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Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation.
Lancet. 2015 Dec 05; 386(10010):2275-86.Lct

Abstract

BACKGROUND

In 2000, world leaders agreed on the Millennium Development Goals (MDGs). MDG 4 called for a two-thirds reduction in the under-5 mortality rate between 1990 and 2015. We aimed to estimate levels and trends in under-5 mortality for 195 countries from 1990 to 2015 to assess MDG 4 achievement and then intended to project how various post-2015 targets and observed rates of change will affect the burden of under-5 deaths from 2016 to 2030.

METHODS

We updated the UN Inter-agency Group for Child Mortality Estimation (UN IGME) database with 5700 country-year datapoints. As of July, 2015, the database contains about 17 000 country-year datapoints for mortality of children younger than 5 years for 195 countries, and includes all available nationally-representative data from vital registration systems, population censuses, household surveys, and sample registration systems. We used these data to generate estimates, with uncertainty intervals, of under-5 (age 0-4 years) mortality using a Bayesian B-spline bias-reduction model (B3 model). This model includes a data model to adjust for systematic biases associated with different types of data sources. To provide insights into the global and regional burden of under-5 deaths associated with post-2015 targets, we constructed five scenario-based projections for under-5 mortality from 2016 to 2030 and estimated national, regional, and global under-5 mortality rates up to 2030 for each scenario.

RESULTS

The global under-5 mortality rate has fallen from 90·6 deaths per 1000 livebirths (90% uncertainty interval 89·3-92·2) in 1990 to 42·5 (40·9-45·6) in 2015. During the same period, the annual number of under-5 deaths worldwide dropped from 12·7 million (12·6 million-13·0 million) to 5·9 million (5·7 million-6·4 million). The global under-5 mortality rate reduced by 53% (50-55%) in the past 25 years and therefore missed the MDG 4 target. Based on point estimates, two regions-east Asia and the Pacific, and Latin America and the Caribbean-achieved the MDG 4 target. 62 countries achieved the MDG 4 target, of which 24 were low-income and lower-middle income countries. Between 2016 and 2030, 94·4 million children are projected to die before the age of 5 years if the 2015 mortality rate remains constant in each country, and 68·8 million would die if each country continues to reduce its mortality rate at the pace estimated from 2000 to 2015. If all countries achieve the Sustainable Development Goal of an under-5 mortality rate of 25 or fewer deaths per 1000 livebirths by 2030, we project 56·0 million deaths by 2030. About two-thirds of all sub-Saharan African countries need to accelerate progress to achieve this target.

INTERPRETATION

Despite substantial progress in reducing child mortality, concerted efforts remain necessary to avoid preventable under-5 deaths in the coming years and to accelerate progress in improving child survival further. Urgent actions are needed most in the regions and countries with high under-5 mortality rates, particularly those in sub-Saharan Africa and south Asia.

FUNDING

None.

Authors+Show Affiliations

Division of Data, Research, and Policy, UNICEF, New York, NY, USA. Electronic address: dyou@unicef.org.Division of Data, Research, and Policy, UNICEF, New York, NY, USA.Division of Data, Research, and Policy, UNICEF, New York, NY, USA.Division of Data, Research, and Policy, UNICEF, New York, NY, USA.WHO, Geneva, Switzerland.WHO, Geneva, Switzerland.United Nations Population Division, New York, NY, USA.University of California, Berkeley, CA, USA.Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26361942

