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Global, Regional, and National Progress Towards Sustainable Development Goal 3.2 for Neonatal and Child Health: All-Cause and Cause-Specific Mortality Findings From the Global Burden of Disease Study 2019 Publisher Pubmed



Paulson KR1 ; Kamath AM2 ; Alam T1 ; Bienhoff K1 ; Abady GG6 ; Abbas J7 ; Abbasikangevari M8 ; Abbastabar H14 ; Abdallah F28 ; Abdelsalam SM31 ; Abdoli A32 ; Abedi A33 ; Abolhassani H15, 35 ; Abreu LG36 Show All Authors
Authors
  1. Paulson KR1
  2. Kamath AM2
  3. Alam T1
  4. Bienhoff K1
  5. Abady GG6
  6. Abbas J7
  7. Abbasikangevari M8
  8. Abbastabar H14
  9. Abdallah F28
  10. Abdelsalam SM31
  11. Abdoli A32
  12. Abedi A33
  13. Abolhassani H15, 35
  14. Abreu LG36
  15. Abugharbieh E41
  16. Aburmeileh NME44
  17. Abushouk AI45, 50
  18. Adamu AL53, 54
  19. Adebayo OM56
  20. Adegbosin AE60
  21. Adekanmbi V61
  22. Adetokunboh OO64, 65
  23. Adeyinka DA66, 67
  24. Adsuar JC68
  25. Afshari K16, 69
  26. Aghaali M70
  27. Agudelobotero M71
  28. Ahinkorah BO74
  29. Ahmad T75
  30. Ahmadi K76
  31. Ahmed MB77, 78
  32. Aji B80
  33. Akalu Y81
  34. Akinyemi OO57, 89
  35. Aklilu A93
  36. Alaly Z97, 98
  37. Alam K99
  38. Alanezi FM104
  39. Alanzi TM100
  40. Alcalderabanal JE105
  41. Aleyadhy A108
  42. Ali T111
  43. Alicandro G114
  44. Alif SM115
  45. Alipour V118, 119
  46. Alizade H128
  47. Aljunid SM129, 130
  48. Almasihashiani A131
  49. Almasri NA134
  50. Almekhlafi HM135, 138
  51. Alonso J139, 140
  52. Alraddadi RM141
  53. Altirkawi KA108
  54. Alumran AK101
  55. Alvisguzman N143, 145
  56. Alviszakzuk NJ144, 146
  57. Ameyaw EK74
  58. Amini S132
  59. Aminirarani M147
  60. Amit AML151, 152
  61. Amugsi DA154
  62. Ancuceanu R156
  63. Anderlini D162, 166
  64. Andrei CL157
  65. Ansari F167, 177
  66. Ansarimoghaddam A178
  67. Antonio CAT153, 180
  68. Antriyandarti E181
  69. Anvari D182, 186
  70. Anwer R187
  71. Aqeel M188
  72. Arabloo J118
  73. Arabzozani M189
  74. Aripov T191, 192
  75. Arnlov J193, 197
  76. Artanti KD198
  77. Arzani A201, 203
  78. Asaad M204
  79. Asadialiabadi M120
  80. Asadipooya AA205, 212
  81. Jafarabadi MA168, 213
  82. Athari SS214
  83. Athari SM216
  84. Atnafu DD218
  85. Atreya A221
  86. Atteraya MS222
  87. Ausloos M223, 225
  88. Awan AT226, 227
  89. Quintanilla BPA228
  90. Ayano G231
  91. Ayanore MA232
  92. Aynalem YA233
  93. Azari S118
  94. Azarian G235
  95. Azene ZN82
  96. Darshan BB240
  97. Babaee E120
  98. Badiye AD245
  99. Baig AA246
  100. Banach M247, 248
  101. Banik PC249
  102. Barkercollo SL250
  103. Barqawi HJ42
  104. Bassat Q251, 252
  105. Basu S46, 253
  106. Baune BT258, 260
  107. Bayati M206
  108. Bedi N137, 261
  109. Beghi E262
  110. Beghi M265
  111. Bell ML266
  112. Bendak S268
  113. Bennett DA269
  114. Bensenor IM274
  115. Berhe K276
  116. Berman AE278
  117. Bezabih YM219, 279
