Abstract
Monitoring development indicators has become a central interest of international agencies and countries for tracking progress towards the Millennium Development Goals. In this review, which also provides an introduction to a collection of articles, we describe the methodology used by the United Nations Inter-agency Group for Child Mortality Estimation to track country-specific changes in the key indicator for Millennium Development Goal 4 (MDG 4), the decline of the under-five mortality rate (the probability of dying between birth and age five, also denoted in the literature as U5MR and (5)q(0)). We review how relevant data from civil registration, sample registration, population censuses, and household surveys are compiled and assessed for United Nations member states, and how time series regression models are fitted to all points of acceptable quality to establish the trends in U5MR from which infant and neonatal mortality rates are generally derived. The application of this methodology indicates that, between 1990 and 2010, the global U5MR fell from 88 to 57 deaths per 1,000 live births, and the annual number of under-five deaths fell from 12.0 to 7.6 million. Although the annual rate of reduction in the U5MR accelerated from 1.9% for the period 1990-2000 to 2.5% for the period 2000-2010, it remains well below the 4.4% annual rate of reduction required to achieve the MDG 4 goal of a two-thirds reduction in U5MR from its 1990 value by 2015. Thus, despite progress in reducing child mortality worldwide, and an encouraging increase in the pace of decline over the last two decades, MDG 4 will not be met without greatly increasing efforts to reduce child deaths.
Highlights
Evidence-based estimation of child mortality is a cornerstone for tracking progress towards Millennium Development Goal 4 (MDG 4), which calls for a two-thirds reduction in the underfive mortality rate between 1990 and 2015, and for planning national and global health strategies, policies, and interventions on child health
Child mortality estimates from Full birth history (FBH) are typically calculated for periods up to 25 years before the survey date, even though such estimates are increasingly affected by selection bias because earlier recorded births increasingly represent those to mothers young at the time of the birth who survived to the survey
The under-five mortality rate (U5MR) has declined by 35% from 87.6 deaths per 1,000 live births in 1990 to 56.7 in 2010, with an annual rate of reduction (ARR) of 2.2%; the infant mortality rate (IMR) has fallen by 34%, and the neonatal mortality rate (NMR) has declined by 30%
Summary
Evidence-based estimation of child mortality is a cornerstone for tracking progress towards Millennium Development Goal 4 (MDG 4), which calls for a two-thirds reduction in the underfive mortality rate (the probability of dying between birth and age five, denoted in the literature as U5MR and 5q0) between 1990 and 2015, and for planning national and global health strategies, policies, and interventions on child health. Child mortality estimates from FBHs are typically calculated for periods up to 25 years before the survey date, even though such estimates are increasingly affected by selection bias because earlier recorded births increasingly represent those to mothers young at the time of the birth who survived to the survey In another example, UN IGME adjusts the data used to estimate child mortality in eastern European countries because of concerns about the low levels of early neonatal death recorded in the civil registration systems of these countries compared to western European countries as a result of differences in the definition of live births [6]. For neonatal deaths in 2010, India accounted for about 30% of deaths, and Nigeria for about 8%
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