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

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 rate...

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Vydané v:The Lancet (British edition) Ročník 398; číslo 10303; s. 870 - 905
Hlavní autori: Abbas, Jaffar, Abbasi-Kangevari, Mohsen, Adamu, Aishatu L, Adekanmbi, Victor, Adeyinka, Daniel Adedayo, Agudelo-Botero, Marcela, Alam, Khurshid, Alanezi, Fahad Mashhour, Antonio, Carl Abelardo T, Antriyandarti, Ernoiz, Athari, Seyyede Masoume, Atteraya, Madhu Sudhan, Banach, Maciej, Bennett, Derrick A, Bhagavathula, Akshaya Srikanth, Bhardwaj, Nikha, Bikbov, Boris, Bragazzi, Nicola Luigi, Cahuana-Hurtado, Lucero, Castaldelli-Maia, Joao Mauricio, Castelpietra, Giulio, Charan, Jaykaran, Chattu, Soosanna Kumary, Chen, Simiao, Dahlawi, Saad M A, Davletov, Kairat, Doshmangir, Leila, Emami, Amir, Enany, Shymaa, Ezzikouri, Sayeh, Fazlzadeh, Mehdi, Feigin, Valery L, Garcia-Gordillo, MA, Gilani, Syed Amir, Goel, Amit, Goudarzi, Houman, Haj-Mirzaian, Arvin, Hargono, Arief, Hole, Michael K, Hosseinzadeh, Mehdi, Islam, M Mofizul, Jayaram, Shubha, Karami Matin, Behzad, Kayode, Gbenga A, Khater, Mona M, Kim, Yun Jin, Kosen, Soewarta, Kuate Defo, Barthelemy, Kumar, Manasi, La Vecchia, Carlo, Lee, Yo Han, Leonardi, Matilde, Liang, Juan, Lodha, Rakesh, Lugo, Alessandra, Mackay, Mark T, Malik, Ahmad Azam, Mansournia, Mohammad Ali, Martins-Melo, Francisco Rogerlândio, Mehrabi Nasab, Entezar, Mohammed, Shafiu, Mokdad, Ali H, Molokhia, Mariam, Naderi, Mehdi, Nagaraju, Shankar Prasad, Naghshtabrizi, Behshad, Nena, Evangelia, Nguyen, Cuong Tat, Nguyen, Huong Lan Thi, Panda-Jonas, Songhomitra, Patel, Sangram Kishor, Pawar, Shrikant, Pazoki Toroudi, Hamidreza, Perico, Norberto, Pilgrim, Thomas, Pupillo, Elisabetta, Rafiee, Ata, Rafiei, Alireza, Rahmani, Amir Masoud, Reshmi, Bhageerathy, Rothenbacher, Dietrich, Sathish, Thirunavukkarasu, Sattin, Davide, Saxena, Sonia, Saya, Ganesh Kumar, Sheikh, Aziz, Shiferaw, Wondimeneh Shibabaw, Singh, Jasvinder A, Soriano, Joan B, Tabarés-Seisdedos, Rafael, Taherkhani, Amir, Uddin, Riaz, Upadhyay, Era, Verma, Madhur, Vu, Giang Thu, Wado, Yohannes Dibaba, Wang, Yanping, Wang, Yuan-Pang, Werdecker, Andrea, Yu, Chuanhua
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: England Elsevier Ltd 04.09.2021
Elsevier Limited
Elsevier
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ISSN:0140-6736, 1474-547X, 1474-547X
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Abstract 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. 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. 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. 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. Bill & Melinda Gates Foundation.
AbstractList Summary 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.
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.BACKGROUNDSustainable 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.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.METHODSWe 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.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.FINDINGSGlobal 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.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.INTERPRETATIONGlobal 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.Bill & Melinda Gates Foundation.FUNDINGBill & Melinda Gates Foundation.
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. 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. 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. 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. Bill & Melinda Gates Foundation.
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.
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 (USMR). 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 WI] 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 USMR 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 3.53-4.021) 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 USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.