  118. Bhagavathula AS280, 281
  119. Bhandari D283, 287
  120. Bhardwaj N288
  121. Bhardwaj P289, 290
  122. Bhattacharyya K293, 294
  123. Bhattarai S295
  124. Bhutta ZA296, 298
  125. Bikbov B300
  126. Biondi A301
  127. Birihane BM302, 303
  128. Biswas RK304
  129. Bohlouli S310
  130. Bragazzi NL311
  131. Breusov AV312
  132. Brunoni AR274, 275
  133. Burkart K1, 3
  134. Nagaraja SB313
  135. Busse R314
  136. Butt ZA315, 316
  137. Dos Santos FLC317
  138. Cahuanahurtado L318
  139. Camargos P37
  140. Camera LA319, 320
  141. Cardenas R322
  142. Carreras G323
  143. Carrero JJ194
  144. Carvalho F324
  145. Castaldellimaia JM275
  146. Castanedaorjuela CA146, 329
  147. Castelpietra G331, 332
  148. Cerin E333, 334
  149. Chang JC337, 338
  150. Chanie WF83, 112
  151. Charan J291
  152. Chatterjee S339
  153. Chattu SK340
  154. Chattu VK297, 341
  155. Chaturvedi S342
  156. Chen S343
  157. Cho DY4
  158. Choi JYJ345
  159. Chu DT346
  160. Ciobanu LG79, 284
  161. Cirillo M347
  162. Conde J348
  163. Costa VM324
  164. Couto RAS325
  165. Dachew BA84, 231
  166. Dahlawi SMA102
  167. Dai H349
  168. Dai X1
  169. Dandona L1, 351, 352
  170. Dandona R1, 3, 351
  171. Daneshpajouhnejad P148, 353
  172. Darmstadt GL355
  173. Das JK299
  174. Davilacervantes CA357
  175. Davis AC254, 358
  176. Davletov K361
  177. De La Hoz FP330
  178. De Leo D362
  179. Deeba F363
  180. Denovagutierrez E106
  181. Dervenis N364, 365
  182. Desalew A113
  183. Deuba K195, 366
  184. Dey S367
  185. Dharmaratne SD1, 3, 368
  186. Dhingra S369
  187. Dhungana GP370
  188. Da Silva DD326
  189. Diaz D72, 371
  190. Dorostkar F121
  191. Doshmangir L169
  192. Dubljanin E372
  193. Duraes AR375, 377
  194. Eagan AW47, 378
  195. Edinur HA379
  196. Efendi F199, 229
  197. Eftekharzadeh S380
  198. El Sayed I381
  199. El Tantawi M382
  200. Elbarazi I281
  201. Elgendy IY48, 383
  202. Eljaafary SI28
  203. Emami A207
  204. Enany S384
  205. Eyawo O385
  206. Ezzikouri S386
  207. Faris PS387, 388
  208. Farzadfar F17
  209. Fattahi N389
  210. Fauk NK396, 398
  211. Fazlzadeh M18, 399
  212. Feigin VL1, 400, 402
  213. Ferede TY403
  214. Fereshtehnejad SM196, 405
  215. Fernandes E327
  216. Ferrara P407
  217. Filip I408, 409
  218. Fischer F410
  219. Fisher JL411
  220. Foigt NA412
  221. Folayan MO413
  222. Foroutan M414
  223. Franklin RC415
  224. Freitas M327
  225. Friedman SD416
  226. Fukumoto T417
  227. Gad MM418, 420
  228. Gaidhane AM421
  229. Gaidhane S422
  230. Gaihre S424
  231. Gallus S263
  232. Garciabasteiro AL425, 426
  233. Garciagordillo MA427
  234. Gardner WM1
  235. Fonseca MG428
  236. Gebremedhin KB429
  237. Getacher L234
  238. Ghashghaee A118, 122
  239. Gholamian A430, 431
  240. Gilani SA433, 435
  241. Gill TK284
  242. Giussani G264
  243. Gnedovskaya EV401
  244. Godinho MA436
  245. Goel A437
  246. Golechha M438
  247. Gona PN439
  248. Gopalani SV440, 441
