Wang, Haidong2; Liddell, Chelsea A2; Coates, Matthew M2; Mooney, Meghan D2; Levitz, Carly E2; Schumacher, Austin E2; Apfel, Henry2; Iannarone, Marissa2; Phillips, Bryan2; Lofgren, Katherine T2; Sandar, Logan2; Dorrington, Rob E2; Rakovac, Ivo2; Jacobs, Troy A2; Liang, Xiaofeng2; Zhou, Maigeng2; Zhu, Jun2; Yang, Gonghuan2; Wang, Yanping2; Liu, Shiwei2; Li, Yichong2; Ozgoren, Ayse Abbasoglu2; Abera, Semaw Ferede2; Abubakar, Ibrahim2; Achoki, Tom2; Adelekan, Ademola2; Ademi, Zanfina2; Alemu, Zewdie Aderaw2; Allen, Peter J2; AlMazroa, Mohammad AbdulAziz2; Alvarez, Elena2; Amankwaa, Adansi A2; Amare, Azmeraw T2; Ammar, Walid2; Anwari, Palwasha2; Cunningham, Solveig Argeseanu2; Asad, Majed Masoud2; Assadi, Reza2; Banerjee, Amitava2; Basu, Sanjay2; Bedi, Neeraj2; Bekele, Tolesa2; Bell, Michelle L2; Bhutta, Zulfiqar2; Blore, Jed D2; Basara, Berrak Bora2; Boufous, Soufiane2; Breitborde, Nicholas2; Bruce, Nigel G2; Bui, Linh Ngoc2; Carapetis, Jonathan R2; Cárdenas, Rosario2; Carpenter, David O2; Caso, Valeria2; Castro, Ruben Estanislao2; Catalá-Lopéz, Ferrán2; Cavlin, Alanur2; Che, Xuan2; Chiang, Peggy Pei-Chia2; Chowdhury, Rajiv2; Christophi, Costas A2; Chuang, Ting-Wu2; Cirillo, Massimo2; da Costa Leite, Iuri2; Courville, Karen J2; Dandona, Lalit2; Dandona, Rakhi2; Davis, Adrian2; Dayama, Anand2; Deribe, Kebede2; Dharmaratne, Samath D2; Dherani, Mukesh K2; Dilmen, Uğur2; Ding, Eric L2; Edmond, Karen M2; Ermakov, Sergei Petrovich2; Farzadfar, Farshad2; Fereshtehnejad, Seyed-Mohammad2; Fijabi, Daniel Obadare2; Foigt, Nataliya2; Forouzanfar, Mohammad H2; Garcia, Ana C2; Geleijnse, Johanna M2; Gessner, Bradford D2; Goginashvili, Ketevan2; Gona, Philimon2; Goto, Atsushi2; Gouda, Hebe N2; Green, Mark A2; Greenwell, Karen Fern2; Gugnani, Harish Chander2; Gupta, Rahul2; Hamadeh, Randah Ribhi2; Hammami, Mouhanad2; Harb, Hilda L2; Hay, Simon2; Hedayati, Mohammad T2; Hosgood, H Dean2; Hoy, Damian G2; Idrisov, Bulat T2; Islami, Farhad2; Ismayilova, Samaya2; Jha, Vivekanand2; Jiang, Guohong2; Jonas, Jost B2; Juel, Knud4; Kabagambe, Edmond Kato2; Kazi, Dhruv S2; Kengne, Andre Pascal2; Kereselidze, Maia2; Khader, Yousef Saleh2; Khalifa, Shams Eldin Ali Hassan2; Khang, Young-Ho2; Kim, Daniel2; Kinfu, Yohannes2; Kinge, Jonas M2; Kokubo, Yoshihiro2; Kosen, Soewarta2; Defo, Barthelemy Kuate2; Kumar, G Anil2; Kumar, Kaushalendra2; Kumar, Ravi B2; Lai, Taavi2; Lan, Qing2; Larsson, Anders2; Lee, Jong-Tae2; Leinsalu, Mall2; Lim, Stephen S2; Lipshultz, Steven E2; Logroscino, Giancarlo2; Lotufo, Paulo