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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 H 1 , Liddell CA 2 , Coates MM 2 , Mooney MD 2 , Levitz CE 2 , Schumacher AE 2 Show all authors , Apfel H 2 , Iannarone M 2 , Phillips B 2 , Lofgren KT 2 , Sandar L 2 , Dorrington RE 3 , Rakovac I 4 , Jacobs TA 5 , Liang X 6 , Zhou M 6 , Zhu J 7 , Yang G 8 , Wang Y 7 , Liu S 6 , Li Y 6 , Ozgoren AA 9 , Abera SF 10 , Abubakar I 11 , Achoki T 12 , Adelekan A 13 , Ademi Z 14 , Alemu ZA 15 , Allen PJ 16 , AlMazroa MA 17 , Alvarez E 18 , Amankwaa AA 19 , Amare AT 20 , Ammar W 21 , Anwari P 22 , Cunningham SA 23 , Asad MM 24 , Assadi R 25 , Banerjee A 26 , Basu S 27 , Bedi N 28 , Bekele T 29 , Bell ML 30 , Bhutta Z 31 , Blore JD 14 , Basara BB 32 , Boufous S 33 , Breitborde N 34 , Bruce NG 35 , Bui LN 36 , Carapetis JR 37 , Cárdenas R 38 , Carpenter DO 39 , Caso V 40 , Castro RE 41 , Catalá-Lopéz F 42 , Cavlin A 9 , Che X 43 , Chiang PP 44 , Chowdhury R 45 , Christophi CA 46 , Chuang TW 47 , Cirillo M 48 , da Costa Leite I 49 , Courville KJ 50 , Dandona L 51 , Dandona R 52 , Davis A 53 , Dayama A 54 , Deribe K 55 , Dharmaratne SD 56 , Dherani MK 35 , Dilmen U 32 , Ding EL 57 , Edmond KM 58 , Ermakov SP 59 , Farzadfar F 60 , Fereshtehnejad SM 61 , Fijabi DO 62 , Foigt N 63 , Forouzanfar MH 2 , Garcia AC 64 , Geleijnse JM 65 , Gessner BD 66 , Goginashvili K 67 , Gona P 68 , Goto A 69 , Gouda HN 70 , Green MA 71 , Greenwell KF 72 , Gugnani HC 73 , Gupta R 74 , Hamadeh RR 75 , Hammami M 76 , Harb HL 21 , Hay S 77 , Hedayati MT 78 , Hosgood HD 79 , Hoy DG 80 , Idrisov BT 81 , Islami F 82 , Ismayilova S 83 , Jha V 84 , Jiang G 85 , Jonas JB 86 , Juel K 87 , Kabagambe EK 88 , Kazi DS 89 , Kengne AP 90 , Kereselidze M 91 , Khader YS 92 , Khalifa SE 93 , Khang YH 94 , Kim D 95 , Kinfu Y 96 , Kinge JM 97 , Kokubo Y 98 , Kosen S 99 , Defo BK 100 , Kumar GA 52 , Kumar K 101 , Kumar RB 52 , Lai T 102 , Lan Q 103 , Larsson A 104 , Lee JT 105 , Leinsalu M 106 , Lim SS 2 , Lipshultz SE 107 , Logroscino G 108 , Lotufo PA 109 , Lunevicius R 110 , Lyons RA 111 , Ma S 112 , Mahdi AA 113 , Marzan MB 114 , Mashal MT 115 , Mazorodze TT 116 , McGrath JJ 70 , Memish ZA 17 , Mendoza W 117 , Mensah GA 118 , Meretoja A 14 , Miller TR 119 , Mills EJ 120 , Mohammad KA 121 , Mokdad AH 2 , Monasta L 122 , Montico M 122 , Moore AR 123 , Moschandreas J 124 , Msemburi WT 90 , Mueller UO 125 , Muszynska MM 126 , Naghavi M 2 , Naidoo KS 127 , Narayan KM 23 , Nejjari C 128 , Ng M 2 , de Dieu Ngirabega J 129 , Nieuwenhuijsen MJ 130 , Nyakarahuka L 131 , Ohkubo T 132 , Omer SB 23 , Caicedo AJ 133 , Pillay-van Wyk V 90 , Pope D 35 , Pourmalek F 134 , Prabhakaran D 135 , Rahman SU 136 , Rana SM 137 , Reilly RQ 138 , Rojas-Rueda D 130 , Ronfani L 122 , Rushton L 139 , Saeedi MY 17 , Salomon JA 57 , Sampson U 88 , Santos IS 109 , Sawhney M 140 , Schmidt JC 53 , Shakh-Nazarova M 91 , She J 141 , Sheikhbahaei S 60 , Shibuya K 142 , Shin HH 143 , Shishani K 144 , Shiue I 145 , Sigfusdottir ID 146 , Singh JA 147 , Skirbekk V 97 , Sliwa K 148 , Soshnikov SS 149 , Sposato LA 150 , Stathopoulou VK 151 , Stroumpoulis K 152 , Tabb KM 153 , Talongwa RT 154 , Teixeira CM 155 , Terkawi AS 156 , Thomson AJ 157 , Thorne-Lyman AL 158 , Toyoshima H 159 , Dimbuene ZT 160 , Uwaliraye P 161 , Uzun SB 32 , Vasankari TJ 162 , Vasconcelos AM 163 , Vlassov VV 164 , Vollset SE 97 , Waller S 165 , Wan X 166 , Weichenthal S 143 , Weiderpass E 167 , Weintraub RG 168 , Westerman R 125 , Wilkinson JD 169 , Williams HC 170 , Yang YC 171 , Yentur GK 32 , Yip P 172 , Yonemoto N 173 , Younis M 174 , Yu C 175 , Jin KY 176 , El Sayed Zaki M 177 , Zhu S 178 , Vos T 2 , Lopez AD 14 , Murray CJ 2

Affiliations 

  • 1 Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: haidong@uw.edu
  • 2 Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
  • 3 University of Cape Town, Cape Town, South Africa
