Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: A systematic analysis of progress towards Millennium Development Goal 4

Rajaratnam, Julie Knoll, Marcus, Jake R. Marcus, Flaxman, Abraham D., Wang, Haidong, Levin-Rector, Alison, Dwyer, Laura, Costa, Megan, Lopez, Alan D. and Murray, Christopher J. L. (2010) Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: A systematic analysis of progress towards Millennium Development Goal 4. Lancet, 375 9730: 1988-2008. doi:10.1016/S0140-6736(10)60703-9


Author Rajaratnam, Julie Knoll
Marcus, Jake R. Marcus
Flaxman, Abraham D.
Wang, Haidong
Levin-Rector, Alison
Dwyer, Laura
Costa, Megan
Lopez, Alan D.
Murray, Christopher J. L.
Title Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: A systematic analysis of progress towards Millennium Development Goal 4
Journal name Lancet   Check publisher's open access policy
ISSN 0140-6736
1474-547X
Publication date 2010-06-05
Sub-type Article (original research)
DOI 10.1016/S0140-6736(10)60703-9
Volume 375
Issue 9730
Start page 1988
End page 2008
Total pages 21
Place of publication London, U.K.
Publisher The Lancet Publishing Group
Collection year 2011
Language eng
Formatted abstract
Background Previous assessments have highlighted that less than a quarter of countries are on track to achieve Millennium Development Goal 4 (MDG 4), which calls for a two-thirds reduction in mortality in children younger than 5 years between 1990 and 2015. In view of policy initiatives and investments made since 2000, it is important to see if there is acceleration towards the MDG 4 target. We assessed levels and trends in child mortality for 187 countries from 1970 to 2010.

Methods We compiled a database of 16 174 measurements of mortality in children younger than 5 years for 187 countries from 1970 to 2009, by use of data from all available sources, including vital registration systems, summary birth histories in censuses and surveys, and complete birth histories. We used Gaussian process regression to generate estimates of the probability of death between birth and age 5 years. This is the first study that uses Gaussian process regression to estimate child mortality, and this technique has better out-of-sample predictive validity than do previous methods and captures uncertainty caused by sampling and non-sampling error across data types. Neonatal, postneonatal, and childhood mortality was estimated from mortality in children younger than 5 years by use of the 1760 measurements from vital registration systems and complete birth histories that contained specific information about neonatal and postneonatal mortality.

Findings Worldwide mortality in children younger than 5 years has dropped from 11·9 million deaths in 1990 to 7·7 million deaths in 2010, consisting of 3·1 million neonatal deaths, 2·3 million postneonatal deaths, and 2·3 million childhood deaths (deaths in children aged 1-4 years). 33·0% of deaths in children younger than 5 years occur in south Asia and 49·6% occur in sub-Saharan Africa, with less than 1% of deaths occurring in high-income countries. Across 21 regions of the world, rates of neonatal, postneonatal, and childhood mortality are declining. The global decline from 1990 to 2010 is 2·1% per year for neonatal mortality, 2·3% for postneonatal mortality, and 2·2% for childhood mortality. In 13 regions of the world, including all regions in sub-Saharan Africa, there is evidence of accelerating declines from 2000 to 2010 compared with 1990 to 2000. Within sub-Saharan Africa, rates of decline have increased by more than 1% in Angola, Botswana, Cameroon, Congo, Democratic Republic of the Congo, Kenya, Lesotho, Liberia, Rwanda, Senegal, Sierra Leone, Swaziland, and The Gambia.

Interpretation Robust measurement of mortality in children younger than 5 years shows that accelerating declines are occurring in several low-income countries. These positive developments deserve attention and might need enhanced policy attention and resources.

Funding: Bill & Melinda Gates Foundation.
Keyword Infant mortality
Health
Survival
Trends
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes 'This online publication has been corrected. The corrected version first appeared at TheLancet.com on August 17, 2010'. DOI: 10.1016/S0140-6736(10)61338-4

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
ERA 2012 Admin Only
School of Public Health Publications
 
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Created: Sun, 27 Jun 2010, 00:03:54 EST