Author Iso, Hiroyasu
Herteliu, Claudiu
Wiysonge, Charles Shey
Rahimzadeh, Shadi
Joukar, Farahnaz
Mohammadi, Seyyede Momeneh
Sykes, Bryan L
Schlaich, Markus P
Mohammed, Shafiu
Naghavi, Mohsen
Anwer, Razique
Onwujekwe, Obinna E
Goudarzi, Houman
Lozano, Rafael
Thankappan, Kavumpurathu Raman
Mohammadian-Hafshejani, Abdollah
Daneshpajouhnejad, Parnaz
Padubidri, Jagadish Rao
Otstavnov, Stanislav S
Maheri, Mina
Adamu, Aishatu L
Ogbo, Felix Akpojene
Saylan, Mete
Tessema, Gizachew Assefa
Dervenis, Nikolaos
Butt, Zahid A
Caetano dos Santos, Florentino Luciano
Castaldelli-Maia, Joao Mauricio
Alanezi, Fahad Mashhour
Guido, Davide
Mustafa, Ghulam
Rawaf, Salman
Shaikh, Masood Ali
Kamyari, Naser
Shiri, Rahman
Athari, Seyyede Masoume
Zhao, Xiu-Ju George
Paulson, Katherine R
Unim, Brigid
Nepal, Samata
Alif, Sheikh Mohammad
Shiue, Ivy
Tareque, Md Ismail
Ilic, Irena M
Zastrozhin, Mikhail Sergeevich
Hosseini, Mostafa
Sha, Feng
Abady, Gdiom Gebreheat
Maleki, Afshin
Pirsaheb, Meghdad
Shuval, Kerem
Mansournia, Mohammad Ali
Miri, Mohammad
Shiferaw, Wondimeneh Shibabaw
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  givenname: Fahad Mashhour
  surname: Alanezi
  fullname: Alanezi, Fahad Mashhour
– sequence: 67
  givenname: Carl Abelardo T
  surname: Antonio
  fullname: Antonio, Carl Abelardo T
– sequence: 68
  givenname: Ernoiz
  surname: Antriyandarti
  fullname: Antriyandarti, Ernoiz
– sequence: 83
  givenname: Seyyede Masoume
  surname: Athari
  fullname: Athari, Seyyede Masoume
– sequence: 86
  givenname: Madhu Sudhan
  surname: Atteraya
  fullname: Atteraya, Madhu Sudhan
– sequence: 100
  givenname: Maciej
  surname: Banach
  fullname: Banach, Maciej
– sequence: 113
  givenname: Derrick A
  surname: Bennett
  fullname: Bennett, Derrick A
– sequence: 118
  givenname: Akshaya Srikanth
  surname: Bhagavathula
  fullname: Bhagavathula, Akshaya Srikanth
– sequence: 120
  givenname: Nikha
  surname: Bhardwaj
  fullname: Bhardwaj, Nikha
– sequence: 125
  givenname: Boris
  surname: Bikbov
  fullname: Bikbov, Boris
– sequence: 130
  givenname: Nicola Luigi
  surname: Bragazzi
  fullname: Bragazzi, Nicola Luigi
– sequence: 138
  givenname: Lucero
  surname: Cahuana-Hurtado
  fullname: Cahuana-Hurtado, Lucero
– sequence: 145
  givenname: Joao Mauricio
  surname: Castaldelli-Maia
  fullname: Castaldelli-Maia, Joao Mauricio
– sequence: 147
  givenname: Giulio
  surname: Castelpietra
  fullname: Castelpietra, Giulio
– sequence: 151
  givenname: Jaykaran
  surname: Charan
  fullname: Charan, Jaykaran
– sequence: 153
  givenname: Soosanna Kumary
  surname: Chattu
  fullname: Chattu, Soosanna Kumary
– sequence: 156
  givenname: Simiao
  surname: Chen
  fullname: Chen, Simiao
– sequence: 166
  givenname: Saad M A
  surname: Dahlawi
  fullname: Dahlawi, Saad M A
– sequence: 176
  givenname: Kairat
  surname: Davletov
  fullname: Davletov, Kairat
– sequence: 191
  givenname: Leila
  surname: Doshmangir
  fullname: Doshmangir, Leila
– sequence: 203
  givenname: Amir
  surname: Emami
  fullname: Emami, Amir
– sequence: 204
  givenname: Shymaa
  surname: Enany
  fullname: Enany, Shymaa
– sequence: 206
  givenname: Sayeh
  surname: Ezzikouri
  fullname: Ezzikouri, Sayeh
– sequence: 211
  givenname: Mehdi
  surname: Fazlzadeh