  • 4 WHO Regional Office for Europe, Copenhagen, Denmark
  • 5 MCH Division, USAID - Global Health Bureau, HIDN, Washington, DC, USA
  • 6 National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
  • 7 National Office for Maternal and Child's Health Surveillance, Chengdu, China
  • 8 Peking Union Medical College, Beijing, China; Peking Union Medical College, Beijing, China
  • 9 Hacettepe University Institute of Population Studies, Ankara, Turkey
  • 10 Mekelle University, Tigray, Ethiopia
  • 11 University College London, London, United Kingdom
  • 12 Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Ministry of Health, Gaborone, Botswana
  • 13 Public Health Promotion Alliance, Osogpb, Nigeria
  • 14 University of Melbourne, Melbourne, VIC, Australia
  • 15 Debre Markos Univerity, Debre Markos, Ethiopia
  • 16 Ministry of Health, Belmopan, Cayo, Belize
  • 17 Saudi Ministry of Health, Riyadh, Kingdom of Saudi Arabia
  • 18 Government, Madrid, Spain
  • 19 Albany State University, Albany, GA, USA
  • 20 Department of Epidemiology, University of Groningen, Groningen, Netherlands
  • 21 Ministry of Public Health, Beirut, Lebanon
  • 22 UNFPA, Kabul, Afghanistan
  • 23 Emory University, Atlanta, GA, USA
  • 24 Ministry of Health, Amman, Jordan
  • 25 Mashhad University of Medical Sciences, Mashhad, Khorasan, Iran
  • 26 University of Birmingham, Birmingham, West Midlands, United Kingdom
  • 27 Stanford University, Stanford, CA, USA
  • 28 College of Public Health and Tropical Medicine, Jazan, Saudi Arabia
  • 29 Madawalabu University, Bale Goba, Oromia, Ethiopia
  • 30 Yale University, New Haven, CT, USA
  • 31 Aga Khan University Medical Center, Karachi, Pakistan
  • 32 Ministry of Health, General Directorate of Health Research, Ankara, Turkey
  • 33 Transport and Road Safety (TARS) Research, University of New South Wales, Sydney, NSW, Australia
  • 34 University of Arizona, Tucson, AZ, USA
  • 35 University of Liverpool, Merseyside, United Kingdom
  • 36 Hanoi School of Public Health, Hanoi, Vietnam
  • 37 Telethon Institute for Child Health Research, Subiaco, WA, Australia
  • 38 Universidad Autonoma Metropolitana, Mexico, DF, Mexico
  • 39 University at Albany, Rensselaer, NY, USA
  • 40 Stroke Unit, University of Perugia, Perugia, Italy
  • 41 Universidad Diego Portales, Santiago, Chile
  • 42 Division of Pharmacology and Pharmacovigilance, Spanish Medicines and Healthcare Products Agency (AEMPS), Ministry of Health, Madrid, Spain
  • 43 National Institutes of Health, Bethesda, MD, USA
  • 44 General Practice and Primary Health Care Academic Centre, Melbourne, VIC, Australia
  • 45 University of Cambridge, Cambridge, United Kingdom
  • 46 Cyprus University of Technology, Limassol, Cyprus
  • 47 Taipei Medical University, Taipei, Taiwan
  • 48 University of Salerno, Baronissi, SA, Italy
  • 49 National School of Public Health (ENSP/Fiocruz), Rio De Janeiro, Brazil
  • 50 Hospital Dr. Gustavo N. Collado, Chitre, Herrera, Panama
  • 51 Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Public Health Foundation of India, New Delhi, India
  • 52 Public Health Foundation of India, New Delhi, India
  • 53 Public Health England, London, United Kingdom
  • 54 School of Medicine, Atlanta, GA, USA
  • 55 Addis Ababa University, Addis Ababa, Ethiopia
  • 56 University of Peradeniya, Peradeniya, Sri Lanka
  • 57 Harvard School of Public Health, Harvard University, Boston, MA, USA
  • 58 University of Western Australia, Perth, WA, Australia
  • 59 The Institute of Social and Economic Studies of Population at the Russian Academy of Sciences, Moscow, Russia
  • 60 Non-Communicable Diseases Research Center, Endocrine and Metabolic Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  • 61 Karolinska Institutet, Stockholm, Sweden
  • 62 Heller Graduate School, Waltham, MA, USA
  • 63 Institute of Gerontology, Academy of Medical Sciences, Kyiv, Ukraine