  249. Goudarzi H442, 443
  250. Grivna M281, 444
  251. Gugnani HC445, 446
  252. Guido D447
  253. Guimaraes RA448
  254. Gupta RD451, 452
  255. Gupta R449, 450
  256. Hafezinejad N19, 354
  257. Haider MR453
  258. Hajmirzaian A9, 16
  259. Hamidi S454
  260. Hanif A434
  261. Hankey GJ455, 457
  262. Hargono A198
  263. Hasaballah AI458
  264. Hasan MM459, 460
  265. Hasan SS461, 462
  266. Hassan A28
  267. Hassanipour S463, 464
  268. Hassankhani H170
  269. Havmoeller RJ467
  270. Hayat K468, 469
  271. Heidarisoureshjani R20
  272. Henry NJ270
  273. Herteliu C225, 470
  274. Hole MK471
  275. Holla R240
  276. Hossain N472
  277. Hosseini M21, 22
  278. Hosseinzadeh M118
  279. Hostiuc M158
  280. Hostiuc S159, 473
  281. Househ M474
  282. Huang J475
  283. Humayun A476
  284. Hwang BF477
  285. Iavicoli I347
  286. Ibitoye SE90
  287. Ikuta KS1, 5
  288. Ilesanmi OS58, 91
  289. Ilic IM373
  290. Ilic MD479
  291. Inamdar S480
  292. Inbaraj LR481
  293. Iqbal K482
  294. Iqbal U483
  295. Islam MM230
  296. Islam SMS484, 486
  297. Iso H489
  298. Iwagami M55, 491
  299. Iwu CCD493
  300. Jaafari J465
  301. Jacobsen KH494
  302. Jagnoor J495
  303. Jain V419
  304. Janodia MD241
  305. Javaheri T496
  306. Javanmardi F208
  307. Jayaram S498
  308. Jayatilleke AU499, 500
  309. Jenabi E236
  310. Jha RP501, 502
  311. Ji JS503, 505
  312. John O305, 508
  313. Jonas JB344, 510
  314. Joo T511
  315. Joseph N513
  316. Joukar F463, 464
  317. Jozwiak JJ516
  318. Jurisson M517
  319. Kabir A123
  320. Kabir Z518
  321. Kalankesh LR171
  322. Kamyari N237
  323. Kanchan T292
  324. Kapoor N245
  325. Matin BK389
  326. Karch A259
  327. Karimi SE172
  328. Kassahun G404
  329. Kayode GA520, 521
  330. Karyani AK389
  331. Kemmer L1
  332. Khalid N523
  333. Khalilov R524, 525
  334. Khammarnia M179
  335. Khan EA526
  336. Khan G282
  337. Khan M136
  338. Khan MN527
  339. Khang YH528, 529
  340. Khatab K530, 531
  341. Khater AM29
  342. Khater MM30
  343. Khayamzadeh M13, 532
  344. Khosravi A23, 533
  345. Kim D534
  346. Kim YE536
  347. Kim YJ537
  348. Kimokoti RW538
  349. Kisa A539, 540
  350. Kisa S541
  351. Kissoon N542
  352. Kopec JA543, 544
  353. Kosen S545
  354. Koul PA546
  355. Laxminarayana SLK547
  356. Koyanagi A252, 548
  357. Krishan K549
  358. Krishnamoorthy V2, 506
  359. Defo BK550, 551
  360. Bicer BK552
  361. Kulkarni V513
  362. Kumar GA351
  363. Kumar M359, 553
  364. Kumar N513
  365. Kurmi OP555, 556
  366. Kusuma D255, 558
  367. La Vecchia C559
  368. Lacey B269, 560
  369. Lalloo R163
  370. Lami FH561
  371. Landires I562, 565
  372. Larsson AO566, 567
  373. Lasrado S568
  374. Lassi ZS285
  375. Lauriola P569
  376. Lee PH224
  377. Lee SWH570, 571
  378. Lee YH572
  379. Leigh J487
  380. Leonardi M447
  381. Lewycka S271, 573
  382. Li B574
  383. Li S116
  384. Liang J575, 576
  385. Lim LL577, 578
  386. Limenih MA85
