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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 Publisher Pubmed



Wang H1 ; Bhutta ZA4, 6 ; Coates MM1 ; Coggeshall M1 ; Dandona L1, 9 ; Diallo K10 ; Franca EB11 ; Fraser M1 ; Fullman N1 ; Gething PW13 ; Hay SI1, 12 ; Kinfu Y17 ; Kita M19 ; Kulikoff XR1 Show All Authors
Authors
  1. Wang H1
  2. Bhutta ZA4, 6
  3. Coates MM1
  4. Coggeshall M1
  5. Dandona L1, 9
  6. Diallo K10
  7. Franca EB11
  8. Fraser M1
  9. Fullman N1
  10. Gething PW13
  11. Hay SI1, 12
  12. Kinfu Y17
  13. Kita M19
  14. Kulikoff XR1
  15. Larson HJ1, 20
  16. Liang J21
  17. Liang X23
  18. Lim SS1
  19. Lind M1
  20. Lopez AD1, 24
  21. Lozano R29
  22. Mensah GA30
  23. Mikesell JB1
  24. Mokdad AH1
  25. Mooney MD1
  26. Naghavi M1
  27. Nguyen G1
  28. Rakovac I10
  29. Salomon JA31
  30. Silpakit N1
  31. Sligar A1
  32. Sorensen RJD1
  33. Vos T1
  34. Zhu J35
  35. Abajobir AA36, 72
  36. Abate KH39
  37. Abbas KM40
  38. Abdallah F41
  39. Abdulle AM42
  40. Abera SF44, 46, 47
  41. Aboyans V48
  42. Abraham B49
  43. Abubakar I50
  44. Aburaddad LJ53
  45. Aburmeileh NME54
  46. Abyu GY45
  47. Achoki T1
  48. Adebiyi AO55, 57
  49. Adedeji IA58
  50. Adelekan AL56, 59
  51. Adou AK60
  52. Agarwal A65, 66
  53. Ajala ON33, 67
  54. Akinyemiju TF68
  55. Akseer N6, 61
  56. Alam K25, 28, 70
  57. Alam NKM71, 74
  58. Alasfoor D75
  59. Aldridge RW51
  60. Alegretti MA76
  61. Alemu ZA77
  62. Ali R16
  63. Alkerwi A78
  64. Alla F79
  65. Alraddadi R80
  66. Alsharif U81
  67. Altirkawi KA82
  68. Alvarez Martin E83
  69. Alvisguzman N84
  70. Amare AT85, 87
  71. Amberbir A89
  72. Amegah AK90
  73. Ameh EA91
  74. Ammar W92
  75. Amrock SM93
  76. Andersen HH94
  77. Anderson GM1
  78. Antonio CAT95
  79. Arnlov J97, 98
  80. Artaman A99
  81. Asayesh H100
  82. Asghar RJ101
  83. Assadi R102
  84. Atique S103
  85. Avokpaho EFGA104, 105
  86. Awasthi A106
  87. Ayala Quintanilla BP107, 108
  88. Bacha U109
  89. Badawi A62, 110
  90. Balakrishnan K111
  91. Banerjee A52
  92. Banigbe BF112
  93. Barac A113
  94. Barber RM1
  95. Barkercollo SL114
  96. Barnighausen T33, 115, 116
  97. Barrero LH117
  98. Bayou TA45
  99. Bayou YT118
  100. Bazarganhejazi S119, 120, 121
  101. Beardsley J122
  102. Bedi N123
  103. Bekele T124
  104. Bell ML126
  105. Bello AK127
  106. Bennett DA16
  107. Bensenor IM129
  108. Berhane A130
  109. Bernabe E132
  110. Betsu BD45
  111. Beyene AS239
  112. Bhatt S134
  113. Biadgilign S135
  114. Bikbov B136
  115. Birlik SM137
  116. Bisanzio D14
  117. Bjertness E138
  118. Blore JD1
  119. Bourne RRA139
  120. Brainin M140
  121. Brazinova A141, 142
  122. Breitborde NJK145
  123. Brown A1
  124. Buckle GC146
  125. Burch M147
  126. Butt ZA148
  127. Camposnonato IR29, 33