  • 64 Public Health Unit of Primary Health Care Group of Almada-Seixal (region of Lisbon), Almada, Portugal
  • 65 Wageningen University, Division of Human Nutrition, Wageningen, the Netherlands
  • 66 Agence de Medecine Preventive, Paris, France
  • 67 Ministry of Labour, Health, and Social Affairs, Tbilisi, Georgia
  • 68 University of Massachusetts Medical School, Worcester, MA, USA
  • 69 Department of Diabetes Research, National Center for Global Health and Medicine, Tokyo, Japan
  • 70 University of Queensland, Brisbane, QLD, Australia
  • 71 University of Sheffield, Sheffield, South York, United Kingdom
  • 72 Stattis LLC, Chisinau, Moldova
  • 73 Saint James School of Medicine, Kralendijk, Bonaire, Netherlands Antilles
  • 74 Kanawha Charleston Health Department, Charleston, WV, USA
  • 75 Arabian Gulf University, Manama, Bahrain
  • 76 Wayne County Department of Health and Human Services, Detroit, MI, USA
  • 77 University of Oxford, Oxford, United Kingdom
  • 78 Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
  • 79 Albert Einstein College of Medicine, Bronx, NY, USA
  • 80 School of Population Health, Brisbane, QLD, Australia; Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia
  • 81 Brandeis University, Waltham, MA, USA
  • 82 American Cancer Society, New York, NY, USA
  • 83 Self-Employed, Baku, Azerbaijan
  • 84 Postgraduate Institute of Medical Education and Research, Chandigarh, India
  • 85 Tianjin Centers for Disease Control and Prevention, Tianjin, China
  • 86 Department of Ophthalmology, Medical Faculty Mannheim, Mannheim, Germany
  • 87 The National Institute of Public Health, Copenhagen, Denmark
  • 88 Vanderbilt University, Nashville, TN, USA
  • 89 University of California San Francisco, San Francisco, CA, USA
  • 90 South African Medical Research Council, Cape Town, Western Cape, South Africa
  • 91 National Centre for Diseases Control and Public Health, Tbilisi, Georgia
  • 92 Jordan University of Science and Technology, AlRamtha, Irbid, Jordan
  • 93 Supreme Council of Health, Doha, Qatar
  • 94 Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
  • 95 Northeastern University, Boston, MA, USA
  • 96 University of Canberra, Canberra, ACT, Australia
  • 97 The Norwegian Institute of Public Health, Oslo, Norway
  • 98 Department of Preventive Cardiology, Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
  • 99 Center for Community Empowerment, Health Policy & Humanities, NIHRD, Jakarta, Indonesia
  • 100 University of Montreal, Montreal, Quebec, Canada
  • 101 International Institute for Population Sciences, Mumbai, India
  • 102 Fourth View Consulting, Tallinn, Estonia
  • 103 National Cancer Institute, Bethesda, MD, USA
  • 104 Uppsala University, Uppsala, Sweden
  • 105 Korea University, Seoul, South Korea
  • 106 The National Institute for Health Development, Tallinn, Estonia
  • 107 Wayne State University, Miami, FL, USA
  • 108 University of Bari, Bari, Italy
  • 109 University of Sao Paulo, Sao Paulo, Brazil
  • 110 Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
  • 111 Swansea University, Swansea, United Kingdom
  • 112 Ministry of Health Singapore, Singapore
  • 113 King George's Medical University, Lucknow, Uttar Pradesh, India
  • 114 University of the East Ramon Magsaysay Medical Center, Quezon City, Metro Manila, Philippines
  • 115 Ministry of Public Health, Kabul, Afghanistan
  • 116 AIDC EC, Port Elizabeth, Eastern Cape, South Africa
  • 117 UNFPA, Lima, Peru
  • 118 Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, Bethesda, MD, USA
  • 119 Pacific Institute for Research & Evaluation, Calverton, MD, USA
  • 120 University of Ottawa, Ottawa, Ontario, Canada
  • 121 University of Salahaddin, Erbil, Iraq
  • 122 Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy
  • 123 University of North Texas, Denton, TX, USA
  • 124 University of Crete, Crete, Greece
