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 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 & 210 others 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, Uʇur 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, K. M 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 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, 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

Research output: Contribution to journalArticle

385 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. Funding: Bill & Melinda Gates Foundation, US Agency for International Development.

Original languageEnglish
Pages (from-to)957-979
Number of pages23
JournalThe Lancet
Volume384
Issue number9947
DOIs
StatePublished - 2014
Externally publishedYes

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Child Mortality
Mortality
Developing Countries
Africa South of the Sahara
Age Groups
Education
Guinea-Bissau
United States Agency for International Development
Mothers
Parturition
Central Africa
Global Burden of Disease
Western Africa
Selection Bias
Singapore
Censuses
HIV
Health

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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, Uʇur; 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, K. M Venkat; Nejjari, Chakib; Ng, Marie; De Dieu Ngirabega, Jean; Nieuwenhuijsen, Mark J.; Nyakarahuka, Luke; Ohkubo, Takayoshi; Omer, Saad B.; Paternina Caicedo, Angel J.; Pillay-Van Wyk, Victoria; 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 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.

In: The Lancet, Vol. 384, No. 9947, 2014, p. 957-979.

Research output: Contribution to journalArticle

Wang, H, Liddell, CA, Coates, MM, Mooney, MD, Levitz, CE, Schumacher, AE, Apfel, H, Iannarone, M, Phillips, B, Lofgren, KT, Sandar, L, Dorrington, RE, Rakovac, I, Jacobs, TA, Liang, X, Zhou, M, Zhu, J, Yang, G, Wang, Y, Liu, S, Li, Y, Ozgoren, AA, Abera, SF, Abubakar, I, Achoki, T, Adelekan, A, Ademi, Z, Alemu, ZA, Allen, PJ, AlMazroa, MA, Alvarez, E, Amankwaa, AA, Amare, AT, Ammar, W, Anwari, P, Cunningham, SA, Asad, MM, Assadi, R, Banerjee, A, Basu, S, Bedi, N, Bekele, T, Bell, ML, Bhutta, Z, Blore, JD, Basara, BB, Boufous, S, Breitborde, N, Bruce, NG, Bui, LN, Carapetis, JR, Cárdenas, R, Carpenter, DO, Caso, V, Castro, RE, Catalá-Lopéz, F, Cavlin, A, Che, X, Chiang, PPC, Chowdhury, R, Christophi, CA, Chuang, TW, Cirillo, M, Da Costa Leite, I, Courville, KJ, Dandona, L, Dandona, R, Davis, A, Dayama, A, Deribe, K, Dharmaratne, SD, Dherani, MK, Dilmen, U, Ding, EL, Edmond, KM, Ermakov, SP, Farzadfar, F, Fereshtehnejad, SM, Fijabi, DO, Foigt, N, Forouzanfar, MH, Garcia, AC, Geleijnse, JM, Gessner, BD, Goginashvili, K, Gona, P, Goto, A, Gouda, HN, Green, MA, Greenwell, KF, Gugnani, HC, Gupta, R, Hamadeh, RR, Hammami, M, Harb, HL, Hay, S, Hedayati, MT, Hosgood, HD, Hoy, DG, Idrisov, BT, Islami, F, Ismayilova, S, Jha, V, Jiang, G, Jonas, JB, Juel, K, Kabagambe, EK, Kazi, DS, Kengne, AP, Kereselidze, M, Khader, YS, Khalifa, SEAH, Khang, YH, Kim, D, Kinfu, Y, Kinge, JM, Kokubo, Y, Kosen, S, Defo, BK, Kumar, GA, Kumar, K, Kumar, RB, Lai, T, Lan, Q, Larsson, A, Lee, JT, Leinsalu, M, Lim, SS, Lipshultz, SE, Logroscino, G, Lotufo, PA, Lunevicius, R, Lyons, RA, Ma, S, Mahdi, AA, Marzan, MB, Mashal, MT, Mazorodze, TT, McGrath, JJ, Memish, ZA, Mendoza, W, Mensah, GA, Meretoja, A, Miller, TR, Mills, EJ, Mohammad, KA, Mokdad, AH, Monasta, L, Montico, M, Moore, AR, Moschandreas, J, Msemburi, WT, Mueller, UO, Muszynska, MM, Naghavi, M, Naidoo, KS, Narayan, KMV, Nejjari, C, Ng, M, De Dieu