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. Funding Bill & Melinda Gates Foundation.
Original language | English (US) |
---|---|
Pages (from-to) | 1725-1774 |
Number of pages | 50 |
Journal | The Lancet |
Volume | 388 |
Issue number | 10053 |
DOIs | |
State | Published - Oct 8 2016 |
ASJC Scopus subject areas
- Medicine(all)
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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. / Wang, Haidong; Bhutta, Zulfiqar A.; Coates, Matthew M.; Coggeshall, Megan; Dandona, Lalit; Diallo, Khassoum; Franca, Elisabeth Barboza; Fraser, Maya; Fullman, Nancy; Gething, Peter W.; Hay, Simon I.; Kinfu, Yohannes; Kita, Maaya; Kulikoff, Xie Rachel; Larson, Heidi J.; Liang, Juan; Liang, Xiaofeng; Lind, Margaret; Lopez, Alan D.; Lozano, Rafael; Mensah, George A.; Mikesell, Joseph B.; Mokdad, Ali H.; Mooney, Meghan D.; Nguyen, Grant; Rakovac, Ivo; Salomon, Joshua A.; Silpakit, Naris; Sligar, Amber; Sorensen, Reed J D; Vos, Theo; Zhu, Jun; Abajobir, Amanuel Alemu; Abate, Kalkidan Hassen; Abbas, Kaja M.; Abd-Allah, Foad; Abdulle, Abdishakur M.; Abera, Semaw Ferede; Aboyans, Victor; Abraham, Biju; Abubakar, Ibrahim; Abu-Raddad, Laith J.; Abu-Rmeileh, Niveen M E; Abyu, Gebre Yitayih; Achoki, Tom; Adebiyi, Akindele Olupelumi; Adedeji, Isaac Akinkunmi; Adelekan, Ademola Lukman; Adou, Arsène Kouablan; Agarwal, Arnav; Ajala, Oluremi N.; Akinyemiju, Tomi F.; Akseer, Nadia; Alam, Khurshid; Alam, Noore K M; Alasfoor, Deena; Aldridge, Robert William; Alegretti, Miguel Angel; Alemu, Zewdie Aderaw; Ali, Raghib; Alkerwi, Ala'a; Alla, François; Al-Raddadi, Rajaa; Alsharif, Ubai; Altirkawi, Khalid A.; Martin, Elena Alvarez; Alvis-Guzman, Nelson; Amare, Azmeraw T.; Amberbir, Alemayehu; Amegah, Adeladza Kofi; Ameh, Emmanuel A.; Ammar, Walid; Amrock, Stephen Marc; Andersen, Hjalte H.; Anderson, Gregory M.; Antonio, Carl Abelardo T; Ärnlöv, Johan; Artaman, Al; Asayesh, Hamid; Asghar, Rana Jawad; Assadi, Reza; Atique, Suleman; Avokpaho, Euripide Frinel G Arthur; Awasthi, Ashish; Quintanilla, Beatriz Paulina Ayala; Bacha, Umar; Badawi, Alaa; Balakrishnan, Kalpana; Banerjee, Amitava; Banigbe, Bolanle F.; Barac, Aleksandra; Barber, Ryan M.; Barker-Collo, Suzanne L.; Bärnighausen, Till; Barrero, Lope H.; Bayou, Tigist Assefa; Bayou, Yibeltal Tebekaw; Bazargan-Hejazi, Shahrzad; Beardsley, Justin; Bedi, Neeraj; Bekele, Tolesa; Bell, Michelle L.; Bello, Aminu K.; Bennett, Derrick A.; Bensenor, Isabela M.; Berhane, Adugnaw; Bernabé, Eduardo; Betsu, Balem Demtsu; Bhatt, Samir; Biadgilign, Sibhatu; Bikbov, Boris; Birlik, Sait Mentes; Bisanzio, Donal; Bjertness, Espen; Blore, Jed D.; Bourne, Rupert R A; Brainin, Michael; Brazinova, Alexandra; Breitborde, Nicholas J K; Brown, Alexandria; Buckle, Geoffrey Colin; Burch, Michael; Butt, Zahid A.; Campos-Nonato, Ismael Ricardo; Campuzano, Julio Cesar; Cárdenas, Rosario; Carpenter, David O.; Carrero, Juan Jesus; Carter, Austin; Casey, Daniel C.; Castañeda-Orjuela, Carlos A.; Rivas, Jacqueline Castillo; Castro, Ruben Estanislao; Catalá-López, Ferrán; Cercy, Kelly; Chang, Hsing Yi; Chang, Jung Chen; Chibueze, Chioma Ezinne; Chisumpa, Vesper Hichilombwe; Choi, Jee Young Jasmine; Chowdhury, Rajiv; Christopher, Devasahayam Jesudas; Ciobanu, Liliana G.; Colquhoun, Samantha M.; Cooper, Cyrus; Cornaby, Leslie; Damtew, Solomon Abrha; Danawi, Hadi; Dandona, Rakhi; das Neves, José; Davis, Adrian C.; de Jager, Pieter; De Leo, Diego; Degenhardt, Louisa; Deribe, Kebede; Deribew, Amare; Jarlais, Don C Des; deVeber, Gabrielle A.; Dharmaratne, Samath D.; Dhillon, Preet K.; Ding, Eric L.; Doshi, Pratik Pinal; Doyle, Kerrie