  • 125 Philipps-University Marburg, Marburg, Hessia, Germany
  • 126 Warsaw School of Economics, Warsaw, Poland
  • 127 University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
  • 128 Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy, University sidi Mohamed Ben Abdellah, Fez, Morocco
  • 129 Rwanda Biomedical Center, Kigali, Rwanda
  • 130 Centre of Research in Environmental Epidemiology (CREAL), Barcelona, Spain
  • 131 Makerere University, Kampala, Uganda
  • 132 Teikyo University School of Medicine, Tokyo, Japan
  • 133 Universidad de Cartagena, Cartagena, Bolivar, Colombia
  • 134 University of British Columbia, Vancouver, BC, Canada
  • 135 Centre for Chronic Disease Control, New Delhi, Delhi, India
  • 136 Hamad Medical Corporation, Doha, Qatar
  • 137 Department of Public Health, University of the Punjab, Lahore, Punjab, Pakistan
  • 138 Private Consultant, Cairns, QLD, Australia
  • 139 Imperial College London, London, United Kingdom
  • 140 Marshall University, Huntington, WV, USA
  • 141 Zhongshan Hospital, Fudan, University, Shanghai, China
  • 142 University of Tokyo, Tokyo, Japan
  • 143 Health Canada, Ottawa, Ontario, Canada
  • 144 Washington State University, Spokane, WA, USA
  • 145 Heriot-Watt University, Edinburgh, Scotland, United Kingdom
  • 146 Reykjavik University, Reykjavik, Iceland
  • 147 University of Alabama at Birmingham, Birmingham, AL, USA
  • 148 Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
  • 149 Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow, Russia
  • 150 Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
  • 151 Centre Hospitalier Nord Deux-Sevres, Bressuire, France
  • 152 KEELPNO (Center for Disease Control, Greece, dispatched to "Alexandra" General Hospital of Athens), Athens, Greece
  • 153 University of Illinois, Champaign, IL, USA
  • 154 Ministry of Health, Yaounde, Centre, Cameroon
  • 155 ARS Norte, Porto, Portugal
  • 156 Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA; Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia
  • 157 Adaptive Knowledge Management, Victoria, BC, Canada
  • 158 Columbia University and The Earth Institute, New York, NY, USA
  • 159 Health Care Center of Anjo Kosei Hospital, Anjo City, Aichi Prefecture, Japan
  • 160 Department of Population Sciences and Development, Faculty of Economics and Management, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, Rwanda, Kigali City, Rwanda
  • 161 Ministry of Health, Rwanda, Kigali City, Rwanda
  • 162 UKK Institute for Health Promotion Research, Tampere, Finland
  • 163 Universidade de Brasilia, Brasilia, Distrito Federal, Brazil
  • 164 National Research University Higher School of Economics, Moscow, Russia
  • 165 Uniformed Services University of Health Sciences, Bethesda, MD, USA
  • 166 Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
  • 167 Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden
  • 168 University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
  • 169 University of Miami, Miami, FL, USA
  • 170 University of Nottingham, Nottingham, United Kingdom
  • 171 University of North Carolina at Chapel Hill, Chapel Hill, NC. USA
  • 172 The University of Hong Kong, Hong Kong
  • 173 National Center of Neurology and Psychiatry, Kodira, Tokyo, Japan
  • 174 Jackson State University, Jackson, MS, USA
  • 175 Department of Epidemiology and Biostatistics, School of Public Health, and Global Health Institute, Wuhan University, Wuhan, Hubei, China
  • 176 TCM MEDICAL TK SDN BHD, Nusajaya, Johor Bahru, Malaysia
  • 177 Mansoura Faculty of Medicine, Mansoura, Egypt
  • 178 Zhejiang University School of Public Health, Hangzhou, Zhejiang, China
Lancet, 2014 Sep 13;384(9947):957-79.
PMID: 24797572 DOI: 10.1016/S0140-6736(14)60497-9

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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