  387. Lin RT478, 579
  388. Liu X580
  389. Lodha R581
  390. Lopez AD1, 3, 583
  391. Lozano R1, 3
  392. Lugo A263
  393. Lunevicius R586, 587
  394. Mackay MT589, 590
  395. Kunjathur SM592
  396. Magnani FG447
  397. Prasad DRM593
  398. Maheri M594
  399. Mahmoudi M595
  400. Majeed A256
  401. Maled V596, 597
  402. Maleki A18, 598
  403. Maleki S390
  404. Malekzadeh R24, 209
  405. Malik AA142, 434
  406. Malta DC38
  407. Mamun AA459
  408. Mansouri B391
  409. Mansournia MA21
  410. Martinez G601
  411. Martini S200, 602
  412. Martinsmelo FR603
  413. Masoumi SZ238
  414. Maulik PK306, 509
  415. Mcalinden C604
  416. Mcgrath JJ164, 605
  417. Medinasolis CE606
  418. Nasab EM25
  419. Mejiarodriguez F107
  420. Memish ZA607, 608
  421. Mendoza W609
  422. Menezes RG103
  423. Mengesha EW220
  424. Mensah GA610, 611
  425. Meretoja A584, 613
  426. Meretoja TJ614, 615
  427. Mersha AM94
  428. Mestrovic T616, 617
  429. Miazgowski B618, 620
  430. Miazgowski T619
  431. Michalek IM621
  432. Miller TR231, 622
  433. Mini GK623, 624
  434. Miri M625, 626
  435. Mirica A225
  436. Mirrakhimov EM627, 628
  437. Mirzaei H629
  438. Mirzaei M392
  439. Moazen B343, 630
  440. Moghadaszadeh M173, 174
  441. Mohajer B17
  442. Mohamad O631
  443. Mohammad Y109
  444. Mohammadi SM215
  445. Mohammadianhafshejani A632
  446. Mohammed S343
  447. Mokdad AH1, 3
  448. Molokhia M62
  449. Monasta L636
  450. Mondello S637
  451. Moni MA307
  452. Moore CE272
  453. Moradi G599, 600
  454. Moradi M389
  455. Moradzadeh R131
  456. Moraga P638
  457. Morawska L639
  458. Morrison SD640
  459. Mosser JF1
  460. Khaneghah AM641
  461. Mustafa G642, 643
  462. Naderi M390
  463. Nagarajan AJ644, 645
  464. Nagaraju SP242
  465. Naghavi M1, 3
  466. Naghshtabrizi B646
  467. Naimzada MD647, 648
  468. Nangia V649
  469. Swamy SN650
  470. Nascimento BR39, 40
  471. Naveed M651
  472. Nazari J133
  473. Ndejjo R652
  474. Negoi I160, 653
  475. Negoi RI161, 654
  476. Nena E655
  477. Nepal S656
  478. Netsere HB86, 657
  479. Nguefacktsague G658
  480. Ngunjiri JW659
  481. Nguyen CTY660
  482. Nguyen CT661
  483. Nguyen HLT661
  484. Nigatu YT662, 663
  485. Nigussie SN664
  486. Nixon MR1
  487. Nnaji CA612, 665
  488. Nomura S666, 667
  489. Noor NM360, 668
  490. Noubiap JJ286
  491. Nunezsamudio V563, 564
  492. Nwatah VE588, 669
  493. Oancea B670
  494. Odukoya OO671, 672
  495. Ogbo FA673
  496. Olusanya BO674
  497. Olusanya JO674
  498. Bali AO675
  499. Onwujekwe OE676
  500. Ortiz A677, 679
  501. Otoiu A225
  502. Otstavnov N647
  503. Otstavnov SS647, 680
  504. Owolabi MO59, 92
  505. Mahesh PA682
  506. Padubidri JR240
  507. Pakhale S683
  508. Pakshir K210
  509. Pal PK684
  510. Palladino R256, 347
  511. Pana A225, 685
  512. Pandajonas S344
  513. Pandey A350
  514. Pandey A350
  515. Pandiperumal SR688
  516. Pangaribuan HU689
  517. Pardomontano AM73
  518. Park EK690
