Journal article
Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015
The Lancet (British edition), Vol.388(10053), pp.1725-1774
10/08/2016
DOI: 10.1016/S0140-6736(16)31575-6
PMCID: PMC5224696
PMID: 27733285
Abstract
Background Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time.
Methods Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1-4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980-2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age-sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).
Findings Globally, 5.8 million (95% uncertainty interval [UI] 5.7-6.0) children younger than 5 years died in 2015, representing a 52.0% (95% UI 50.7-53.3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42.4% (41.3-43.6) to 2.6 million (2.6-2.7) neonatal deaths and 47.0% (35.1-57.0) to 2.1 million (1. 8-2.5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3. 0% (2.6-3.3), falling short of the 4.4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4.4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10.3 million fewer under-5 deaths than expected on the basis of improving SDI alone.
Interpretation Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. Copyright (C) The Author(s). Published by Elsevier Ltd.
Details
- Title: Subtitle
- Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015
- Creators
- Haidong Wang - University of WashingtonZulfiqar A. Bhutta - Aga Khan Univ, Ctr Excellence Women & Child Hlth, Karachi, PakistanMatthew M. Coates - University of WashingtonMegan Coggeshall - University of WashingtonLalit Dandona - University of WashingtonKhassoum Diallo - WHO Reg Off Europe, Copenhagen, DenmarkElisabeth Barboza Franca - Univ Fed Minas Gerais, Belo Horizonte, MG, BrazilMaya Fraser - University of WashingtonNancy Fullman - University of WashingtonPeter W. Gething - University of OxfordSimon I. Hay - University of WashingtonYohannes Kinfu - University of CanberraMaaya Kita - The University of TokyoXie Rachel Kulikoff - University of WashingtonHeidi J. Larson - University of WashingtonJuan Liang - Sichuan UniversityXiaofeng Liang - Chinese Ctr Dis Control & Prevent, Beijing, Peoples R ChinaStephen S. Lim - University of WashingtonMargaret Lind - University of WashingtonAlan D. Lopez - University of WashingtonRafael Lozano - Natl Inst Publ Hlth, Cuernavaca, Morelos, MexicoGeorge A. Mensah - NHLBI, Ctr Translat Res & Implementat Sci, NIH, Bldg 10, Bethesda, MD 20892 USAJoseph B. Mikesell - University of WashingtonAli H. Mokdad - University of WashingtonMeghan D. Mooney - University of WashingtonMohsen Naghavi - University of WashingtonGrant Nguyen - University of WashingtonIvo Rakovac - WHO Reg Off Europe, Copenhagen, DenmarkJoshua A. Salomon - Harvard UniversityNaris Silpakit - University of WashingtonAmber Sligar - University of WashingtonReed J. D. Sorensen - University of WashingtonTheo Vos - University of WashingtonJun Zhu - Natl Off MCH Surveillance China, Chengdu, Sichuan, Peoples R ChinaAmanuel Alemu Abajobir - The University of QueenslandKalkidan Hassen Abate - Jimma UniversityKaja M. Abbas - Virginia TechFoad Abd-Allah - Cairo UniversityAbdishakur M. Abdulle - New York University Abu DhabiSemaw Ferede Abera - Mekelle UniversityVictor Aboyans - Dupuytren Univ Hosp, Limoges, FranceBiju Abraham - NMSM Govt Coll Kalpetta, Kalpetta, Kerala, IndiaIbrahim Abubakar - UCL, Inst Global Hlth, London, EnglandLaith J. Abu-Raddad - Weill Cornell Med Coll Qatar, Infect Dis Epidemiol Grp, Doha, QatarNiveen M. E. Abu-Rmeileh - Birzeit UniversityGebre Yitayih Abyu - Mekelle UniversityTom Achoki - University of WashingtonAkindele Olupelumi Adebiyi - University of IbadanIsaac Akinkunmi Adedeji - Olabisi Onabanjo UniversityAdemola Lukman Adelekan - University of IbadanArsene Kouablan Adou - Assoc Ivoirienne Bien Etre Familial, Abidjan, Cote IvoireArnav Agarwal - University of TorontoOluremi N. Ajala - Harvard UniversityTomi F. Akinyemiju - University of AlabamaNadia Akseer - Hosp