  128. Campuzano JC29
  129. Cardenas R149
  130. Carpenter DO150
  131. Carrero JJ151
  132. Carter A1
  133. Casey DC1
  134. Castanedaorjuela CA157, 158
  135. Castillo Rivas J159, 160
  136. Castro RE161
  137. Catalalopez F162, 163
  138. Cercy K1
  139. Chang HY164, 165
  140. Chang JC166
  141. Chibueze CE167, 378
  142. Chisumpa VH168, 169
  143. Choi JYJ170
  144. Chowdhury R171
  145. Christopher DJ172
  146. Ciobanu LG86
  147. Colquhoun SM25, 28
  148. Cooper C15, 173, 174
  149. Cornaby L1
  150. Damtew SA175, 178
  151. Danawi H179
  152. Dandona R9
  153. Das Neves J180
  154. Davis AC183
  155. De Jager P184, 186
  156. De Leo D187
  157. Degenhardt L188
  158. Deribe K176, 190
  159. Deribew A14, 191
  160. Des Jarlais DC192, 193
  161. Deveber GA7
  162. Dharmaratne SD194
  163. Dhillon PK196
  164. Ding EL33
  165. Doshi PP197
  166. Doyle KE198
  167. Duan L22
  168. Dubey M199
  169. Ebrahimi H200, 202
  170. Ellingsen CL210
  171. Elyazar I211
  172. Endries AY212
  173. Ermakov SP213, 214
  174. Eshrati B215, 216
  175. Esteghamati A201
  176. Faraon EJA96, 217
  177. Farid TA218
  178. Farinha CSES219, 220
  179. Faro A221
  180. Farvid MS33, 222
  181. Farzadfar F200
  182. Fereshtehnejad SM152
  183. Fernandes JC223
  184. Fischer F224
  185. Fitchett JRA34
  186. Foigt N225
  187. Franklin RC226
  188. Friedman J1
  189. Furst T133, 227, 229
  190. Gambashidze K230
  191. Gamkrelidze A230
  192. Ganguly P196, 231
  193. Gebre T232
  194. Gebrehiwot TT39
  195. Gebremedhin AT39, 233
  196. Gebru AA45, 234
  197. Geleijnse JM235
  198. Gessner BD237
  199. Ginawi IAM238
  200. Giref AZ178
  201. Gishu MD240, 241
  202. Gomezdantes H29
  203. Gona P242
  204. Goodridge A243
  205. Gopalani SV244
  206. Goto A245
  207. Gouda HN38
  208. Gugnani HC246
  209. Guo Y38
  210. Gupta R247
  211. Gupta R247
  212. Gupta V249
  213. Gyawali B250
  214. Haagsma JA1, 251
  215. Hafezinejad N201
  216. Haile D178
  217. Hailu AD176, 253
  218. Hailu GB45, 234
  219. Hamadeh RR254
  220. Hamidi S255
  221. Hancock J1
  222. Handal AJ256
  223. Hankey GJ257, 258, 259
  224. Harb HL92
  225. Harikrishnan S260
  226. Harun KM3, 261
  227. Havmoeller R156
  228. Hay RJ132, 262
  229. Herediapi IB29
  230. Hoek HW263, 265
  231. Horino M266
  232. Horita N267
  233. Hosgood HD268
  234. Hotez PJ269
  235. Hoy DG270
  236. Hsairi M271
  237. Hu G272
  238. Huang C273
  239. Huang JJ126
  240. Huang H274
  241. Huiart L275
  242. Huynh C1
  243. Iburg KM250
  244. Idrisov BT276
  245. Innos K277
  246. Jacobsen KH278
  247. Jahanmehr N279
  248. Javanbakht M281
  249. Jayatilleke AU282, 283
  250. Jee SH284
  251. Jeemon P8, 195, 285
  252. Jha V16, 286
  253. Jiang G287
  254. Jiang Y288
  255. Jibat T178, 236
  256. Jin Y22
  257. Jonas JB289