E.; Duan, Leilei; Dubey, Manisha; Ebrahimi, Hedyeh; Ellingsen, Christian Lycke; Elyazar, Iqbal; Endries, Aman Yesuf; Ermakov, Sergey Petrovich; Eshrati, Babak; Esteghamati, Alireza; Faraon, Emerito Jose Aquino; Farid, Talha A.; Farinha, Carla Sofia e Sa; Faro, André; Farvid, Maryam S.; Farzadfar, Farshad; Fereshtehnejad, Seyed Mohammad; Fernandes, Joao C.; Fischer, Florian; Fitchett, Joseph R A; Foigt, Nataliya; Franklin, Richard C.; Friedman, Joseph; Fürst, Thomas; Gambashidze, Ketevan; Gamkrelidze, Amiran; Ganguly, Parthasarathi; Gebre, Teshome; Gebrehiwot, Tsegaye Tewelde; Gebremedhin, Amanuel Tesfay; Gebru, Alemseged Aregay; Geleijnse, Johanna M.; Gessner, Bradford D.; Ginawi, Ibrahim Abdelmageem Mohamed; Giref, Ababi Zergaw; Gishu, Melkamu Dedefo; Gomez-Dantes, Hector; Gona, Philimon; Goodridge, Amador; Gopalani, Sameer Vali; Goto, Atsushi; Gouda, Hebe N.; Gugnani, Harish Chander; Guo, Yuming; Gupta, Rahul; Gupta, Rajeev; Gupta, Vipin; Gyawali, Bishal; Haagsma, Juanita A.; Hafezi-Nejad, Nima; Haile, Demewoz; Hailu, Alemayehu Desalegne; Hailu, Gessessew Bugssa; Hamadeh, Randah Ribhi; Hancock, Jamie; Handal, Alexis J.; Hankey, Graeme J.; Harb, Hilda L.; Harikrishnan, Sivadasanpillai; Harun, Kimani M.; Havmoeller, Rasmus; Hay, Roderick J.; Heredia-Pi, Ileana Beatriz; Hoek, Hans W.; Horino, Masako; Horita, Nobuyuki; Hosgood, H. Dean; Hotez, Peter J.; Hoy, Damian G.; Hsairi, Mohamed; Hu, Guoqing; Huang, Cheng; Huang, John J.; Huang, Hsiang; Huiart, Laetitia; Iburg, Kim Moesgaard; Idrisov, Bulat T.; Innos, Kaire; Jacobsen, Kathryn H.; Jahanmehr, Nader; Javanbakht, Mehdi; Jayatilleke, Achala Upendra; Jee, Sun Ha; Jeemon, Panniyammakal; Jha, Vivekanand; Jiang, Guohong; Jiang, Ying; Jibat, Tariku; Jin, Ye; Jonas, Jost B.; Kabir, Zubair; Kalkonde, Yogeshwar; Kamal, Ritul; Kan, Haidong; Kang, Gagandeep; Karch, André; Karema, Corine Kakizi; Kasaeian, Amir; Kaul, Anil; Kawakami, Norito; Kayibanda, Jeanne Françoise; Kazanjan, Konstantin; Keiyoro, Peter Njenga; Kemp, Andrew Haddon; Kengne, Andre Pascal; Keren, Andre; Kereselidze, Maia; Kesavachandran, Chandrasekharan Nair; Khader, Yousef Saleh; Khalil, Ibrahim A.; Khan, Abdur Rahman; Khan, Ejaz Ahmad; Khang, Young Ho; Khonelidze, Irma; Khubchandani, Jagdish; Kim, Cho il; Kim, Daniel; Kim, Yun Jin; Kissoon, Niranjan; Kivipelto, Miia; Knibbs, Luke D.; Kokubo, Yoshihiro; Kosen, Soewarta; Koul, Parvaiz A.; Koyanagi, Ai; Defo, Barthelemy Kuate; Bicer, Burcu Kucuk; Kudom, Andreas A.; Kumar, G. Anil; Kyu, Hmwe H.; Lal, Dharmesh Kumar; Lalloo, Ratilal; Lam, Hilton; Lam, Jennifer O.; Lansingh, Van C.; Larsson, Anders; Leigh, James; Leung, Ricky; Li, Yichong; Li, Yongmei; Lindsay, M. Patrice; Liu, Patrick Y.; Liu, Shiwei; Lloyd, Belinda K.; Lo, Warren D.; Logroscino, Giancarlo; Low, Nicola; Lunevicius, Raimundas; Lyons, Ronan A.; Ma, Stefan; Razek, Hassan Magdy Abd El; Razek, Mohammed Magdy Abd El; Mahdavi, Mahdi; Majdan, Marek; Majeed, Azeem; Malekzadeh, Reza; Mapoma, Chabila C.; Marcenes, Wagner; Martinez-Raga, Jose; Marzan, Melvin Barrientos; Masiye, Felix; McGrath, John J.; Meaney, Peter A.; Mehari, Alem; Mehndiratta, Man Mohan; Mekonnen, Alemayehu B.; Melaku, Yohannes Adama; Memiah, Peter; Memish, Ziad A.; Mendoza, Walter; Meretoja, Atte; Meretoja, Tuomo J.; Mhimbira, Francis Apolinary; Miller, Ted R.; Mills, Edward J.; Mirarefin, Mojde; Misganaw, Awoke; Mock, Charles N.; Mohammad, Karzan Abdulmuhsin; Mohammadi, Alireza; Mohammed, Shafiu; Monasta, Lorenzo; Hernandez, Julio Cesar Montañez; Montico, Marcella; Moore, Ami R.; Moradi-Lakeh, Maziar; Morawska, Lidia; Mori, Rintaro; Mueller, Ulrich O.; Murphy, Georgina A V; Murthy, Srinivas; Nachega, Jean B.; Naheed, Aliya; Naidoo, Kovin