PHM-Exch> The Lancet: Child mortality and MDG4

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crossposted from: EQUIDAD at listserv.paho.org


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

*
*Julie Knoll Rajaratnam PhD a, Jake R Marcus BA a, Abraham D Flaxman PhD a,
Haidong Wang PhD a, Alison Levin-Rector BSPH a, Laura Dwyer BA a, Megan
Costa BA a, Prof Alan D Lopez PhD b, Prof Christopher JL Murray MD a
a Institute for Health Metrics and Evaluation, University of Washington,
Seattle, WA, USA

b School of Population Health, University of Queensland, Brisbane, QLD,
Australia

*The Lancet, Early Online Publication, 24 May 2010 -- *
doi:10.1016/S0140-6736(10)60703-9

Website: http://bit.ly/cAXevh

“….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.



*Supplementary webappendix*

*PDF
<http://download.thelancet.com/mmcs/journals/lancet/PIIS0140673610607039/mmc1.pdf?id=4d037fefcb72946c:1d94ae93:128d01481a2:7d301274806800829>
(4163K)*
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