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

Collaborators, GBD 2015 Child Mortality and Wang, H. and Coates, M.M. and Coggeshall, M. and Dandona, L. and Fraser, M. and Fullman, N. and Hay, S.I. and Huynh, C. and Kulikoff, X.R. and Kutz, M.J. and Larson, H.J. and Lim, S.S. and Lind, M. and Lopez, A.D. and Mikesell, J.B. and Mokdad, A.H. and Mooney, M.D. and Naghavi, M. and Nguyen, G. and Silpakit, N. and Sligar, A. and Sorensen, R.J.D. and Vos, T. and Achoki, T. and Anderson, G.M. and Barber, R.M. and Blore, J.D. and Brown, A. and Carter, A. and Casey, D.C. and Cercy, K. and Cornaby, L. and Friedman, J. and Haagsma, J.A. and Hancock, J. and Khalil, I.A. and Kyu, H.H. and Liu, P.Y. and Masiye, F. and Mirarefin, M. and Misganaw, A. and Moradi-Lakeh, M. and Ng, M. and Rao, P. and Reynolds, A. and Roth, G.A. and Troeger, C. and Vollset, S.E. and Zhou, M. and Murray, C.J.L. and Mock, C.N. and Harun, K.M. and Bhutta, Z.A. and Nisar, M.I. and Akseer, N. and deVeber, G.A. and Jeemon, P. and Dandona, R. and Kumar, G.A. and Diallo, K. and Rakovac, I. and Franca, E.B. and Hay, S.I. and Gething, P.W. and Bisanzio, D. and Deribew, A. and Cooper, C. and Ali, R. and Bennett, D.A. and Jha, V. and Murphy, G.A.V. and Weiss, D.J. and Kinfu, Y. and Kawakami, N. and Kita, M. and Shibuya, K. and Liang, J. and Duan, L. and Jin, Y. and Li, Y. and Liu, S. and Wang, L. and Ye, P. and Liang, X. and Alam, K. and Colquhoun, S.M. and Weintraub, R.G. and Meretoja, A. and Szoeke, C.E.I. and Wijeratne, T. and Lozano, R. and Campos-Nonato, I.R. and Campuzano, J.C. and Gomez-Dantes, H. and Heredia-Pi, I.B. and Montañez Hernandez, J.C. and Servan-Mori, E.E. and Mensah, G.A. and Salomon, J.A. and Thorne-Lyman, A.L. and Ajala, O.N. and Bärnighausen, T. and Ding, E.L. and Farvid, M.S. and Fitchett, J.R.A. and Zhu, J. and Abajobir, A.A. and Knibbs, L.D. and Lalloo, R. and Gouda, H.N. and Guo, Y. and McGrath, J.J. and Abate, K.H. and Gebrehiwot, T.T. and Gebremedhin, A.T. and Abbas, K.M. and Abd-Allah, F. and Abdulle, A.M. and Melaku, Y.A. and Abera, S.F. and Tesfay, F.H. and Abyu, G.Y. and Bayou, T.A. and Betsu, B.D. and Gebru, A.A. and Hailu, G.B. and Tekle, T. and Yebyo, H.G. and Aboyans, V. and Abraham, B. and Abubakar, I. and Aldridge, R.W. and Banerjee, A. and Abu-Raddad, L.J. and Abu-Rmeileh, N.M. and Adebiyi, A.O. and Adelekan, A.L. and Ojelabi, F.A. and Adedeji, I.A. and Adou, A.K. and Badawi, A. and Lindsay, M.P. and Popova, S. and Agarwal, A. and Akinyemiju, T.F. and Schwebel, D.C. and Singh, J.A. and Leigh, J. and Mekonnen, A.B. and Alam, N.K.M. and Alasfoor, D. and Alegretti, M.A. and Alemu, Z.A. and Alkerwi, A. and Alla, F. and Al-Raddadi, R. and Alsharif, U. and Altirkawi, K.A. and Alvarez Martin, E. and Alvis-Guzman, N. and Amare, A.T. and Ciobanu, L.G. and Tessema, G.A. and Setegn, T. and Amberbir, A. and Amegah, A.K. and Kudom, A.A. and Ameh, E.A. and Ammar, W. and Harb, H.L. and Amrock, S.M. and Andersen, H.H. and Antonio, C.A.T. and Faraon, E.J.A. and �rnlöv, J. and Larsson, A. and Artaman, A. and Asayesh, H. and Asghar, R.J. and Assadi, R. and Atique, S. and Avokpaho, E.F.G.A. and Awasthi, A. and Ayala Quintanilla, B.P. and Bacha, U. and Balakrishnan, K. and Banigbe, B.F. and Barac, A. and Barker-Collo, S.L. and Mohammed, S. and