Ngirabega, J, Nieuwenhuijsen, MJ, Nyakarahuka, L, Ohkubo, T, Omer, SB, Paternina Caicedo, AJ, Pillay-Van Wyk, V, Pope, D, Pourmalek, F, Prabhakaran, D, Rahman, SUR, Rana, SM, Reilly, RQ, Rojas-Rueda, D, Ronfani, L, Rushton, L, Saeedi, MY, Salomon, JA, Sampson, U, Santos, IS, Sawhney, M, Schmidt, JC, Shakh-Nazarova, M, She, J, Sheikhbahaei, S, Shibuya, K, Shin, HH, Shishani, K, Shiue, I, Sigfusdottir, ID, Singh, JA, Skirbekk, V, Sliwa, K, Soshnikov, SS, Sposato, LA, Stathopoulou, VK, Stroumpoulis, K, Tabb, KM, Talongwa, RT, Teixeira, CM, Terkawi, AS, Thomson, AJ, Thorne-Lyman, AL, Toyoshima, H, Dimbuene, ZT, Uwaliraye, P, Uzun, SB, Vasankari, TJ, Vasconcelos, AMN, Vlassov, VV, Vollset, SE, Waller, S, Wan, X, Weichenthal, S, Weiderpass, E, Weintraub, RG, Westerman, R, Wilkinson, JD, Williams, HC, Yang, YC, Yentur, GK, Yip, P, Yonemoto, N, Younis, M, Yu, C, Jin, KY, El Sayed Zaki, M, Zhu, S, Vos, T, Lopez, AD & Murray, CJL 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', The Lancet, vol. 384, no. 9947, pp. 957-979. https://doi.org/10.1016/S0140-6736(14)60497-9
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, Uʇur ; 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, K. M Venkat ; Nejjari, Chakib ; Ng, Marie ; De Dieu Ngirabega, Jean ; Nieuwenhuijsen, Mark J. ; Nyakarahuka, Luke ; Ohkubo, Takayoshi ; Omer, Saad B. ; Paternina Caicedo, Angel J. ; Pillay-Van Wyk, Victoria ; 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 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. / 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. In: The Lancet. 2014 ; Vol. 384, No. 9947. pp. 957-979.
@article{e935d13aa09841dfbc2adc7f8fe5b18d,
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",
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.",
author = "Haidong Wang and Liddell, {Chelsea A.} and Coates, {Matthew M.} and Mooney, {Meghan D.} and Levitz, {Carly E.} and Schumacher, {Austin E.} and Henry Apfel and Marissa Iannarone and Bryan Phillips and Lofgren, {Katherine T.} and Logan Sandar and Dorrington, {Rob E.} and Ivo Rakovac and Jacobs, {Troy A.} and Xiaofeng Liang and Maigeng Zhou and Jun Zhu and Gonghuan Yang and Yanping Wang and Shiwei Liu and Yichong Li and Ozgoren, {Ayse Abbasoglu} and Abera, {Semaw Ferede} and Ibrahim Abubakar and Tom Achoki and Ademola Adelekan and Zanfina Ademi and Alemu, {Zewdie Aderaw} and Allen, {Peter J.} and AlMazroa, {Mohammad Abdulaziz} and Elena Alvarez and Amankwaa, {Adansi A.} and Amare, {Azmeraw T.} and Walid Ammar and Palwasha Anwari and Cunningham, {Solveig Argeseanu} and Asad, {Majed Masoud} and Reza Assadi and Amitava Banerjee and Sanjay Basu and Neeraj Bedi and Tolesa Bekele and Bell, {Michelle L.} and Zulfiqar Bhutta and Blore, {Jed D.} and Basara, {Berrak Bora} and Soufiane Boufous and Nicholas Breitborde and Bruce, {Nigel G.} and Bui, {Linh Ngoc} and Carapetis, {Jonathan R.} and Rosario C{\'a}rdenas and Carpenter, {David O.} and Valeria Caso and Castro, {Ruben Estanislao} and Ferr{\'a}n Catal{\'a}-Lop{\'e}z and Alanur Cavlin and Xuan Che and Chiang, {Peggy Pei Chia} and Rajiv Chowdhury and Christophi, {Costas A.} and Chuang, {Ting Wu} and Massimo Cirillo and {Da Costa Leite}, Iuri and Courville, {Karen J.} and Lalit Dandona and Rakhi Dandona and Adrian Davis and Anand Dayama and Kebede Deribe and Dharmaratne, {Samath D.} and Dherani, {Mukesh K.} and Uʇur Dilmen and Ding, {Eric L.} and Edmond, {Karen M.} and Ermakov, {Sergei Petrovich} and Farshad Farzadfar and Fereshtehnejad, {Seyed Mohammad} and Fijabi, {Daniel Obadare} and Nataliya Foigt and Forouzanfar, {Mohammad H.} and Garcia, {Ana C.} and Geleijnse, {Johanna M.