S.; Naldi, Luigi; Nand, Devina; Nangia, Vinay; Neupane, Subas; Newton, Charles R.; Newton, John N.; Ng, Marie; Ngalesoni, Frida Namnyak; Nguhiu, Peter; Nguyen, Quyen Le; Nisar, Muhammad Imran; Pete, Patrick Martial Nkamedjie; Norheim, Ole F.; Norman, Rosana E.; Ogbo, Felix Akpojene; Oh, In Hwan; Ojelabi, Foluke Adetola; Olivares, Pedro R.; Olusanya, Bolajoko Olubukunola; Olusanya, Jacob Olusegun; Oren, Eyal; Ota, Erika; PA, Mahesh; Park, Eun Kee; Park, Hye Youn; Parsaeian, Mahboubeh; Caicedo, Angel J Paternina; Patten, Scott B.; Pedro, João Mário; Pereira, David M.; Perico, Norberto; Pesudovs, Konrad; Petzold, Max; Phillips, Michael Robert; Pillay, Julian David; Pishgar, Farhad; Polinder, Suzanne; Pope, Daniel; Popova, Svetlana; Pourmalek, Farshad; Qorbani, Mostafa; Rabiee, Rynaz H S; Rafay, Anwar; Rahimi-Movaghar, Vafa; Rahman, Mahfuzar; Rahman, Mohammad Hifz Ur; Rahman, Sajjad Ur; Rai, Rajesh Kumar; Raju, Murugesan; Ram, Usha; Rana, Saleem M.; Ranabhat, Chhabi Lal; Rao, Puja; Refaat, Amany H.; Remuzzi, Giuseppe; Resnikoff, Serge; Reynolds, Alex; Rojas-Rueda, David; Ronfani, Luca; Roshandel, Gholamreza; Roth, Gregory A.; Roy, Ambuj; Ruhago, George Mugambage; Sagar, Rajesh; Saleh, Muhammad Muhammad; Sanabria, Juan R.; Sanchez-Niño, Maria Dolores; Santos, Itamar S.; Santos, João Vasco; Sarmiento-Suarez, Rodrigo; Sartorius, Benn; Satpathy, Maheswar; Savic, Miloje; Sawhney, Monika; Schneider, Ione J C; Schöttker, Ben; Schwebel, David C.; Seedat, Soraya; Sepanlou, Sadaf G.; Servan-Mori, Edson E.; Setegn, Tesfaye; Shahraz, Saeid; Shaikh, Masood Ali; Shakh-Nazarova, Marina; Sharma, Rajesh; She, Jun; Sheikhbahaei, Sara; Shen, Jiabin; Sheth, Kevin N.; Shibuya, Kenji; Shin, Hwashin Hyun; Shin, Min Jeong; Shiri, Rahman; Shuie, Ivy; Sigfusdottir, Inga Dora; Silva, Diego Augusto Santos; Silverberg, Jonathan; Simard, Edgar P.; Sindi, Shireen; Singh, Abhishek; Singh, Jasvinder A.; Singh, Om Prakash; Singh, Prashant Kumar; Singh, Virendra; Soriano, Joan B.; Soshnikov, Sergey; Sposato, Luciano A.; Sreeramareddy, Chandrashekhar T.; Stathopoulou, Vasiliki; Steel, Nicholas; Stroumpoulis, Konstantinos; Sturua, Lela; Sunguya, Bruno F.; Swaminathan, Soumya; Sykes, Bryan L.; Szoeke, Cassandra E I; Tabarés-Seisdedos, Rafael; Tavakkoli, Mohammad; Taye, Bineyam; Tedla, Bemnet Amare; Tefera, Worku Mekonnen; Tekle, Tesfaye; Shifa, Girma Temam; Terkawi, Abdullah Sulieman; Tesfay, Fisaha Haile; Tessema, Gizachew Assefa; Thapa, Kiran; Thomson, Alan J.; Thorne-Lyman, Andrew L.; Tobe-Gai, Ruoyan; Tonelli, Marcello; Topor-Madry, Roman; Topouzis, Fotis; Tran, Bach Xuan; Troeger, Christopher; Truelsen, Thomas; Dimbuene, Zacharie Tsala; Tura, Abera Kenay; Tyrovolas, Stefanos; Ukwaja, Kingsley N.; Uneke, Chigozie Jesse; Uthman, Olalekan A.; Vaezghasemi, Masoud; Vasankari, Tommi; Vasconcelos, Ana Maria Nogales; Venketasubramanian, Narayanaswamy; Verma, Raj Kumar; Violante, Francesco S.; Vladimirov, Sergey K.; Vlassov, Vasiliy Victorovich; Vollset, Stein Emil; Wang, Linhong; Wang, Yanping; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G.; Weiss, Daniel J.; Werdecker, Andrea; Westerman, Ronny; Widdowson, Marc Alain; Wijeratne, Tissa; Williams, Thomas Neil; Wiysonge, Charles Shey; Wolfe, Charles D A; Wolfe, Ingrid; Won, Sungho; Wubshet, Mamo; Xiao, Qingyang; Xu, Gelin; Yadav, Ajit Kumar; Yakob, Bereket; Yano, Yuichiro; Yaseri, Mehdi; Ye, Pengpeng; Yebyo, Henock Gebremedhin; Yip, Paul; Yonemoto, Naohiro; Yoon, Seok Jun; Younis, Mustafa Z.; Yu, Chuanhua; Zaidi, Zoubida; Zaki, Maysaa El Sayed; Zeeb, Hajo; Zhang, Hao; Zhao, Yong; Zheng, Yingfeng; Zhou, Maigeng; Zodpey, Sanjay; Murray, Christopher J L.