  258. Kabir Z290
  259. Kalkonde Y291
  260. Kamal R292
  261. Kan H295
  262. Kang G172
  263. Karch A296, 297
  264. Karema CK228, 298
  265. Kasaeian A200, 203
  266. Kaul A299
  267. Kawakami N18
  268. Kayibanda JF300
  269. Kazanjan K230
  270. Keiyoro PN301, 302
  271. Kemp AH304, 305
  272. Kengne AP306, 307
  273. Keren A308
  274. Kereselidze M230
  275. Kesavachandran CN292
  276. Khader YS309
  277. Khalil IA1
  278. Khan AR218
  279. Khan EA310
  280. Khang YH311
  281. Khonelidze I230
  282. Khubchandani J313
  283. Kim CI314
  284. Kim D315
  285. Kim YJ316
  286. Kissoon N317
  287. Kivipelto M153
  288. Knibbs LD36, 72
  289. Kokubo Y318
  290. Kosen S319
  291. Koul PA320
  292. Koyanagi A321
  293. Kuate Defo B322, 323
  294. Kucuk Bicer B324
  295. Kudom AA90
  296. Kumar GA9
  297. Kutz MJ1
  298. Kyu HH1
  299. Lal DK196
  300. Lalloo R37, 73
  301. Lam H325
  302. Lam JO326
  303. Lansingh VC329, 330
  304. Larsson A97
  305. Leigh J70
  306. Leung R331
  307. Li Y22
  308. Li Y22
  309. Lindsay MP63, 333
  310. Liu PY1
  311. Liu S22
  312. Lloyd BK334, 335
  313. Lo WD143, 336
  314. Logroscino G337
  315. Low N338
  316. Lunevicius R339, 340
  317. Lyons RA303
  318. Ma S342, 343
  319. Magdy Abd El Razek H344
  320. Magdy Abd El Razek M345
  321. Mahdavi M346, 347
  322. Majdan M141
  323. Majeed A134
  324. Malekzadeh R204
  325. Mapoma CC168
  326. Marcenes W348
  327. Martinezraga J349, 350
  328. Marzan MB351
  329. Masiye F1, 168
  330. Mcgrath JJ38
  331. Meaney PA352, 353
  332. Mehari A354
  333. Mehndiratta MM355
  334. Mekonnen AB70, 356, 474
  335. Melaku YA43, 85
  336. Memiah P357
  337. Memish ZA358, 359
  338. Mendoza W360
  339. Meretoja A26, 361
  340. Meretoja TJ362, 363, 365
  341. Mhimbira FA364, 366
  342. Miller TR363, 364, 365, 366
  343. Mills EJ367
  344. Mirarefin M1
  345. Misganaw A1
  346. Mock CN2
  347. Mohammad KA368
  348. Mohammadi A369
  349. Mohammed S116, 370
  350. Monasta L371
  351. Montanez Hernandez JC29
  352. Montico M371
  353. Moore AR372
  354. Moradilakeh M1, 373
  355. Morawska L374, 375, 377
  356. Mori R167, 378
  357. Mueller UO380
  358. Murphy GAV16, 381
  359. Murthy S317
  360. Nachega JB327, 382, 384
  361. Naheed A385
  362. Naidoo KS386
  363. Naldi L387
  364. Nand D388
  365. Nangia V389
  366. Neupane S390
  367. Newton CR391
  368. Newton JN183
  369. Ng M1
  370. Ngalesoni FN392
  371. Nguhiu P393
  372. Nguyen Q394
  373. Nisar MI5
  374. Nkamedjie Pete PM395
  375. Norheim OF253
  376. Norman RE375, 376, 377
  377. Ogbo FA396
  378. Oh IH397
  379. Ojelabi FA56
  380. Olivares PR398
  381. Olusanya BO399
  382. Olusanya JO399
  383. Oren E400
  384. Ota E401
  385. Mahesh PA402
  386. Park EK403
  387. Park HY404
  388. Parsaeian M200, 205
  389. Paternina Caicedo AJ383, 405