} and Gessner, {Bradford D.} and Ketevan Goginashvili and Philimon Gona and Atsushi Goto and Gouda, {Hebe N.} and Green, {Mark A.} and Greenwell, {Karen Fern} and Gugnani, {Harish Chander} and Rahul Gupta and Hamadeh, {Randah Ribhi} and Mouhanad Hammami and Harb, {Hilda L.} and Simon Hay and Hedayati, {Mohammad T.} and Hosgood, {H. Dean} and Hoy, {Damian G.} and Idrisov, {Bulat T.} and Farhad Islami and Samaya Ismayilova and Vivekanand Jha and Guohong Jiang and Jonas, {Jost B.} and Knud Juel and Kabagambe, {Edmond Kato} and Kazi, {Dhruv S.} and Kengne, {Andre Pascal} and Maia Kereselidze and Khader, {Yousef Saleh} and Khalifa, {Shams Eldin Ali Hassan} and Khang, {Young Ho} and Daniel Kim and Yohannes Kinfu and Kinge, {Jonas M.} and Yoshihiro Kokubo and Soewarta Kosen and Defo, {Barthelemy Kuate} and Kumar, {G. Anil} and Kaushalendra Kumar and Kumar, {Ravi B.} and Taavi Lai and Qing Lan and Anders Larsson and Lee, {Jong Tae} and Mall Leinsalu and Lim, {Stephen S.} and Lipshultz, {Steven E} and Giancarlo Logroscino and Lotufo, {Paulo A.} and Raimundas Lunevicius and Lyons, {Ronan Anthony} and Stefan Ma and Mahdi, {Abbas Ali} and Marzan, {Melvin Barrientos} and Mashal, {Mohammad Taufiq} and Mazorodze, {Tasara T.} and McGrath, {John J.} and Memish, {Ziad A.} and Walter Mendoza and Mensah, {George A.} and Atte Meretoja and Miller, {Ted R.} and Mills, {Edward J.} and Mohammad, {Karzan Abdulmuhsin} and Mokdad, {Ali H.} and Lorenzo Monasta and Marcella Montico and Moore, {Ami R.} and Joanna Moschandreas and Msemburi, {William T.} and Mueller, {Ulrich O.} and Muszynska, {Magdalena M.} and Mohsen Naghavi and Naidoo, {Kovin S.} and Narayan, {K. M Venkat} and Chakib Nejjari and Marie Ng and {De Dieu Ngirabega}, Jean and Nieuwenhuijsen, {Mark J.} and Luke Nyakarahuka and Takayoshi Ohkubo and Omer, {Saad B.} and {Paternina Caicedo}, {Angel J.} and {Pillay-Van Wyk}, Victoria and Dan Pope and Farshad Pourmalek and Dorairaj Prabhakaran and Rahman, {Sajjad U R} and Rana, {Saleem M.} and Reilly, {Robert Quentin} and David Rojas-Rueda and Luca Ronfani and Lesley Rushton and Saeedi, {Mohammad Yahya} and Salomon, {Joshua A.} and Uchechukwu Sampson and Santos, {Itamar S.} and Monika Sawhney and Schmidt, {J{\"u}rgen C.} and Marina Shakh-Nazarova and Jun She and Sara Sheikhbahaei and Kenji Shibuya and Shin, {Hwashin Hyun} and Kawkab Shishani and Ivy Shiue and Sigfusdottir, {Inga Dora} and Singh, {Jasvinder A.} and Vegard Skirbekk and Karen Sliwa and Soshnikov, {Sergey S.} and Sposato, {Luciano A.} and Stathopoulou, {Vasiliki Kalliopi} and Konstantinos Stroumpoulis and Tabb, {Karen M.} and Talongwa, {Roberto Tchio} and Teixeira, {Carolina Maria} and Terkawi, {Abdullah Sulieman} and Thomson, {Alan J.} and Thorne-Lyman, {Andrew L.} and Hideaki Toyoshima and Dimbuene, {Zacharie Tsala} and Parfait Uwaliraye and Uzun, {Selen Beg{\"u}m} and Vasankari, {Tommi J.} and Vasconcelos, {Ana Maria Nogales} and Vlassov, {Vasiliy Victorovich} and Vollset, {Stein Emil} and Stephen Waller and Xia Wan and Scott Weichenthal and Elisabete Weiderpass and Weintraub, {Robert G.} and Ronny Westerman and Wilkinson, {James D.} and Williams, {Hywel C.} and Yang, {Yang C.} and Yentur, {Gokalp Kadri} and Paul Yip and Naohiro Yonemoto and Mustafa Younis and Chuanhua Yu and Jin, {Kim Yun} and {El Sayed Zaki}, Maysaa and Shankuan Zhu and Theo Vos and Lopez, {Alan D.} and Murray, {Christopher J L}",
year = "2014",
doi = "10.1016/S0140-6736(14)60497-9",
language = "English",
volume = "384",
pages = "957--979",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier Limited",
number = "9947",