In: The Lancet, Vol. 388, No. 10053, 08.10.2016, p. 1725-1774.Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015
T2 - a systematic analysis for the Global Burden of Disease Study 2015
AU - Wang, Haidong
AU - Bhutta, Zulfiqar A.
AU - Coates, Matthew M.
AU - Coggeshall, Megan
AU - Dandona, Lalit
AU - Diallo, Khassoum
AU - Franca, Elisabeth Barboza
AU - Fraser, Maya
AU - Fullman, Nancy
AU - Gething, Peter W.
AU - Hay, Simon I.
AU - Kinfu, Yohannes
AU - Kita, Maaya
AU - Kulikoff, Xie Rachel
AU - Larson, Heidi J.
AU - Liang, Juan
AU - Liang, Xiaofeng
AU - Lind, Margaret
AU - Lopez, Alan D.
AU - Lozano, Rafael
AU - Mensah, George A.
AU - Mikesell, Joseph B.
AU - Mokdad, Ali H.
AU - Mooney, Meghan D.
AU - Nguyen, Grant
AU - Rakovac, Ivo
AU - Salomon, Joshua A.
AU - Silpakit, Naris
AU - Sligar, Amber
AU - Sorensen, Reed J D
AU - Vos, Theo
AU - Zhu, Jun
AU - Abajobir, Amanuel Alemu
AU - Abate, Kalkidan Hassen
AU - Abbas, Kaja M.
AU - Abd-Allah, Foad
AU - Abdulle, Abdishakur M.
AU - Abera, Semaw Ferede
AU - Aboyans, Victor
AU - Abraham, Biju
AU - Abubakar, Ibrahim
AU - Abu-Raddad, Laith J.
AU - Abu-Rmeileh, Niveen M E
AU - Abyu, Gebre Yitayih
AU - Achoki, Tom
AU - Adebiyi, Akindele Olupelumi
AU - Adedeji, Isaac Akinkunmi
AU - Adelekan, Ademola Lukman
AU - Adou, Arsène Kouablan
AU - Agarwal, Arnav
AU - Ajala, Oluremi N.
AU - Akinyemiju, Tomi F.
AU - Akseer, Nadia
AU - Alam, Khurshid
AU - Alam, Noore K M
AU - Alasfoor, Deena
AU - Aldridge, Robert William
AU - Alegretti, Miguel Angel
AU - Alemu, Zewdie Aderaw
AU - Ali, Raghib
AU - Alkerwi, Ala'a
AU - Alla, François
AU - Al-Raddadi, Rajaa
AU - Alsharif, Ubai
AU - Altirkawi, Khalid A.
AU - Martin, Elena Alvarez
AU - Alvis-Guzman, Nelson
AU - Amare, Azmeraw T.
AU - Amberbir, Alemayehu
AU - Amegah, Adeladza Kofi
AU - Ameh, Emmanuel A.
AU - Ammar, Walid
AU - Amrock, Stephen Marc
AU - Andersen, Hjalte H.
AU - Anderson, Gregory M.
AU - Antonio, Carl Abelardo T
AU - Ärnlöv, Johan
AU - Artaman, Al
AU - Asayesh, Hamid
AU - Asghar, Rana Jawad
AU - Assadi, Reza
AU - Atique, Suleman
AU - Avokpaho, Euripide Frinel G Arthur
AU - Awasthi, Ashish
AU - Quintanilla, Beatriz Paulina Ayala
AU - Bacha, Umar
AU - Badawi, Alaa
AU - Balakrishnan, Kalpana
AU - Banerjee, Amitava
AU - Banigbe, Bolanle F.
AU - Barac, Aleksandra
AU - Barber, Ryan M.
AU - Barker-Collo, Suzanne L.
AU - Bärnighausen, Till
AU - Barrero, Lope H.
AU - Bayou, Tigist Assefa
AU - Bayou, Yibeltal Tebekaw
AU - Bazargan-Hejazi, Shahrzad
AU - Beardsley, Justin
AU - Bedi, Neeraj
AU - Bekele, Tolesa
AU - Bell, Michelle L.
AU - Bello, Aminu K.
AU - Bennett, Derrick A.
AU - Bensenor, Isabela M.
AU - Berhane, Adugnaw
AU - Bernabé, Eduardo
AU - Betsu, Balem Demtsu
AU - Bhatt, Samir
AU - Biadgilign, Sibhatu
AU - Bikbov, Boris
AU - Birlik, Sait Mentes
AU - Bisanzio, Donal
AU - Bjertness, Espen
AU - Blore, Jed D.
