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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

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 E; 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; 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; 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 Kato; 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, KM 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 UR; 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 C; Yentur, Gokalp Kadri; Yip, Paul; Yonemoto, Naohiro; Younis, Mustafa; Yu, Chuanhua; Jin, Kim Yun; El Sayed Zaki, Maysaa; Zhu, Shankuan; Vos, Theo; Lopez, Alan D; Murray, Christopher J L

Authors

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

Ademola Adelekan

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

Berrak Bora Basara

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

Xuan Che

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

Nataliya Foigt

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

Tasara T Mazorodze

John J McGrath

Ziad A Memish

Walter Mendoza

George A Mensah

Atte Meretoja

Ted R Miller

Edward J Mills

Karzan Abdulmuhsin Mohammad

Ali H Mokdad

Lorenzo Monasta

Marcella Montico

Ami R Moore

Joanna Moschandreas

William T Msemburi

Ulrich O Mueller

Magdalena M Muszynska

Mohsen Naghavi

Kovin S Naidoo

KM Venkat Narayan

Chakib Nejjari

Marie Ng

Jean de Dieu Ngirabega

Mark J Nieuwenhuijsen

Luke Nyakarahuka

Takayoshi Ohkubo

Saad B Omer

Angel J Paternina Caicedo

Victoria Pillay-van Wyk

Dan Pope

Farshad Pourmalek

Dorairaj Prabhakaran

Sajjad UR 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

Profile Image

HYWEL WILLIAMS hywel.williams@nottingham.ac.uk
Professor of Dermato-Epidemiology

Yang C Yang

Gokalp Kadri Yentur

Paul Yip

Naohiro Yonemoto

Mustafa Younis

Chuanhua Yu

Kim Yun Jin

Maysaa El Sayed Zaki

Shankuan Zhu

Theo Vos

Alan D Lopez

Christopher J L Murray



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 numbersof 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.

Journal Article Type Article
Publication Date 2014-09
Journal The Lancet
Print ISSN 0140-6736
Electronic ISSN 1474-547X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 384
Issue 9947
Pages 957-979
APA6 Citation Wang, H., Liddell, C. A., Coates, M. M., Mooney, M. D., Levitz, C. E., Schumacher, A. E., …Murray, C. J. L. (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. https://doi.org/10.1016/s0140-6736%2814%2960497-9
DOI https://doi.org/10.1016/s0140-6736%2814%2960497-9
Publisher URL http://dx.doi.org/10.1016/S0140-6736(14)60497-9
Additional Information This article is maintained by: Elsevier; Article Title: 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; Journal Title: The Lancet; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/S0140-6736(14)60497-9; Content Type: article; Copyright: Copyright © 2014 Elsevier Ltd. All rights reserved.
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