Citation

You, Danzhen, et al. "Global, Regional, and National Levels and Trends in Under-5 Mortality Between 1990 and 2015, With Scenario-based Projections to 2030: a Systematic Analysis By the UN Inter-agency Group for Child Mortality Estimation." Lancet (London, England), vol. 386, no. 10010, 2015, pp. 2275-86.
You D, Hug L, Ejdemyr S, et al. Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet. 2015;386(10010):2275-86.
You, D., Hug, L., Ejdemyr, S., Idele, P., Hogan, D., Mathers, C., Gerland, P., New, J. R., & Alkema, L. (2015). Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet (London, England), 386(10010), 2275-86. https://doi.org/10.1016/S0140-6736(15)00120-8
You D, et al. Global, Regional, and National Levels and Trends in Under-5 Mortality Between 1990 and 2015, With Scenario-based Projections to 2030: a Systematic Analysis By the UN Inter-agency Group for Child Mortality Estimation. Lancet. 2015 Dec 5;386(10010):2275-86. PubMed PMID: 26361942.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. AU - You,Danzhen, AU - Hug,Lucia, AU - Ejdemyr,Simon, AU - Idele,Priscila, AU - Hogan,Daniel, AU - Mathers,Colin, AU - Gerland,Patrick, AU - New,Jin Rou, AU - Alkema,Leontine, AU - ,, Y1 - 2015/09/08/ PY - 2015/9/13/entrez PY - 2015/9/13/pubmed PY - 2016/1/5/medline SP - 2275 EP - 86 JF - Lancet (London, England) JO - Lancet VL - 386 IS - 10010 N2 - BACKGROUND: In 2000, world leaders agreed on the Millennium Development Goals (MDGs). MDG 4 called for a two-thirds reduction in the under-5 mortality rate between 1990 and 2015. We aimed to estimate levels and trends in under-5 mortality for 195 countries from 1990 to 2015 to assess MDG 4 achievement and then intended to project how various post-2015 targets and observed rates of change will affect the burden of under-5 deaths from 2016 to 2030. METHODS: We updated the UN Inter-agency Group for Child Mortality Estimation (UN IGME) database with 5700 country-year datapoints. As of July, 2015, the database contains about 17 000 country-year datapoints for mortality of children younger than 5 years for 195 countries, and includes all available nationally-representative data from vital registration systems, population censuses, household surveys, and sample registration systems. We used these data to generate estimates, with uncertainty intervals, of under-5 (age 0-4 years) mortality using a Bayesian B-spline bias-reduction model (B3 model). This model includes a data model to adjust for systematic biases associated with different types of data sources. To provide insights into the global and regional burden of under-5 deaths associated with post-2015 targets, we constructed five scenario-based projections for under-5 mortality from 2016 to 2030 and estimated national, regional, and global under-5 mortality rates up to 2030 for each scenario. RESULTS: The global under-5 mortality rate has fallen from 90·6 deaths per 1000 livebirths (90% uncertainty interval 89·3-92·2) in 1990 to 42·5 (40·9-45·6) in 2015. During the same period, the annual number of under-5 deaths worldwide dropped from 12·7 million (12·6 million-13·0 million) to 5·9 million (5·7 million-6·4 million). The global under-5 mortality rate reduced by 53% (50-55%) in the past 25 years and therefore missed the MDG 4 target. Based on point estimates, two regions-east Asia and the Pacific, and Latin America and the Caribbean-achieved the MDG 4 target. 62 countries achieved the MDG 4 target, of which 24 were low-income and lower-middle income countries. Between 2016 and 2030, 94·4 million children are projected to die before the age of 5 years if the 2015 mortality rate remains constant in each country, and 68·8 million would die if each country continues to reduce its mortality rate at the pace estimated from 2000 to 2015. If all countries achieve the Sustainable Development Goal of an under-5 mortality rate of 25 or fewer deaths per 1000 livebirths by 2030, we project 56·0 million deaths by 2030. About two-thirds of all sub-Saharan African countries need to accelerate progress to achieve this target. INTERPRETATION: Despite substantial progress in reducing child mortality, concerted efforts remain necessary to avoid preventable under-5 deaths in the coming years and to accelerate progress in improving child survival further. Urgent actions are needed most in the regions and countries with high under-5 mortality rates, particularly those in sub-Saharan Africa and south Asia. FUNDING: None. SN - 1474-547X UR - https://www.unboundmedicine.com/medline/citation/26361942/Global_regional_and_national_levels_and_trends_in_under_5_mortality_between_1990_and_2015_with_scenario_based_projections_to_2030:_a_systematic_analysis_by_the_UN_Inter_agency_Group_for_Child_Mortality_Estimation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(15)00120-8 DB - PRIME DP - Unbound Medicine ER -