AU - Bourne, Rupert R A
AU - Brainin, Michael
AU - Brazinova, Alexandra
AU - Breitborde, Nicholas J K
AU - Brown, Alexandria
AU - Buckle, Geoffrey Colin
AU - Burch, Michael
AU - Butt, Zahid A.
AU - Campos-Nonato, Ismael Ricardo
AU - Campuzano, Julio Cesar
AU - Cárdenas, Rosario
AU - Carpenter, David O.
AU - Carrero, Juan Jesus
AU - Carter, Austin
AU - Casey, Daniel C.
AU - Castañeda-Orjuela, Carlos A.
AU - Rivas, Jacqueline Castillo
AU - Castro, Ruben Estanislao
AU - Catalá-López, Ferrán
AU - Cercy, Kelly
AU - Chang, Hsing Yi
AU - Chang, Jung Chen
AU - Chibueze, Chioma Ezinne
AU - Chisumpa, Vesper Hichilombwe
AU - Choi, Jee Young Jasmine
AU - Chowdhury, Rajiv
AU - Christopher, Devasahayam Jesudas
AU - Ciobanu, Liliana G.
AU - Colquhoun, Samantha M.
AU - Cooper, Cyrus
AU - Cornaby, Leslie
AU - Damtew, Solomon Abrha
AU - Danawi, Hadi
AU - Dandona, Rakhi
AU - das Neves, José
AU - Davis, Adrian C.
AU - de Jager, Pieter
AU - De Leo, Diego
AU - Degenhardt, Louisa
AU - Deribe, Kebede
AU - Deribew, Amare
AU - Jarlais, Don C Des
AU - deVeber, Gabrielle A.
AU - Dharmaratne, Samath D.
AU - Dhillon, Preet K.
AU - Ding, Eric L.
AU - Doshi, Pratik Pinal
AU - Doyle, Kerrie E.
AU - Duan, Leilei
AU - Dubey, Manisha
AU - Ebrahimi, Hedyeh
AU - Ellingsen, Christian Lycke
AU - Elyazar, Iqbal
AU - Endries, Aman Yesuf
AU - Ermakov, Sergey Petrovich
AU - Eshrati, Babak
AU - Esteghamati, Alireza
AU - Faraon, Emerito Jose Aquino
AU - Farid, Talha A.
AU - Farinha, Carla Sofia e Sa
AU - Faro, André
AU - Farvid, Maryam S.
AU - Farzadfar, Farshad
AU - Fereshtehnejad, Seyed Mohammad
AU - Fernandes, Joao C.
AU - Fischer, Florian
AU - Fitchett, Joseph R A
AU - Foigt, Nataliya
AU - Franklin, Richard C.
AU - Friedman, Joseph
AU - Fürst, Thomas
AU - Gambashidze, Ketevan
AU - Gamkrelidze, Amiran
AU - Ganguly, Parthasarathi
AU - Gebre, Teshome
AU - Gebrehiwot, Tsegaye Tewelde
AU - Gebremedhin, Amanuel Tesfay
AU - Gebru, Alemseged Aregay
AU - Geleijnse, Johanna M.
AU - Gessner, Bradford D.
AU - Ginawi, Ibrahim Abdelmageem Mohamed
AU - Giref, Ababi Zergaw
AU - Gishu, Melkamu Dedefo
AU - Gomez-Dantes, Hector
AU - Gona, Philimon
AU - Goodridge, Amador
AU - Gopalani, Sameer Vali
AU - Goto, Atsushi
AU - Gouda, Hebe N.
AU - Gugnani, Harish Chander
AU - Guo, Yuming
AU - Gupta, Rahul
AU - Gupta, Rajeev
AU - Gupta, Vipin
AU - Gyawali, Bishal
AU - Haagsma, Juanita A.
AU - Hafezi-Nejad, Nima
AU - Haile, Demewoz
AU - Hailu, Alemayehu Desalegne
AU - Hailu, Gessessew Bugssa
AU - Hamadeh, Randah Ribhi
AU - Hancock, Jamie
AU - Handal, Alexis J.
AU - Hankey, Graeme J.
AU - Harb, Hilda L.
AU - Harikrishnan, Sivadasanpillai
AU - Harun, Kimani M.
AU - Havmoeller, Rasmus
AU - Hay, Roderick J.
AU - Heredia-Pi, Ileana Beatriz
AU - Hoek, Hans W.
AU - Horino, Masako
AU - Horita, Nobuyuki
AU - Hosgood, H. Dean
AU - Hotez, Peter J.
AU - Hoy, Damian G.
AU - Hsairi, Mohamed
AU - Hu, Guoqing
AU - Huang, Cheng
AU - Huang, John J.
AU - Huang, Hsiang
AU - Huiart, Laetitia
AU - Iburg, Kim Moesgaard
AU - Idrisov, Bulat T.
AU - Innos, Kaire
AU - Jacobsen, Kathryn H.
AU - Jahanmehr, Nader
AU - Javanbakht, Mehdi
AU - Jayatilleke, Achala Upendra
AU - Jee, Sun Ha
AU - Jeemon, Panniyammakal
AU - Jha, Vivekanand
AU - Jiang, Guohong
AU - Jiang, Ying
AU - Jibat, Tariku
AU - Jin, Ye
AU - Jonas, Jost B.