}

TY - JOUR

T1 - Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013

T2 - A systematic analysis for the Global Burden of Disease Study 2013

AU - Wang, Haidong

AU - Liddell, Chelsea A.

AU - Coates, Matthew M.

AU - Mooney, Meghan D.

AU - Levitz, Carly E.

AU - Schumacher, Austin E.

AU - Apfel, Henry

AU - Iannarone, Marissa

AU - Phillips, Bryan

AU - Lofgren, Katherine T.

AU - Sandar, Logan

AU - Dorrington, Rob E.

AU - Rakovac, Ivo

AU - Jacobs, Troy A.

AU - Liang, Xiaofeng

AU - Zhou, Maigeng

AU - Zhu, Jun

AU - Yang, Gonghuan

AU - Wang, Yanping

AU - Liu, Shiwei

AU - Li, Yichong

AU - Ozgoren, Ayse Abbasoglu

AU - Abera, Semaw Ferede

AU - Abubakar, Ibrahim

AU - Achoki, Tom

AU - Adelekan, Ademola

AU - Ademi, Zanfina

AU - Alemu, Zewdie Aderaw

AU - Allen, Peter J.

AU - AlMazroa, Mohammad Abdulaziz

AU - Alvarez, Elena

AU - Amankwaa, Adansi A.