  519. Patel SK691
  520. Patton GC585, 591
  521. Pawar S267
  522. Toroudi HP124, 125
  523. Peden AE308, 692
  524. Pepito VCF693
  525. Peprah EK416
  526. Pereira J694
  527. Perezgomez J695
  528. Perico N696
  529. Pesudovs K309
  530. Pilgrim T697
  531. Pinheiro M328
  532. Piradov MA402
  533. Pirsaheb M389
  534. Plattsmills JA698
  535. Pokhrel KN699
  536. Postma MJ700, 701
  537. Pourjafar H217, 702
  538. Prada SI704, 705
  539. Prakash S707
  540. Pupillo E262
  541. Syed ZQ421
  542. Rabiee N708
  543. Radfar A709
  544. Rafiee A710
  545. Rafiei A183, 184
  546. Raggi A447
  547. Rahimzadeh S711
  548. Rahman MHU712
  549. Rahmani AM713, 714
  550. Ramezanzadeh K10
  551. Rana J715, 716
  552. Ranabhat CL717, 718
  553. Rao SJ719
  554. Rasella D376
  555. Rastogi P514
  556. Rathi P240
  557. Rawaf DL257, 720
  558. Rawaf S256, 721
  559. Rawasia WF722
  560. Rawassizadeh R497
  561. Remuzzi G696
  562. Renzaho AMN723, 724
  563. Reshmi B243, 244
  564. Resnikoff S309, 725
  565. Rezaei N15, 726
  566. Rezaei N15, 726
  567. Rezapour A118
  568. Riahi SM190
  569. Ribeiro D325
  570. Rickard J727, 728
  571. Roever L729
  572. Ronfani L636
  573. Rothenbacher D730
  574. Rubagotti E706, 731
  575. Rumisha SF732, 733
  576. Ryan PM519
  577. Saddik B43
  578. Sadeghi E389
  579. Moghaddam SS17
  580. Sagar R582
  581. Sahebkar A734, 735
  582. Salahshoor MR393
  583. Salehi S34
  584. Salem MR736
  585. Salimzadeh H24
  586. Salomon JA356
  587. Samodra YL737
  588. Samy AM51
  589. Sanabria J738, 739
  590. Santricmilicevic MM373, 374
  591. Saraswathy SYI740, 741
  592. Sarker AR742
  593. Sarrafzadegan N149, 543
  594. Sarveazad A126
  595. Sathian B743, 744
  596. Sathish T557
  597. Sattin D447
  598. Saxena S253
  599. Saya GK745
  600. Saylan M746
  601. Schiavolin S447
  602. Schlaich MP456, 747
  603. Schwebel DC748
  604. Schwendicke F750
  605. Senthilkumaran S751
  606. Sepanlou SG24, 209
  607. Servanmori E105
  608. Sha F752
  609. Shafaat O150, 354
  610. Shahabi S211
  611. Shahbaz M11
  612. Shaheen AA753
  613. Shahid I754
  614. Shaikh MA755
  615. Shakiba S27
  616. Shalash AS52
  617. Shamsbeyranvand M703
  618. Shannawaz M633, 756
  619. Sharafi K389
  620. Sheikh A49, 757
  621. Sheikhbahaei S354
  622. Shiferaw WS233
  623. Shigematsu M758
  624. Shin JI759
  625. Shiri R760
  626. Shiue I761
  627. Shuval K762, 763
  628. Siddiqi TJ764
  629. Sidemo NB95
  630. Sigfusdottir ID767, 768
  631. Sigurvinsdottir R767
  632. Silva JP324
  633. Silverberg JIS770
  634. Simonetti B771, 772
  635. Singh BB488, 773
  636. Singh JA749, 774
  637. Singhal D423, 775
  638. Sinha DN776, 777
  639. Skiadaresi E778
  640. Skryabin VY779
  641. Skryabina AA781
  642. Sleet DA782, 783
  643. Sobaih BH110, 784
  644. Sobhiyeh MR394
  645. Soltani S389
  646. Soriano JB678, 785
  647. Spurlock EE1
  648. Sreeramareddy CT786
  649. Steiropoulos P655
  650. Stokes MA485