  390. Patten SB406
  391. Pedro JM181, 408
  392. Pereira DM409
  393. Perico N410
  394. Pesudovs K411
  395. Petzold M185, 412
  396. Phillips MR413, 415
  397. Pillay JD416
  398. Pishgar F200, 207
  399. Polinder S417
  400. Pope D341
  401. Popova S64
  402. Pourmalek F317
  403. Qorbani M418
  404. Rabiee RHS154
  405. Rafay A419
  406. Rahimimovaghar V206
  407. Rahman M420
  408. Rahman MHU199
  409. Rahman SU421
  410. Rai RK422
  411. Raju M423
  412. Ram U199
  413. Rana SM419, 424
  414. Ranabhat CL425, 426
  415. Rao P1
  416. Refaat AH179, 427
  417. Remuzzi G387, 410, 428
  418. Resnikoff S189
  419. Reynolds A1
  420. Rojasrueda D429
  421. Ronfani L371
  422. Roshandel G204, 430
  423. Roth GA1
  424. Roy A431
  425. Ruhago GM432
  426. Sagar R431
  427. Saleh MM433
  428. Sanabria JR434, 435
  429. Sancheznino MD436
  430. Santos IS128
  431. Santos JV182
  432. Sarmientosuarez R437
  433. Sartorius B386
  434. Satpathy M431
  435. Savic M210
  436. Sawhney M438
  437. Schneider IJC439
  438. Schottker B440, 441
  439. Schwebel DC69
  440. Seedat S384
  441. Sepanlou SG204
  442. Servanmori EE29
  443. Setegn T88
  444. Shahraz S442
  445. Shaikh MA443
  446. Shakhnazarova M230
  447. Sharma R444
  448. She J293
  449. Sheikhbahaei S201
  450. Shen J144, 445
  451. Sheth KN125
  452. Shibuya K19
  453. Shin HH446
  454. Shin MJ447
  455. Shiri R449
  456. Shuie I450, 451
  457. Sigfusdottir ID452
  458. Silva DAS439
  459. Silverberg J453
  460. Simard EP414
  461. Sindi S156
  462. Singh A199
  463. Singh JA69
  464. Singh OP455
  465. Singh PK456
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  468. Soshnikov S214
  469. Sposato LA459
  470. Sreeramareddy CT460
  471. Stathopoulou V461
  472. Steel N183, 462
  473. Stroumpoulis K463, 464
  474. Sturua L230
  475. Sunguya BF432
  476. Swaminathan S465
  477. Sykes BL466
  478. Szoeke CEI27
  479. Tabaresseisdedos R467
  480. Tavakkoli M468
  481. Taye B469
  482. Tedla BA356, 470, 474
  483. Tefera WM177
  484. Tekle T45
  485. Temam Shifa G178, 212
  486. Terkawi AS471, 472, 473
  487. Tesfay FH44, 411
  488. Tessema GA86, 356, 474
  489. Thapa K475
  490. Thomson AJ476
  491. Thornelyman AL32, 477
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  498. Truelsen T483
  499. Tsala Dimbuene Z484, 485
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  503. Uneke CJ488
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  511. Vladimirov SK495
  512. Vlassov VV496
  513. Vollset SE1, 209, 252
  514. Wang L22
  515. Wang Y497
  516. Weichenthal S498
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  519. Weiss DJ16
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Source: The Lancet Published:2016


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