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

Julie Knoll Rajaratnam, Jake R. Marcus, Abraham D. Flaxman, Haidong Wang, Alison Levin-Rector, Laura Dwyer, Megan Costa, Alan D. Lopez, Christopher JL Murray

Research output: Contribution to journalArticle

521 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1988-2008
Number of pages21
JournalThe Lancet
Volume375
Issue number9730
DOIs
StatePublished - Jan 1 2010
Externally publishedYes

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Child Mortality
Infant Mortality
Mortality
Reproductive History
Africa South of the Sahara
Lesotho
Swaziland
Liberia
Angola
Sierra Leone
Rwanda
Botswana
Gambia
Congo
Democratic Republic of the Congo
Senegal
Cameroon
Kenya
Censuses
Uncertainty

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Rajaratnam, J. K., Marcus, J. R., Flaxman, A. D., Wang, H., Levin-Rector, A., Dwyer, L., ... Murray, C. JL. (2010). Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: a systematic analysis of progress towards Millennium Development Goal 4. The Lancet, 375(9730), 1988-2008. https://doi.org/10.1016/S0140-6736(10)60703-9

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.; Flaxman, Abraham D.; Wang, Haidong; Levin-Rector, Alison; Dwyer, Laura; Costa, Megan; Lopez, Alan D.; Murray, Christopher JL.

In: The Lancet, Vol. 375, No. 9730, 01.01.2010, p. 1988-2008.

Research output: Contribution to journalArticle

Rajaratnam, Julie Knoll ; Marcus, Jake R. ; Flaxman, Abraham D. ; Wang, Haidong ; Levin-Rector, Alison ; Dwyer, Laura ; Costa, Megan ; Lopez, Alan D. ; Murray, Christopher JL. / Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010 : a systematic analysis of progress towards Millennium Development Goal 4. In: The Lancet. 2010 ; Vol. 375, No. 9730. pp. 1988-2008.
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N2 - 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.

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