, Moldova.
73
Saint James School of Medicine, Kralendijk, Bonaire, Netherlands Antilles.
74
Kanawha Charleston Health Department, Charleston, WV, USA.
75
Arabian Gulf University, Manama, Bahrain.
76
Wayne County Department of Health and Human Services, Detroit, MI, USA.
77
University of Oxford, Oxford, United Kingdom.
78
Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran.
79
Albert Einstein College of Medicine, Bronx, NY, USA.
80
School of Population Health, Brisbane, QLD, Australia; Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia.
81
Brandeis University, Waltham, MA, USA.
82
American Cancer Society, New York, NY, USA.
83
Self-Employed, Baku, Azerbaijan.
84
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
85
Tianjin Centers for Disease Control and Prevention, Tianjin, China.
86
Department of Ophthalmology, Medical Faculty Mannheim, Mannheim, Germany.
87
The National Institute of Public Health, Copenhagen, Denmark.
88
Vanderbilt University, Nashville, TN, USA.
89
University of California San Francisco, San Francisco, CA, USA.
90
South African Medical Research Council, Cape Town, Western Cape, South Africa.
91
National Centre for Diseases Control and Public Health, Tbilisi, Georgia.
92
Jordan University of Science and Technology, AlRamtha, Irbid, Jordan.
93
Supreme Council of Health, Doha, Qatar.
94
Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea.
95
Northeastern University, Boston, MA, USA.
96
University of Canberra, Canberra, ACT, Australia.
97
The Norwegian Institute of Public Health, Oslo, Norway.
98
Department of Preventive Cardiology, Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
99
Center for Community Empowerment, Health Policy & Humanities, NIHRD, Jakarta, Indonesia.
100
University of Montreal, Montreal, Quebec, Canada.
101
International Institute for Population Sciences, Mumbai, India.
102
Fourth View Consulting, Tallinn, Estonia.
103
National Cancer Institute, Bethesda, MD, USA.
104
Uppsala University, Uppsala, Sweden.
105
Korea University, Seoul, South Korea.
106
The National Institute for Health Development, Tallinn, Estonia.
107
Wayne State University, Miami, FL, USA.
108
University of Bari, Bari, Italy.
109
University of Sao Paulo, Sao Paulo, Brazil.
110
Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.
111
Swansea University, Swansea, United Kingdom.
112
Ministry of Health Singapore, Singapore.
113
King George's Medical University, Lucknow, Uttar Pradesh, India.
114
University of the East Ramon Magsaysay Medical Center, Quezon City, Metro Manila, Philippines.
115
Ministry of Public Health, Kabul, Afghanistan.
116
AIDC EC, Port Elizabeth, Eastern Cape, South Africa.
117
UNFPA, Lima, Peru.
118
Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
119
Pacific Institute for Research & Evaluation, Calverton, MD, USA.
120
University of Ottawa, Ottawa, Ontario, Canada.
121
University of Salahaddin, Erbil, Iraq.
122
Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy.
123
University of North Texas, Denton, TX, USA.
124
University of Crete, Crete, Greece.
125
Philipps-University Marburg, Marburg, Hessia, Germany.
126
Warsaw School of Economics, Warsaw, Poland.
127
University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
128
Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy, University sidi Mohamed Ben Abdellah, Fez, Morocco.
129
Rwanda Biomedical Center, Kigali, Rwanda.
130
Centre of Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
131
Makerere University, Kampala, Uganda.
132
Teikyo University School of Medicine, Tokyo, Japan.
133
Universidad de Cartagena, Cartagena, Bolivar, Colombia.
134
University of British Columbia, Vancouver, BC, Canada.
135
Centre for Chronic Disease Control, New Delhi, Delhi, India.
136
Hamad Medical Corporation, Doha, Qatar.
137
Department of Public Health, University of the Punjab, Lahore, Punjab, Pakistan.
138
Private Consultant, Cairns, QLD, Australia.
139
Imperial College London, London, United Kingdom.
140
Marshall University, Huntington, WV, USA.
141
Zhongshan Hospital, Fudan, University, Shanghai, China.
142
University of Tokyo, Tokyo, Japan.
143
Health Canada, Ottawa, Ontario, Canada.
144
Washington State University, Spokane, WA, USA.
145
Heriot-Watt University, Edinburgh, Scotland, United Kingdom.
146
Reykjavik University, Reykjavik, Iceland.
147
University of Alabama at Birmingham, Birmingham, AL, USA.
148
Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa.
149
Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow, Russia.
150
Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.
151
Centre Hospitalier Nord Deux-Sevres, Bressuire, France.
152
KEELPNO (Center for Disease Control, Greece, dispatched to "Alexandra" General Hospital of Athens), Athens, Greece.
153
University of Illinois, Champaign, IL, USA.
154
Ministry of Health, Yaounde, Centre, Cameroon.
155
ARS Norte, Porto, Portugal.
156
Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA; Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.
157
Adaptive Knowledge Management, Victoria, BC, Canada.
158
Columbia University and The Earth Institute, New York, NY, USA.
159
Health Care Center of Anjo Kosei Hospital, Anjo City, Aichi Prefecture, Japan.
160
Department of Population Sciences and Development, Faculty of Economics and Management, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, Rwanda, Kigali City, Rwanda.
161
Ministry of Health, Rwanda, Kigali City, Rwanda.
162
UKK Institute for Health Promotion Research, Tampere, Finland.
163
Universidade de Brasilia, Brasilia, Distrito Federal, Brazil.
164
National Research University Higher School of Economics, Moscow, Russia.
165
Uniformed Services University of Health Sciences, Bethesda, MD, USA.
166
Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China.
167
Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
168
University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.
169
University of Miami, Miami, FL, USA.
170
University of Nottingham, Nottingham, United Kingdom.
171
University of North Carolina at Chapel Hill, Chapel Hill, NC. USA.
172
The University of Hong Kong, Hong Kong.
173
National Center of Neurology and Psychiatry, Kodira, Tokyo, Japan.
174
Jackson State University, Jackson, MS, USA.
175
Department of Epidemiology and Biostatistics, School of Public Health, and Global Health Institute, Wuhan University, Wuhan, Hubei, China.
176
TCM MEDICAL TK SDN BHD, Nusajaya, Johor Bahru, Malaysia.
177
Mansoura Faculty of Medicine, Mansoura, Egypt.
178
Zhejiang University School of Public Health, Hangzhou, Zhejiang, China.

Erratum in

  • Lancet. 2014 Sep 13;384(9947):956.

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.

PMID:
24797572
PMCID:
PMC4165626
DOI:
10.1016/S0140-6736(14)60497-9
[Indexed for MEDLINE]
Free PMC Article
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