AU - Kabir, Zubair
AU - Kalkonde, Yogeshwar
AU - Kamal, Ritul
AU - Kan, Haidong
AU - Kang, Gagandeep
AU - Karch, André
AU - Karema, Corine Kakizi
AU - Kasaeian, Amir
AU - Kaul, Anil
AU - Kawakami, Norito
AU - Kayibanda, Jeanne Françoise
AU - Kazanjan, Konstantin
AU - Keiyoro, Peter Njenga
AU - Kemp, Andrew Haddon
AU - Kengne, Andre Pascal
AU - Keren, Andre
AU - Kereselidze, Maia
AU - Kesavachandran, Chandrasekharan Nair
AU - Khader, Yousef Saleh
AU - Khalil, Ibrahim A.
AU - Khan, Abdur Rahman
AU - Khan, Ejaz Ahmad
AU - Khang, Young Ho
AU - Khonelidze, Irma
AU - Khubchandani, Jagdish
AU - Kim, Cho il
AU - Kim, Daniel
AU - Kim, Yun Jin
AU - Kissoon, Niranjan
AU - Kivipelto, Miia
AU - Knibbs, Luke D.
AU - Kokubo, Yoshihiro
AU - Kosen, Soewarta
AU - Koul, Parvaiz A.
AU - Koyanagi, Ai
AU - Defo, Barthelemy Kuate
AU - Bicer, Burcu Kucuk
AU - Kudom, Andreas A.
AU - Kumar, G. Anil
AU - Kyu, Hmwe H.
AU - Lal, Dharmesh Kumar
AU - Lalloo, Ratilal
AU - Lam, Hilton
AU - Lam, Jennifer O.
AU - Lansingh, Van C.
AU - Larsson, Anders
AU - Leigh, James
AU - Leung, Ricky
AU - Li, Yichong
AU - Li, Yongmei
AU - Lindsay, M. Patrice
AU - Liu, Patrick Y.
AU - Liu, Shiwei
AU - Lloyd, Belinda K.
AU - Lo, Warren D.
AU - Logroscino, Giancarlo
AU - Low, Nicola
AU - Lunevicius, Raimundas
AU - Lyons, Ronan A.
AU - Ma, Stefan
AU - Razek, Hassan Magdy Abd El
AU - Razek, Mohammed Magdy Abd El
AU - Mahdavi, Mahdi
AU - Majdan, Marek
AU - Majeed, Azeem
AU - Malekzadeh, Reza
AU - Mapoma, Chabila C.
AU - Marcenes, Wagner
AU - Martinez-Raga, Jose
AU - Marzan, Melvin Barrientos
AU - Masiye, Felix
AU - McGrath, John J.
AU - Meaney, Peter A.
AU - Mehari, Alem
AU - Mehndiratta, Man Mohan
AU - Mekonnen, Alemayehu B.
AU - Melaku, Yohannes Adama
AU - Memiah, Peter
AU - Memish, Ziad A.
AU - Mendoza, Walter
AU - Meretoja, Atte
AU - Meretoja, Tuomo J.
AU - Mhimbira, Francis Apolinary
AU - Miller, Ted R.
AU - Mills, Edward J.
AU - Mirarefin, Mojde
AU - Misganaw, Awoke
AU - Mock, Charles N.
AU - Mohammad, Karzan Abdulmuhsin
AU - Mohammadi, Alireza
AU - Mohammed, Shafiu
AU - Monasta, Lorenzo
AU - Hernandez, Julio Cesar Montañez
AU - Montico, Marcella
AU - Moore, Ami R.
AU - Moradi-Lakeh, Maziar
AU - Morawska, Lidia
AU - Mori, Rintaro
AU - Mueller, Ulrich O.
AU - Murphy, Georgina A V
AU - Murthy, Srinivas
AU - Nachega, Jean B.
AU - Naheed, Aliya
AU - Naidoo, Kovin S.
AU - Naldi, Luigi
AU - Nand, Devina
AU - Nangia, Vinay
AU - Neupane, Subas
AU - Newton, Charles R.
AU - Newton, John N.
AU - Ng, Marie
AU - Ngalesoni, Frida Namnyak
AU - Nguhiu, Peter
AU - Nguyen, Quyen Le
AU - Nisar, Muhammad Imran
AU - Pete, Patrick Martial Nkamedjie
AU - Norheim, Ole F.
AU - Norman, Rosana E.
AU - Ogbo, Felix Akpojene
AU - Oh, In Hwan
AU - Ojelabi, Foluke Adetola
AU - Olivares, Pedro R.
AU - Olusanya, Bolajoko Olubukunola
AU - Olusanya, Jacob Olusegun
AU - Oren, Eyal
AU - Ota, Erika
AU - PA, Mahesh
AU - Park, Eun Kee
AU - Park, Hye Youn
AU - Parsaeian, Mahboubeh
AU - Caicedo, Angel J Paternina
AU - Patten, Scott B.
AU - Pedro, João Mário
AU - Pereira, David M.
AU - Perico, Norberto
AU - Pesudovs, Konrad
AU - Petzold, Max
AU - Phillips, Michael Robert
AU - Pillay, Julian David
AU - Pishgar, Farhad
AU - Polinder, Suzanne
AU - Pope, Daniel
AU - Popova, Svetlana
AU - Pourmalek, Farshad
AU - Qorbani, Mostafa
AU - Rabiee, Rynaz H S
AU - Rafay, Anwar
AU - Rahimi-Movaghar, Vafa
AU - Rahman, Mahfuzar
AU - Rahman, Mohammad Hifz Ur
AU - Rahman, Sajjad Ur
AU - Rai, Rajesh Kumar
AU - Raju, Murugesan
AU - Ram, Usha
AU - Rana, Saleem M.