AU - Amare, Azmeraw T.

AU - Ammar, Walid

AU - Anwari, Palwasha

AU - Cunningham, Solveig Argeseanu

AU - Asad, Majed Masoud

AU - Assadi, Reza

AU - Banerjee, Amitava

AU - Basu, Sanjay

AU - Bedi, Neeraj

AU - Bekele, Tolesa

AU - Bell, Michelle L.

AU - Bhutta, Zulfiqar

AU - Blore, Jed D.

AU - Basara, Berrak Bora

AU - Boufous, Soufiane

AU - Breitborde, Nicholas

AU - Bruce, Nigel G.

AU - Bui, Linh Ngoc

AU - Carapetis, Jonathan R.

AU - Cárdenas, Rosario

AU - Carpenter, David O.

AU - Caso, Valeria

AU - Castro, Ruben Estanislao

AU - Catalá-Lopéz, Ferrán

AU - Cavlin, Alanur

AU - Che, Xuan

AU - Chiang, Peggy Pei Chia

AU - Chowdhury, Rajiv

AU - Christophi, Costas A.

AU - Chuang, Ting Wu

AU - Cirillo, Massimo

AU - Da Costa Leite, Iuri

AU - Courville, Karen J.

AU - Dandona, Lalit

AU - Dandona, Rakhi

AU - Davis, Adrian

AU - Dayama, Anand

AU - Deribe, Kebede

AU - Dharmaratne, Samath D.

AU - Dherani, Mukesh K.

AU - Dilmen, Uʇur

AU - Ding, Eric L.

AU - Edmond, Karen M.

AU - Ermakov, Sergei Petrovich

AU - Farzadfar, Farshad

AU - Fereshtehnejad, Seyed Mohammad

AU - Fijabi, Daniel Obadare

AU - Foigt, Nataliya

AU - Forouzanfar, Mohammad H.

AU - Garcia, Ana C.

AU - Geleijnse, Johanna M.

AU - Gessner, Bradford D.

AU - Goginashvili, Ketevan

AU - Gona, Philimon

AU - Goto, Atsushi

AU - Gouda, Hebe N.

AU - Green, Mark A.

AU - Greenwell, Karen Fern

AU - Gugnani, Harish Chander

AU - Gupta, Rahul

AU - Hamadeh, Randah Ribhi

AU - Hammami, Mouhanad

AU - Harb, Hilda L.

AU - Hay, Simon

AU - Hedayati, Mohammad T.

AU - Hosgood, H. Dean

AU - Hoy, Damian G.

AU - Idrisov, Bulat T.

AU - Islami, Farhad

AU - Ismayilova, Samaya

AU - Jha, Vivekanand

AU - Jiang, Guohong

AU - Jonas, Jost B.

AU - Juel, Knud

AU - Kabagambe, Edmond Kato

AU - Kazi, Dhruv S.

AU - Kengne, Andre Pascal

AU - Kereselidze, Maia

AU - Khader, Yousef Saleh

AU - Khalifa, Shams Eldin Ali Hassan

AU - Khang, Young Ho

AU - Kim, Daniel

AU - Kinfu, Yohannes

AU - Kinge, Jonas M.

AU - Kokubo, Yoshihiro

AU - Kosen, Soewarta

AU - Defo, Barthelemy Kuate

AU - Kumar, G. Anil

AU - Kumar, Kaushalendra

AU - Kumar, Ravi B.

AU - Lai, Taavi

AU - Lan, Qing

AU - Larsson, Anders

AU - Lee, Jong Tae

AU - Leinsalu, Mall

AU - Lim, Stephen S.

AU - Lipshultz, Steven E

AU - Logroscino, Giancarlo

AU - Lotufo, Paulo A.

AU - Lunevicius, Raimundas

AU - Lyons, Ronan Anthony

AU - Ma, Stefan

AU - Mahdi, Abbas Ali

AU - Marzan, Melvin Barrientos

AU - Mashal, Mohammad Taufiq

AU - Mazorodze, Tasara T.