Barrero, L.H. and Bayou, Y.T. and Bazargan-Hejazi, S. and Beardsley, J. and Bedi, N. and Bekele, T. and Sheth, K.N. and Bell, M.L. and Huang, J.J. and Bello, A.K. and Santos, I.S. and Bensenor, I.M. and Berhane, A. and Wolfe, C.D. and Bernabé, E. and Hay, R.J. and Wolfe, I. and Fürst, T. and Bhatt, S. and Majeed, A. and Williams, T.N. and Biadgilign, S. and Bikbov, B. and Birlik, S.M. and Bjertness, E. and Bourne, R.R.A. and Brainin, M. and Brazinova, A. and Majdan, M. and Lo, W.D. and Shen, J. and Breitborde, N.J.K. and Buckle, G.C. and Burch, M. and Butt, Z.A. and Cárdenas, R. and Carpenter, D.O. and Carrero, J.J. and Fereshtehnejad, S.M. and Kivipelto, M. and Rabiee, R.H.S. and Weiderpass, E. and Havmoeller, R. and Sindi, S. and Castañeda-Orjuela, C.A. and Castillo Rivas, J. and Castro, R.E. and Catalá-López, F. and Chang, H. and Chang, J. and Chibueze, C.E. and Chisumpa, V.H. and Mapoma, C.C. and Choi, J.J. and Chowdhury, R. and Christopher, D.J. and Kang, G. and Damtew, S.A. and Deribe, K. and Hailu, A.D. and Tefera, W. and Giref, A.Z. and Haile, D. and Jibat, T. and Temam Shifa, G. and Danawi, H. and Refaat, A.H. and das Neves, J. and Pedro, J.M. and Santos, J.V. and Davis, A.C. and Newton, J.N. and Steel, N. and de Jager, P. and Petzold, M. and De Leo, D. and Degenhardt, L. and Resnikoff, S. and Des Jarlais, D.C. and Dharmaratne, S.D. and Dhillon, P.K. and Ganguly, P. and Lal, D.K. and Zodpey, S. and Doshi, P.P. and Doyle, K.E. and Dubey, M. and Rahman, M.H.U. and Ram, U. and Singh, A. and Verma, R.K. and Yadav, A.K. and Ebrahimi, H. and Farzadfar, F. and Kasaeian, A. and Parsaeian, M. and Pishgar, F. and Esteghamati, A. and Hafezi-Nejad, N. and Sheikhbahaei, S. and Malekzadeh, R. and Roshandel, G. and Sepanlou, S.G. and Rahimi-Movaghar, V. and Yaseri, M. and Ellingsen, C.L. and Savic, M. and Elyazar, I. and Endries, A.Y. and Ermakov, S.P. and Soshnikov, S. and Eshrati, B. and Farid, T.A. and Khan, A.R. and Farinha, C.S.E.S. and Faro, A. and Fernandes, J.C. and Fischer, F. and Foigt, N. and Franklin, R.C. and Karema, C.K. and Gambashidze, K. and Gamkrelidze, A. and Kazanjan, K. and Kereselidze, M. and Khonelidze, I. and Shakh-Nazarova, M. and Sturua, L. and Gebre, T. and Geleijnse, J.M. and Gessner, B.D. and Ginawi, I.A. and Beyene, A.S. and Gishu, M.D. and Tura, A.K. and Gona, P. and Goodridge, A. and Gopalani, S.V. and Goto, A. and Gugnani, H.C. and Gupta, R. and Gupta, R. and Gupta, V. and Gyawali, B. and Iburg, K.M. and Norheim, O.F. and Hamadeh, R.R. and Hamidi, S. and Handal, A.J. and Hankey, G.J. and Harikrishnan, S. and Hoek, H.W. and Horino, M. and Horita, N. and Hosgood, H.D. and Hotez, P.J. and Hoy, D.G. and Hsairi, M. and Hu, G. and Huang, C. and Huang, H. and Huiart, L. and Idrisov, B.T. and Innos, K. and Jacobsen, K.H. and Jahanmehr, N. and Javanbakht, M. and Jayatilleke, A.U. and Jee, S.H. and Jiang, G. and Jiang, Y. and Jonas, J.B. and Kabir, Z. and Kalkonde, Y. and Kamal, R. and Kesavachandran, C.N. and She, J. and Zhang, H. and Kan, H. and Karch, A. and Kaul, A. and Kayibanda, J.F. and Keiyoro, P.N. and Lyons, R.A. and Kemp, A.H. and Kengne, A.P. and Wiysonge, C.S. and Keren, A. and Khader, Y.S. and Khan, E.A. and Khang, Y.H. and Won, S. and Khubchandani, J. and Kim, C. and Kim, D. and