AU - Ranabhat, Chhabi Lal
AU - Rao, Puja
AU - Refaat, Amany H.
AU - Remuzzi, Giuseppe
AU - Resnikoff, Serge
AU - Reynolds, Alex
AU - Rojas-Rueda, David
AU - Ronfani, Luca
AU - Roshandel, Gholamreza
AU - Roth, Gregory A.
AU - Roy, Ambuj
AU - Ruhago, George Mugambage
AU - Sagar, Rajesh
AU - Saleh, Muhammad Muhammad
AU - Sanabria, Juan R.
AU - Sanchez-Niño, Maria Dolores
AU - Santos, Itamar S.
AU - Santos, João Vasco
AU - Sarmiento-Suarez, Rodrigo
AU - Sartorius, Benn
AU - Satpathy, Maheswar
AU - Savic, Miloje
AU - Sawhney, Monika
AU - Schneider, Ione J C
AU - Schöttker, Ben
AU - Schwebel, David C.
AU - Seedat, Soraya
AU - Sepanlou, Sadaf G.
AU - Servan-Mori, Edson E.
AU - Setegn, Tesfaye
AU - Shahraz, Saeid
AU - Shaikh, Masood Ali
AU - Shakh-Nazarova, Marina
AU - Sharma, Rajesh
AU - She, Jun
AU - Sheikhbahaei, Sara
AU - Shen, Jiabin
AU - Sheth, Kevin N.
AU - Shibuya, Kenji
AU - Shin, Hwashin Hyun
AU - Shin, Min Jeong
AU - Shiri, Rahman
AU - Shuie, Ivy
AU - Sigfusdottir, Inga Dora
AU - Silva, Diego Augusto Santos
AU - Silverberg, Jonathan
AU - Simard, Edgar P.
AU - Sindi, Shireen
AU - Singh, Abhishek
AU - Singh, Jasvinder A.
AU - Singh, Om Prakash
AU - Singh, Prashant Kumar
AU - Singh, Virendra
AU - Soriano, Joan B.
AU - Soshnikov, Sergey
AU - Sposato, Luciano A.
AU - Sreeramareddy, Chandrashekhar T.
AU - Stathopoulou, Vasiliki
AU - Steel, Nicholas
AU - Stroumpoulis, Konstantinos
AU - Sturua, Lela
AU - Sunguya, Bruno F.
AU - Swaminathan, Soumya
AU - Sykes, Bryan L.
AU - Szoeke, Cassandra E I
AU - Tabarés-Seisdedos, Rafael
AU - Tavakkoli, Mohammad
AU - Taye, Bineyam
AU - Tedla, Bemnet Amare
AU - Tefera, Worku Mekonnen
AU - Tekle, Tesfaye
AU - Shifa, Girma Temam
AU - Terkawi, Abdullah Sulieman
AU - Tesfay, Fisaha Haile
AU - Tessema, Gizachew Assefa
AU - Thapa, Kiran
AU - Thomson, Alan J.
AU - Thorne-Lyman, Andrew L.
AU - Tobe-Gai, Ruoyan
AU - Tonelli, Marcello
AU - Topor-Madry, Roman
AU - Topouzis, Fotis
AU - Tran, Bach Xuan
AU - Troeger, Christopher
AU - Truelsen, Thomas
AU - Dimbuene, Zacharie Tsala
AU - Tura, Abera Kenay
AU - Tyrovolas, Stefanos
AU - Ukwaja, Kingsley N.
AU - Uneke, Chigozie Jesse
AU - Uthman, Olalekan A.
AU - Vaezghasemi, Masoud
AU - Vasankari, Tommi
AU - Vasconcelos, Ana Maria Nogales
AU - Venketasubramanian, Narayanaswamy
AU - Verma, Raj Kumar
AU - Violante, Francesco S.
AU - Vladimirov, Sergey K.
AU - Vlassov, Vasiliy Victorovich
AU - Vollset, Stein Emil
AU - Wang, Linhong
AU - Wang, Yanping
AU - Weichenthal, Scott
AU - Weiderpass, Elisabete
AU - Weintraub, Robert G.
AU - Weiss, Daniel J.
AU - Werdecker, Andrea
AU - Westerman, Ronny
AU - Widdowson, Marc Alain
AU - Wijeratne, Tissa
AU - Williams, Thomas Neil
AU - Wiysonge, Charles Shey
AU - Wolfe, Charles D A
AU - Wolfe, Ingrid
AU - Won, Sungho
AU - Wubshet, Mamo
AU - Xiao, Qingyang
AU - Xu, Gelin
AU - Yadav, Ajit Kumar
AU - Yakob, Bereket
AU - Yano, Yuichiro
AU - Yaseri, Mehdi
AU - Ye, Pengpeng
AU - Yebyo, Henock Gebremedhin
AU - Yip, Paul
AU - Yonemoto, Naohiro
AU - Yoon, Seok Jun
AU - Younis, Mustafa Z.