A2; Lunevicius, Raimundas2; Lyons, Ronan Anthony2; Ma, Stefan2; Mahdi, Abbas Ali2; Marzan, Melvin Barrientos2; Mashal, Mohammad Taufiq2; Mazorodze, Tasara T2; McGrath, John J2; Memish, Ziad A2; Mendoza, Walter2; Mensah, George A2; Meretoja, Atte2; Miller, Ted R2; Mills, Edward J2; Mohammad, Karzan Abdulmuhsin2; Mokdad, Ali H2; Monasta, Lorenzo2; Montico, Marcella2; Moore, Ami R2; Moschandreas, Joanna2; Msemburi, William T2; Mueller, Ulrich O2; Muszynska, Magdalena M2; Naghavi, Mohsen2; Naidoo, Kovin S2; Narayan, K M Venkat2; Nejjari, Chakib2; Ng, Marie2; de Dieu Ngirabega, Jean2; Nieuwenhuijsen, Mark J2; Nyakarahuka, Luke2; Ohkubo, Takayoshi2; Omer, Saad B2; Caicedo, Angel J Paternina2; Pillay-van Wyk, Victoria2; Pope, Dan2; Pourmalek, Farshad2; Prabhakaran, Dorairaj2; Rahman, Sajjad U R2; Rana, Saleem M2; Reilly, Robert Quentin2; Rojas-Rueda, David2; Ronfani, Luca2; Rushton, Lesley2; Saeedi, Mohammad Yahya2; Salomon, Joshua A2; Sampson, Uchechukwu2; Santos, Itamar S2; Sawhney, Monika2; Schmidt, Jürgen C2; Shakh-Nazarova, Marina2; She, Jun2; Sheikhbahaei, Sara2; Shibuya, Kenji2; Shin, Hwashin Hyun2; Shishani, Kawkab2; Shiue, Ivy2; Sigfusdottir, Inga Dora2; Singh, Jasvinder A2; Skirbekk, Vegard2; Sliwa, Karen2; Soshnikov, Sergey S2; Sposato, Luciano A2; Stathopoulou, Vasiliki Kalliopi2; Stroumpoulis, Konstantinos2; Tabb, Karen M2; Talongwa, Roberto Tchio2; Teixeira, Carolina Maria2; Terkawi, Abdullah Sulieman2; Thomson, Alan J2; Thorne-Lyman, Andrew L2; Toyoshima, Hideaki2; Dimbuene, Zacharie Tsala2; Uwaliraye, Parfait2; Uzun, Selen Begüm2; Vasankari, Tommi J2; Vasconcelos, Ana Maria Nogales2; Vlassov, Vasiliy Victorovich2; Vollset, Stein Emil2; Waller, Stephen2; Wan, Xia2; Weichenthal, Scott2; Weiderpass, Elisabete2; Weintraub, Robert G2; Westerman, Ronny2; Wilkinson, James D2; Williams, Hywel C2; Yang, Yang C2; Yentur, Gokalp Kadri2; Yip, Paul2; Yonemoto, Naohiro2; Younis, Mustafa2; Yu, Chuanhua2; Jin, Kim Yun2; El Sayed Zaki, Maysaa2; Zhu, Shankuan2; Vos, Theo2; Lopez, Alan D2; Murray, Christopher J L2
1 Research Programme on Health and Morbidity in Denmark, National Institute of Public Health, Det Sundhedsvidenskabelige Fakultet, SDU2 unknown3 Health Promotion and Prevention, National Institute of Public Health, Det Sundhedsvidenskabelige Fakultet, SDU4 Health Promotion and Prevention, National Institute of Public Health, Det Sundhedsvidenskabelige Fakultet, SDU
a systematic analysis for the Global Burden of Disease Study 2013
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.