AU - McGrath, John J.

AU - Memish, Ziad A.

AU - Mendoza, Walter

AU - Mensah, George A.

AU - Meretoja, Atte

AU - Miller, Ted R.

AU - Mills, Edward J.

AU - Mohammad, Karzan Abdulmuhsin

AU - Mokdad, Ali H.

AU - Monasta, Lorenzo

AU - Montico, Marcella

AU - Moore, Ami R.

AU - Moschandreas, Joanna

AU - Msemburi, William T.

AU - Mueller, Ulrich O.

AU - Muszynska, Magdalena M.

AU - Naghavi, Mohsen

AU - Naidoo, Kovin S.

AU - Narayan, K. M Venkat

AU - Nejjari, Chakib

AU - Ng, Marie

AU - De Dieu Ngirabega, Jean

AU - Nieuwenhuijsen, Mark J.

AU - Nyakarahuka, Luke

AU - Ohkubo, Takayoshi

AU - Omer, Saad B.

AU - Paternina Caicedo, Angel J.

AU - Pillay-Van Wyk, Victoria

AU - Pope, Dan

AU - Pourmalek, Farshad

AU - Prabhakaran, Dorairaj

AU - Rahman, Sajjad U R

AU - Rana, Saleem M.

AU - Reilly, Robert Quentin

AU - Rojas-Rueda, David

AU - Ronfani, Luca

AU - Rushton, Lesley

AU - Saeedi, Mohammad Yahya

AU - Salomon, Joshua A.

AU - Sampson, Uchechukwu

AU - Santos, Itamar S.

AU - Sawhney, Monika

AU - Schmidt, Jürgen C.

AU - Shakh-Nazarova, Marina

AU - She, Jun

AU - Sheikhbahaei, Sara

AU - Shibuya, Kenji

AU - Shin, Hwashin Hyun

AU - Shishani, Kawkab

AU - Shiue, Ivy

AU - Sigfusdottir, Inga Dora

AU - Singh, Jasvinder A.

AU - Skirbekk, Vegard

AU - Sliwa, Karen

AU - Soshnikov, Sergey S.

AU - Sposato, Luciano A.

AU - Stathopoulou, Vasiliki Kalliopi

AU - Stroumpoulis, Konstantinos

AU - Tabb, Karen M.

AU - Talongwa, Roberto Tchio

AU - Teixeira, Carolina Maria

AU - Terkawi, Abdullah Sulieman

AU - Thomson, Alan J.

AU - Thorne-Lyman, Andrew L.

AU - Toyoshima, Hideaki

AU - Dimbuene, Zacharie Tsala

AU - Uwaliraye, Parfait

AU - Uzun, Selen Begüm

AU - Vasankari, Tommi J.

AU - Vasconcelos, Ana Maria Nogales

AU - Vlassov, Vasiliy Victorovich

AU - Vollset, Stein Emil

AU - Waller, Stephen

AU - Wan, Xia

AU - Weichenthal, Scott

AU - Weiderpass, Elisabete

AU - Weintraub, Robert G.

AU - Westerman, Ronny

AU - Wilkinson, James D.

AU - Williams, Hywel C.

AU - Yang, Yang C.

AU - Yentur, Gokalp Kadri

AU - Yip, Paul

AU - Yonemoto, Naohiro

AU - Younis, Mustafa

AU - Yu, Chuanhua

AU - Jin, Kim Yun

AU - El Sayed Zaki, Maysaa

AU - Zhu, Shankuan

AU - Vos, Theo

AU - Lopez, Alan D.

AU - Murray, Christopher J L

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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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U2 - 10.1016/S0140-6736(14)60497-9

DO - 10.1016/S0140-6736(14)60497-9

M3 - Article

VL - 384

SP - 957

EP - 979

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 9947

ER -