Journal article
Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019
The Lancet (British edition), Vol.398(10303), pp.870-905
09/04/2021
DOI: 10.1016/S0140-6736(21)01207-1
PMCID: PMC8429803
PMID: 34416195
Abstract
Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival.
Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index.
Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million [95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% [95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier.
Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.
Details
- Title: Subtitle
- Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019
- Creators
- Katherine R. Paulson - University of WashingtonAruna M. Kamath - University of WashingtonTahiya Alam - University of WashingtonKelly Bienhoff - University of WashingtonGdiom Gebreheat Abady - Adigrat UniversityJaffar Abbas - Shanghai Jiao Tong UniversityMohsen Abbasi-Kangevari - Shahid Beheshti UniversityHedayat Abbastabar - University of TehranFoad Abd-Allah - Cairo UniversitySherief M. Abd-Elsalam - Tanta UniversityAmir Abdoli - Jahrom UniversityAidin Abedi - Univ Southern Calif, Dept Orthopaed Surg, Los Angeles, CA 90007 USAHassan Abolhassani - University of TehranLucas Guimaraes Abreu - Federal ReserveEman Abu-Gharbieh - University of SharjahNiveen M. E. Abu-Rmeileh - Birzeit UniversityAbdelrahman Abushouk - Harvard UniversityAishatu L. Adamu - Bayero University KanoOladimeji M. Adebayo - Univ Coll Hosp, Coll Med, Ibadan, NigeriaAdeyinka Emmanuel Adegbosin - Griffith UniversityVictor Adekanmbi - Kings Coll London, Dept Populat Hlth Sci, London, EnglandOlatunji O. Adetokunboh - Stellenbosch UniversityDaniel Adedayo Adeyinka - University of SaskatchewanJose C. Adsuar - Univ Extremadura, Sport Sci Dept, Badajoz, SpainKhashayar Afshari - University of TehranMohammad Aghaali - Qom Univ Med Sci, Dept Epidemiol & Biostat, Qom, IranMarcela Agudelo-Botero - Univ Nacl Autonoma Mexico, Ctr Policy Populat & Hlth Res, Mexico City, DF, MexicoBright Opoku Ahinkorah - University of Technology SydneyTauseef Ahmad - Southeast UniversityKeivan Ahmadi - University of NottinghamMuktar Beshir Ahmed - Jimma UniversityBudi Aji - Jenderal Soedirman UniversityYonas Akalu - University of GondarOluwaseun Oladapo Akinyemi - Univ Coll Hosp, Dept Hlth Policy & Management, Ibadan, NigeriaAddis Aklilu - Arba Minch UniversityZiyad Al-Aly - Washington Univ, John T Milliken Dept Internal Med, St Louis, MO 63110 USAKhurshid Alam - Murdoch UniversityFahad Mashhour Alanezi - Imam Abdulrahman Bin Faisal UniversityTurki M. Alanzi - Imam Abdulrahman Bin Faisal UniversityJacqueline Elizabeth Alcalde-Rabanal - Natl Inst Publ Hlth, Ctr Hlth Syst Res, Cuernavaca, Morelos, MexicoAyman Al-Eyadhy - King Saud UniversityTilahun Ali - Haramaya UniversityGianfranco Alicandro - Italian Natl Inst Stat, Directorate Social Stat & Populat Census, Rome, ItalySheikh Mohammad Alif - Monash UniversityVahid Alipour - Iran Univ Med Sci, Hlth Management & Econ Res Ctr, Tehran, IranHesam Alizade - University of HormozganSyed Mohamed Aljunid - Kuwait UniversityAmir Almasi-Hashiani - Arak UniversityNihad A. Almasri - University of JordanHesham M. Al-Mekhlafi - Jazan UniversityJordi Alonso - Universitat Pompeu FabraRajaa M. Al-Raddadi - King Abdulaziz UniversityKhalid A. Altirkawi - King Saud UniversityArwa Khalid Alumran - Imam Abdulrahman Bin Faisal UniversityNelson Alvis-Guzman - Univ Costa, Res Grp Hosp Management & Hlth Policies, Barranquilla, ColombiaNelson J. Alvis-Zakzuk - Univ Costa, Dept Econ Sci, Barranquilla, ColombiaEdward Kwabena Ameyaw - University of Technology SydneySaeed Amini - Arak UniversityMostafa Amini-Rarani - Isfahan Univ Med Sci, Hlth Management & Econ Res Ctr, Esfahan, IranArianna Maever L. AmitDickson A. Amugsi - African Populat & Hlth Res Ctr, Maternal & Child Wellbeing, Nairobi, KenyaRobert Ancuceanu - Carol Davila Univ Med & Pharm, Pharm Dept, Bucharest, RomaniaDeanna Anderlini - The University of QueenslandCatalina Liliana Andrei - Carol Davila Univ Med & Pharm, Cardiol Dept, Bucharest, RomaniaFereshteh Ansari - Tabriz Univ Med Sci, Res Ctr Evidence Based Med, Tabriz, IranAlireza Ansari-Moghaddam - Zahedan Univ Med Sci, Dept Epidemiol & Biostat, Zahedan, IranCarl Abelardo T. Antonio - University of Hong KongErnoiz Antriyandarti - Sebelas Maret UniversityDavood Anvari - Mazandaran Univ Med Sci, Dept Parasitol, Sari, IranRazique Anwer - Imam Mohammad ibn Saud Islamic UniversityMuhammad Aqeel - Fdn Univ Islamabad, Dept Psychol, Rawalpandi, PakistanJalal Arabloo - Iran Univ Med Sci, Hlth Management & Econ Res Ctr, Tehran, IranMorteza Arab-Zozani - Birjand Univ Med Sci, Social Determinants Hlth Res Ctr, Birjand, IranTimur Aripov - Tashkent Inst Postgrad Med Educ, Publ Hlth & Healthcare Management, Tashkent, UzbekistanJohan Arnlov - Karolinska InstitutetKurnia Dwi Artanti - Univ Airlangga, Dept Epidemiol, Surabaya, IndonesiaAfsaneh Arzani - Babol Univ Med Sci, Sch Nursing & Midwifery, Babol, IranMalke Asaad - Univ Texas Houston, Dept Plast Surg, Houston, TX USAMehran Asadi-Aliabadi - Iran Univ Med Sci, Prevent Med & Publ Hlth Res Ctr, Tehran, IranAli A. Asadi-Pooya - Shiraz UniversityMohammad Asghari Jafarabadi - Tabriz Univ Med Sci, Dept Biostat & Epidemiol, Tabriz, IranSeyyed Shamsadin Athari - Zanjan Univ Med Sci, Dept Immunol, Zanjan, IranSeyyede Masoume Athari - Maragheh Univ Med Sci, Dept Biol, Maragheh, IranDesta Debalkie Atnafu - Bahir Dar UniversityAlok Atreya - Lumbini Med Coll, Dept Forens Med, Palpa, NepalMadhu Sudhan Atteraya - Keimyung UniversityMarcel Ausloos - University of LeicesterAsma Tahir Awan - Capella UniversityBeatriz Paulina Ayala Quintanilla - La Trobe UniversityGetinet Ayano - Curtin UniversityMartin Amogre Ayanore - Univ Hlth & Allied Sci, Dept Hlth Policy Planning & Management, Ho, GhanaYared Asmare Aynalem - Debre Berhan UniversitySamad Azari - Iran Univ Med Sci, Hlth Management & Econ Res Ctr, Tehran, IranGhasem Azarian - Hamadan Univ Med Sci, Dept Environm Hlth Engn, Hamadan, Hamadan, IranZelalem Nigussie Azene - University of GondarB. B. Darshan - Kasturba Med Coll & Hosp, Mangalore, IndiaEbrahim Babaee - Iran Univ Med Sci, Prevent Med & Publ Hlth Res Ctr, Tehran, IranAshish D. Badiye - Govt Inst Forens Sci, Dept Forens Sci, Nagpur, Maharashtra, IndiaAtif Amin Baig - Univ Sultan Zainal Abidin, Unit Biochem, Kuala Terengganu, MalaysiaMaciej Banach - Med Univ Lodz, Dept Hypertens, Lodz, PolandGBD 2019 Under-5 Mortality CollaboratorsDavid C Schwebel (Contributor) - Research Administration
- Resource Type
- Journal article
- Publication Details
- The Lancet (British edition), Vol.398(10303), pp.870-905
- DOI
- 10.1016/S0140-6736(21)01207-1
- PMID
- 34416195
- PMCID
- PMC8429803
- NLM abbreviation
- Lancet
- ISSN
- 0140-6736
- eISSN
- 1474-547X
- Publisher
- Elsevier
- Number of pages
- 36
- Grant note
- K43TW010704 / John E. Fogarty International Center for Advanced Study in the Health Sciences; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Fogarty International Center (FIC) Bill AMP; Melinda Gates Foundation; CGIAR EP/P032427/1 / GCRF; UK Research & Innovation (UKRI)
- Language
- English
- Date published
- 09/04/2021
- Academic Unit
- Research Administration
- Record Identifier
- 9984949193902771
Metrics
5 Record Views