  651. Stortecky S697
  652. Sufiyan MB634
  653. Abdulkader RS787, 788
  654. Sulo G789
  655. Swope CB769
  656. Sykes BL790
  657. Szeto MD791
  658. Szocska M512
  659. Tabaresseisdedos R792, 793
  660. Tadesse EG96
  661. Taherkhani A239
  662. Tamiru AT87
  663. Tareque MI794
  664. Tehranibanihashemi A120, 127
  665. Temsah MH108
  666. Tesfay FH277, 397
  667. Tessema GA231, 283
  668. Tessema ZT88
  669. Thankappan KR795
  670. Thapar R513
  671. Tolani MA635
  672. Tovanipalone MR796, 797
  673. Traini E522, 636
  674. Tran BX798
  675. Tripathy JP799
  676. Tsapparellas G800
  677. Tsatsakis A801
  678. Car LT802
  679. Uddin R165, 803
  680. Ullah A804
  681. Umeokonkwo CD805
  682. Unim B806
  683. Unnikrishnan B515
  684. Upadhyay E807
  685. Usman MS765
  686. Vacante M301
  687. Vaezi M175, 176
  688. Tahbaz SV432, 808
  689. Valdez PR321, 809
  690. Vasankari TJ810
  691. Venketasubramanian N811, 812
  692. Verma M813
  693. Violante FS814, 815
  694. Vlassov V681
  695. Vo B816
  696. Vu GT817
  697. Wado YD155
  698. Waheed Y818
  699. Wamai RG535, 554
  700. Wang Y575, 576
  701. Wang Y575, 576
  702. Wang YP275
  703. Ward P396
  704. Werdecker A819
  705. Westerman R820
  706. Wickramasinghe ND821
  707. Wilner LB1
  708. Wiysonge CS612, 665
  709. Wu AM822
  710. Wu C504, 507
  711. Xie Y823
  712. Jabbari SHY808
  713. Yamagishi K490, 492
  714. Yandrapalli S824, 825
  715. Yaya S273, 406
  716. Yazdifeyzabadi V826, 827
  717. Yip P335, 336
  718. Yonemoto N828, 829
  719. Yoon SJ830
  720. Younis MZ831, 832
  721. Yousefi Z185
  722. Yousefinezhadi T12
  723. Yu C833
  724. Yusuf SS836
  725. Zaidi SS766
  726. Zaman SB117, 837
  727. Zamani M202
  728. Zamanian M131
  729. Zastrozhin MS780, 838
  730. Zastrozhina A839
  731. Zhang Y840, 841
  732. Zhang ZJ834
  733. Zhao XJG835, 842
  734. Ziapour A395
  735. Hay SI1, 3
  736. Murray CJL1, 3
  737. Wang H1, 3
  738. Kassebaum NJ1, 2, 3

Source: The Lancet Published:2021


Abstract

Background: Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods: We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings: Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3–74·0) in 2000 to 37·1 (33·2–41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8–29·5) in 2000 to 17·9 (16·3–19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05–10·30) in 2000 and 5·05 million (4·27–6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53–4·02]) in 2000 to 48% (2·42 million; 2·06–2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71–0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27–1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35–2·58; 37% [95% UI 32–43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation: Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Funding: Bill & Melinda Gates Foundation. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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