  fullname: Fazlzadeh, Mehdi
– sequence: 212
  givenname: Valery L
  surname: Feigin
  fullname: Feigin, Valery L
– sequence: 233
  givenname: MA
  surname: Garcia-Gordillo
  fullname: Garcia-Gordillo, MA
– sequence: 240
  givenname: Syed Amir
  surname: Gilani
  fullname: Gilani, Syed Amir
– sequence: 245
  givenname: Amit
  surname: Goel
  fullname: Goel, Amit
– sequence: 249
  givenname: Houman
  surname: Goudarzi
  fullname: Goudarzi, Houman
– sequence: 258
  givenname: Arvin
  surname: Haj-Mirzaian
  fullname: Haj-Mirzaian, Arvin
– sequence: 262
  givenname: Arief
  surname: Hargono
  fullname: Hargono, Arief
– sequence: 274
  givenname: Michael K
  surname: Hole
  fullname: Hole, Michael K
– sequence: 278
  givenname: Mehdi
  surname: Hosseinzadeh
  fullname: Hosseinzadeh, Mehdi
– sequence: 295
  givenname: M Mofizul
  surname: Islam
  fullname: Islam, M Mofizul
– sequence: 307
  givenname: Shubha
  surname: Jayaram
  fullname: Jayaram, Shubha
– sequence: 325
  givenname: Behzad
  surname: Karami Matin
  fullname: Karami Matin, Behzad
– sequence: 329
  givenname: Gbenga A
  surname: Kayode
  fullname: Kayode, Gbenga A
– sequence: 342
  givenname: Mona M
  surname: Khater
  fullname: Khater, Mona M
– sequence: 347
  givenname: Yun Jin
  surname: Kim
  fullname: Kim, Yun Jin
– sequence: 353
  givenname: Soewarta
  surname: Kosen
  fullname: Kosen, Soewarta
– sequence: 359
  givenname: Barthelemy
  surname: Kuate Defo
  fullname: Kuate Defo, Barthelemy
– sequence: 363
  givenname: Manasi
  surname: Kumar
  fullname: Kumar, Manasi
– sequence: 367
  givenname: Carlo
  surname: La Vecchia
  fullname: La Vecchia, Carlo
– sequence: 378
  givenname: Yo Han
  surname: Lee
  fullname: Lee, Yo Han
– sequence: 380
  givenname: Matilde
  surname: Leonardi
  fullname: Leonardi, Matilde
– sequence: 384
  givenname: Juan
  surname: Liang
  fullname: Liang, Juan
– sequence: 389
  givenname: Rakesh
  surname: Lodha
  fullname: Lodha, Rakesh
– sequence: 392
  givenname: Alessandra
  surname: Lugo
  fullname: Lugo, Alessandra
– sequence: 394
  givenname: Mark T
  surname: Mackay
  fullname: Mackay, Mark T
– sequence: 405
  givenname: Ahmad Azam
  surname: Malik
  fullname: Malik, Ahmad Azam
– sequence: 409
  givenname: Mohammad Ali
  surname: Mansournia
  fullname: Mansournia, Mohammad Ali
– sequence: 412
  givenname: Francisco Rogerlândio
  surname: Martins-Melo
  fullname: Martins-Melo, Francisco Rogerlândio
– sequence: 418
  givenname: Entezar
  surname: Mehrabi Nasab
  fullname: Mehrabi Nasab, Entezar
– sequence: 446
  givenname: Shafiu
  surname: Mohammed
  fullname: Mohammed, Shafiu
– sequence: 447
  givenname: Ali H
  surname: Mokdad
  fullname: Mokdad, Ali H
– sequence: 448
  givenname: Mariam
  surname: Molokhia
  fullname: Molokhia, Mariam
– sequence: 462
  givenname: Mehdi
  surname: Naderi
  fullname: Naderi, Mehdi
– sequence: 464
  givenname: Shankar Prasad
  surname: Nagaraju
  fullname: Nagaraju, Shankar Prasad
– sequence: 466
  givenname: Behshad
  surname: Naghshtabrizi
  fullname: Naghshtabrizi, Behshad
– sequence: 476
  givenname: Evangelia
  surname: Nena
  fullname: Nena, Evangelia
– sequence: 482
  givenname: Cuong Tat
  surname: Nguyen
  fullname: Nguyen, Cuong Tat
– sequence: 483