AU - Yu, Chuanhua
AU - Zaidi, Zoubida
AU - Zaki, Maysaa El Sayed
AU - Zeeb, Hajo
AU - Zhang, Hao
AU - Zhao, Yong
AU - Zheng, Yingfeng
AU - Zhou, Maigeng
AU - Zodpey, Sanjay
AU - Murray, Christopher J L
N1 - Funding Information: We would like to thank the countless individuals who have contributed to the Global Burden of Disease Study 2015 in various capacities. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with licence number SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law, 2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data. The following individuals would like to acknowledge various forms of institutional support: Simon I Hay is funded by a Senior Research Fellowship from the Wellcome Trust (#095066), and grants from the Bill & Melinda Gates Foundation (OPP1119467, OPP1093011, OPP1106023 and OPP1132415). Panniyammakal Jeemon is supported by a clinical and public health intermediate fellowship from the Wellcome Trust-DBT India Alliance (2015–2020). Boris Bikbov, Giuseppe Remuzzi, and Norberto Perico acknowledges that work related to this paper has been done on the behalf of the GBD Genitourinary Disease Expert Group supported by the International Society of Nephrology (ISN). Samir Bhatt would like to acknowledge the support of Department of infectious disease and Epidemiology Imperial College London London, W2 1PG, UK. Ana Maria Nogales Vasconcelos would like to inform that her team in Brazil received funding from Ministry of Health—process number: 25000192049/2014-14. Rodrigo Sarmiento-Suarez receives institutional support from Universidad de Ciencias Aplicadas y Ambientales, UDCA, Bogotá Colombia. Amador Goodridge would like to acknowledge funding for me from Sistema Nacional de Investigadores de Panamá-SNI. José das Neves was supported in his contribution to this work by a Fellowship from Fundação para a Ciência e a Tecnologia, Portugal (SFRH/BPD/92934/2013). Rodrigo Sarmiento-Suarez receives institutional support from Universidad de Ciencias Aplicadas y Ambientales, UDCA, Bogotá, Colombia. Ulrich O Mueller gratefully acknowledges funding by the German National Cohort Consortium (O1ER1511D). No individuals acknowledged received additional compensation for their efforts. Funding Information: Itamar S Santos reports grants from FAPESP (Brazilian public agency), outside the submitted work. Carl Abelardo T Antonio reports grants, personal fees and non-financial support from Johnson & Johnson (Philippines), Inc, outside the submitted work. Ferrán Catalá-López is supported in part by grant PROMETEOII/2015/021 from Generalitat Valenciana. Walter Mendoza is currently employed by the Peru Country Office of the United Nations Population Fund, an institution which does not necessarily endorse this study. Jasvinder A Singh has received research grants from Takeda and Savient and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology; he serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA, Inc, a 501 (c)(3) entity; is a member of the executive of OMERACT, an organisation that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee (AMPC); Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. Ai Koyanagi's work is supported by the Miguel Servet contract financed by the CP13/00150 and PI15/00862 projects, integrated into the National R + D + I and funded by the ISCIII—General Branch Evaluation and Promotion of Health Research—and the European Regional Development Fund (ERDF-FEDER). Donal Bisanzio is supported by Bill & Melinda Gates Foundation (#OPP1068048). Kebede Deribe is supported by a Wellcome Trust Fellowship in Public Health and Tropical Medicine (grant number 099876). Thomas Fürst has received financial support from the Swiss National Science Foundation (SNSF; project no P300P3-154634). Jost B Jonas reports personal fees from Consultant for Mundipharma Co (Cambridge, UK); other from patent application with University of Heidelberg (Heidelberg, Germany) (title: Agents for use in the therapeutic or prophylactic treatment of myopia or hyperopia; Europäische Patentanmeldung 15 000 771.4), and other from patent holder with Biocompatibles UK Ltd. (Franham, Surrey, UK) (title: Treatment of eye diseases using encapsulated cells encoding and secreting neuroprotective factor and/or anti-angiogenic factor; patent number: 20120263794), outside the submitted work. Stefanos Tyrovolas's work is supported by the Foundation for Education and European Culture (IPEP), the Sara Borrell postdoctoral programme (reference number CD15/00019 from the Instituto de Salud Carlos III (ISCIII, Spain) and the Fondos Europeo de Desarrollo Regional (FEDER). Yogeshwar Kalkonde is a Wellcome Trust/DBT Intermediate Fellow in Public Health. Sun Ha Jee has been funded by a grant of the Korean Health Technology R&D project (HI14C2686), Korea. Miia Kivipelto receives research support from the Academy of Finland, the Swedish Research Council, Alzheimerfonden, Alzheimer's Research & Prevention Foundation, Center for Innovative Medicine (CIMED) at Karolinska Institutet South Campus, AXA Research Fund and the Sheika Salama Bint Hamdan Al Nahyan Foundation. Shireen Sindi receives postdoctoral funding from the Fonds de la recherche en santé du Québec (FRSQ), including its renewal. Charles D A Wolfe's research was funded/supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The other authors declare no competing interests. Publisher Copyright: © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license.
PY - 2016/10/8
Y1 - 2016/10/8
N2 - 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. Funding Bill & Melinda Gates Foundation.
AB - 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. Funding Bill & Melinda Gates Foundation.
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U2 - 10.1016/S0140-6736(16)31575-6
DO - 10.1016/S0140-6736(16)31575-6
M3 - Article
C2 - 27733285
AN - SCOPUS:84994071373
VL - 388
SP - 1725
EP - 1774
JO - The Lancet
JF - The Lancet
SN - 0140-6736
IS - 10053
ER -