Kim, Y.J. and Kissoon, N. and Murthy, S. and Pourmalek, F. and Kokubo, Y. and Kosen, S. and Koul, P.A. and Koyanagi, A. and Kuate Defo, B. and Kucuk Bicer, B. and Lam, H. and Lam, J.O. and Nachega, J.B. and Tran, B.X. and Lansingh, V.C. and Leung, R. and Li, Y. and Lloyd, B.K. and Logroscino, G. and Low, N. and Lunevicius, R. and Pope, D. and Ma, S. and Magdy Abd El Razek, H. and Magdy Abd El Razek, M. and Mahdavi, M. and Marcenes, W. and Martinez-Raga, J. and Marzan, M.B. and Meaney, P.A. and Mehari, A. and Mehndiratta, M.M. and Tedla, B.A. and Memiah, P. and Memish, Z.A. and Mendoza, W. and Meretoja, T.J. and Mhimbira, F.A. and Miller, T.R. and Mills, E.J. and Mohammad, K.A. and Mohammadi, A. and Monasta, L. and Montico, M. and Ronfani, L. and Moore, A.R. and Morawska, L. and Norman, R.E. and Mori, R. and Werdecker, A. and Mueller, U.O. and Westerman, R. and Paternina Caicedo, A.J. and Seedat, S. and Naheed, A. and Naidoo, K.S. and Sartorius, B. and Naldi, L. and Remuzzi, G. and Nand, D. and Nangia, V. and Neupane, S. and Newton, C.R. and Ngalesoni, F.N. and Nguhiu, P. and Nguyen, Q.L. and Nkamedjie Pete, P.M. and Ogbo, F.A. and Oh, I. and Olivares, P.R. and Olusanya, B.O. and Olusanya, J.O. and Oren, E. and Ota, E. and Mahesh, P.A. and Park, E. and Park, H. and Patten, S.B. and Tonelli, M. and Pereira, D.M. and Perico, N. and Pesudovs, K. and Phillips, M.R. and Simard, E.P. and Xiao, Q. and Pillay, J.D. and Polinder, S. and Qorbani, M. and Rafay, A. and Rana, S.M. and Rahman, M. and Rahman, S.U. and Rai, R.K. and Raju, M. and Ranabhat, C.L. and Rojas-Rueda, D. and Roy, A. and Sagar, R. and Satpathy, M. and Ruhago, G.M. and Sunguya, B.F. and Saleh, M.M. and Sanabria, J.R. and Sanchez-Niño, M.D. and Sarmiento-Suarez, R. and Sawhney, M. and Schneider, I.J.C. and Silva, D.A.S. and Schöttker, B. and Shahraz, S. and Shaikh, M.A. and Sharma, R. and Shin, H.H. and Shin, M. and Yoon, S. and Shiri, R. and Shuie, I. and Sigfusdottir, I.D. and Silverberg, J. and Yano, Y. and Singh, O.P. and Singh, P.K. and Singh, V. and Soriano, J.B. and Sposato, L.A. and Sreeramareddy, C.T. and Stathopoulou, V. and Stroumpoulis, K. and Swaminathan, S. and Sykes, B.L. and Tabarés-Seisdedos, R. and Tavakkoli, M. and Taye, B. and Terkawi, A.S. and Thapa, K. and Thomson, A.J. and Tobe-Gai, R. and Topor-Madry, R. and Topouzis, F. and Truelsen, T. and Tsala Dimbuene, Z. and Tyrovolas, S. and Ukwaja, K.N. and Uneke, C.J. and Uthman, O.A. and Vaezghasemi, M. and Vasankari, T. and Vasconcelos, A.M.N. and Venketasubramanian, N. and Violante, F.S. and Vladimirov, S.K. and Vlassov, V.V. and Wang, Y. and Weichenthal, S. and Widdowson, M. and Wubshet, M. and Xu, G. and Yakob, B. and Yip, P. and Yonemoto, N. and Younis, M.Z. and Yu, C. and Zaidi, Z. and Zaki, M.E. and Zeeb, H. and Zhao, Y. and Zheng, Y. 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. This online publication has been corrected.


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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. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license.

Item Type: Article
Subjects: WS Pediatrics
Depositing User: eprints admin
Date Deposited: 08 Jul 2018 03:27
Last Modified: 12 Oct 2019 05:14

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