  givenname: Huong Lan Thi
  surname: Nguyen
  fullname: Nguyen, Huong Lan Thi
– sequence: 512
  givenname: Songhomitra
  surname: Panda-Jonas
  fullname: Panda-Jonas, Songhomitra
– sequence: 519
  givenname: Sangram Kishor
  surname: Patel
  fullname: Patel, Sangram Kishor
– sequence: 521
  givenname: Shrikant
  surname: Pawar
  fullname: Pawar, Shrikant
– sequence: 522
  givenname: Hamidreza
  surname: Pazoki Toroudi
  fullname: Pazoki Toroudi, Hamidreza
– sequence: 528
  givenname: Norberto
  surname: Perico
  fullname: Perico, Norberto
– sequence: 530
  givenname: Thomas
  surname: Pilgrim
  fullname: Pilgrim, Thomas
– sequence: 540
  givenname: Elisabetta
  surname: Pupillo
  fullname: Pupillo, Elisabetta
– sequence: 544
  givenname: Ata
  surname: Rafiee
  fullname: Rafiee, Ata
– sequence: 545
  givenname: Alireza
  surname: Rafiei
  fullname: Rafiei, Alireza
– sequence: 549
  givenname: Amir Masoud
  surname: Rahmani
  fullname: Rahmani, Amir Masoud
– sequence: 564
  givenname: Bhageerathy
  surname: Reshmi
  fullname: Reshmi, Bhageerathy
– sequence: 574
  givenname: Dietrich
  surname: Rothenbacher
  fullname: Rothenbacher, Dietrich
– sequence: 597
  givenname: Thirunavukkarasu
  surname: Sathish
  fullname: Sathish, Thirunavukkarasu
– sequence: 598
  givenname: Davide
  surname: Sattin
  fullname: Sattin, Davide
– sequence: 599
  givenname: Sonia
  surname: Saxena
  fullname: Saxena, Sonia
– sequence: 600
  givenname: Ganesh Kumar
  surname: Saya
  fullname: Saya, Ganesh Kumar
– sequence: 621
  givenname: Aziz
  surname: Sheikh
  fullname: Sheikh, Aziz
– sequence: 623
  givenname: Wondimeneh Shibabaw
  surname: Shiferaw
  fullname: Shiferaw, Wondimeneh Shibabaw
– sequence: 637
  givenname: Jasvinder A
  surname: Singh
  fullname: Singh, Jasvinder A
– sequence: 647
  givenname: Joan B
  surname: Soriano
  fullname: Soriano, Joan B
– sequence: 660
  givenname: Rafael
  surname: Tabarés-Seisdedos
  fullname: Tabarés-Seisdedos, Rafael
– sequence: 662
  givenname: Amir
  surname: Taherkhani
  fullname: Taherkhani, Amir
– sequence: 680
  givenname: Riaz
  surname: Uddin
  fullname: Uddin, Riaz
– sequence: 685
  givenname: Era
  surname: Upadhyay
  fullname: Upadhyay, Era
– sequence: 693
  givenname: Madhur
  surname: Verma
  fullname: Verma, Madhur
– sequence: 697
  givenname: Giang Thu
  surname: Vu
  fullname: Vu, Giang Thu
– sequence: 698
  givenname: Yohannes Dibaba
  surname: Wado
  fullname: Wado, Yohannes Dibaba
– sequence: 701
  givenname: Yanping
  surname: Wang
  fullname: Wang, Yanping
– sequence: 703
  givenname: Yuan-Pang
  surname: Wang
  fullname: Wang, Yuan-Pang
– sequence: 705
  givenname: Andrea
  surname: Werdecker
  fullname: Werdecker, Andrea
– sequence: 724
  givenname: Chuanhua
  surname: Yu
  fullname: Yu, Chuanhua
BackLink https://www.ncbi.nlm.nih.gov/pubmed/34416195$$D View this record in MEDLINE/PubMed
https://urn.kb.se/resolve?urn=urn:nbn:se:du-38311$$DView record from Swedish Publication Index
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-451354$$DView record from Swedish Publication Index (Uppsala universitet)
http://kipublications.ki.se/Default.aspx?queryparsed=id:147620241$$DView record from Swedish Publication Index (Karolinska Institutet)