Sick Children, Ctr Global Child Hlth, Toronto, ON, CanadaKhurshid Alam - The University of MelbourneNoore K. M. Alam - Queensland Hlth, Herston, Qld, AustraliaDeena Alasfoor - Minist Hlth, Al Khuwair, OmanRobert William Aldridge - UCL, Ctr Publ Hlth Data Sci, Inst Hlth Informat, London, EnglandMiguel Angel Alegretti - Univ Republica, Dept Prevent & Social Med, Fac Med, Montevideo, UruguayZewdie Aderaw Alemu - Debre Markos UniversityRaghib Ali - University of OxfordAla'a Alkerwi - Luxembourg Inst Hlth, Strassen, LuxembourgFrancois Alla - Univ Lorraine, Sch Publ Hlth, Nancy, FranceRajaa Al-Raddadi - Minist Hlth, Jeddah, Saudi ArabiaUbai Alsharif - Charité - Universitätsmedizin BerlinKhalid A. Altirkawi - King Saud UniversityElena Alvarez Martin - Minist Hlth Social Policy & Equal, Govt Delegat Natl Plan Drugs, Spanish Observ Drugs, Madrid, SpainNelson Alvis-Guzman - University of CartagenaAzmeraw T. Amare - The University of AdelaideAlemayehu Amberbir - Dignitas Int, Zomba, MalawiAdeladza Kofi Amegah - University of Cape CoastEmmanuel A. Ameh - Natl Hosp, Abuja, NigeriaWalid Ammar - Minist Publ Hlth, Beirut, LebanonStephen Marc Amrock - University of PortlandHjalte H. Andersen - Aalborg UniversityGregory M. Anderson - University of WashingtonCarl Abelardo T. Antonio - University of the Philippines ManilaJohan ArlovAl Artaman - University of ManitobaHamid Asayesh - Qom Univ Med Sci, Dept Emergency Med, Sch Paramed, Qom, IranRana Jawad Asghar - ForumReza Assadi - Mashhad Univ Med Sci, Mashhad, IranSuleman Atique - Taipei Med Univ, Grad Inst Biomed Informat, Taipei, TaiwanEuripide Frinel G. Arthur Avokpaho - Inst Rech Clin Benin, Cotonou, BeninAshish Awasthi - Sanjay Gandhi Postgrad Inst Med Sci, Lucknow, Uttar Pradesh, IndiaBeatriz Paulina Ayala Quintanilla - La Trobe UniversityUmar Bacha - Univ Management & Technol, Sch Hlth Sci, Lahore, PakistanAlaa Badawi - University of TorontoKalpana Balakrishnan - Sri Ramachandra Univ, Dept Environm Hlth Engn, Chennai, Tamil Nadu, IndiaAmitava Banerjee - Farr InstituteBolanle F. Banigbe - AIDS Prevent Initiat Nigeria, Abuja, NigeriaAleksandra Barac - University of BelgradeRyan M. Barber - University of WashingtonSuzanne L. Barker-Collo - University of AucklandTill Barnighausen - Harvard UniversityLope H. Barrero - Pontificia Univ Javeriana, Dept Ind Engn, Sch Engn, Bogota, ColombiaTigist Assefa Bayou - Mekelle UniversityYibeltal Tebekaw Bayou - Jhpiego Ethiopia, Addis Ababa, EthiopiaShahrzad Bazargan-Hejazi - Drew UniversityGBD 2015 Child Mortality CollaboratorsDavid C Schwebel (Contributor) - Research Administration
- Resource Type
- Journal article
- Publication Details
- The Lancet (British edition), Vol.388(10053), pp.1725-1774
- DOI
- 10.1016/S0140-6736(16)31575-6
- PMID
- 27733285
- PMCID
- PMC5224696
- NLM abbreviation
- Lancet
- ISSN
- 0140-6736
- eISSN
- 1474-547X
- Publisher
- Elsevier
- Number of pages
- 50
- Grant note
- 16H02643 / Grants-in-Aid for Scientific Research; Ministry of Education, Culture, Sports, Science and Technology, Japan (MEXT); Japan Society for the Promotion of Science; Grants-in-Aid for Scientific Research (KAKENHI) SGL014\1002 / Academy of Medical Sciences (AMS) Bill AMP; Melinda Gates Foundation; CGIAR MC_U147585819; MR/K006525/1; G0400491; MR/K00669X/1; MC_U147585827 / MRC; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) MC_U147585819; U1475000001; G0400491; MC_U147585824; MC_U147585827; MC_UP_A620_1014; MC_UU_12011/1 / Medical Research Council; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) CL-2015-18-011; NF-SI-0513-10085; NF-SI-0510-10060; RP-PG-0407-10184; NF-SI-0508-10082 / National Institute for Health Research; National Institutes of Health Research (NIHR) ES/L007444/1 / ESRC; UK Research & Innovation (UKRI); Economic & Social Research Council (ESRC)
- Language
- English
- Date published
- 10/08/2016
- Academic Unit
- Research Administration
- Record Identifier
- 9984949459102771
Metrics
9 Record Views