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Contributor Abd-Elsalam, Sherief M
Baig, Atif Amin
Athari, Seyyed Shamsadin
Alvis-Guzman, Nelson
Anwer, Razique
Adeyinka, Daniel Adedayo
Abbasi-Kangevari, Mohsen
Adsuar, Jose C
Azene, Zelalem Nigussie
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Alvis-Zakzuk, Nelson J
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Ahmadi, Keivan
Alanezi, Fahad Mashhour
Asghari Jafarabadi, Mohammad
Ansari-Moghaddam, Alireza
Athari, Seyyede Masoume
Paulson, Katherine R
Antriyandarti, Ernoiz
Alif, Sheikh Mohammad
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Anvari, Davood
Ali, Tilahun
Abady, Gdiom Gebreheat
Alonso, Jordi
Artanti, Kurnia Dwi
Azari, Samad
Abreu, Lucas Guimarães
Alcalde-Rabanal, Jacqueline Elizabeth
B, Darshan B
Abolhassani, Hassan
Ameyaw, Edward Kwabena
Afshari, Khashayar
Al-Mekhlafi, Hesham M
Ahmad, Tauseef
Abdoli, Amir
Alicandro, Gianfranco
Arzani, Afsaneh
Ärnlöv, Johan
Adekanmbi, Victor
Alam, Khurshid
Atteraya, Madhu Sudhan
Almasri, Nihad A
Alanzi, Turki M
Alumran, Arwa Khalid
Asadi-Pooya, Ali A
Al-Aly, Ziyad
Ayala Quintanilla, Beatriz Paulina
Akalu, Yonas
Banach, Maciej
Ansari,
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Copyright 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
2021. The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. This work is published under https://creativecommons.org/licenses/by/3.0/ (theLicense”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license 2021
Copyright_xml – notice: 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
– notice: Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
– notice: 2021. The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. This work is published under https://creativecommons.org/licenses/by/3.0/ (theLicense”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
– notice: 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license 2021
CorporateAuthor GBD 2019 Under-5 Mortality Collaborators
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Snippet Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and...
Summary Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per...
Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000...
BACKGROUND: Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000...
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SubjectTerms Age
Age groups
Birth defects
Cause of Death - trends
Charities
Child
Child mortality
Child Mortality - trends
Child, Preschool
Children
Children & youth
Childrens health
Congenital defects
Coronaviruses
COVID-19
COVID-19 - epidemiology
Death
Fatalities
Female
Global Health - statistics & numerical data
Global Health - trends
Health care delivery
Humans
Infant
Infant mortality
Infant Mortality - trends
Infant, Newborn
Life Tables
Malaria
Male
Mortality
Neonates
Newborn babies
NMR
Nuclear magnetic resonance
Optimization
Pandemics
Pediatrics
Poverty
Public health
Reduction
Regional development
Risk analysis
Risk factors
SARS-CoV-2
Sex differences
Statistical analysis
Survival
Sustainable Development
Trends
Vaccination
Vector-borne diseases
Viral diseases
Womens health
Title 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
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