Abstract
SummaryBackgroundDespite remarkable progress in the improvement of child survival between 1990 and 2015, the Millennium Development Goal (MDG) 4 target of a two-thirds reduction of under-5 mortality rate (U5MR) was not achieved globally. In this paper, we updated our annual estimates of child mortality by cause to 2000–15 to reflect on progress toward the MDG 4 and consider implications for the Sustainable Development Goals (SDG) target for child survival.MethodsWe increased the estimation input data for causes of deaths by 43% among neonates and 23% among 1–59-month-olds, respectively. We used adequate vital registration (VR) data where available, and modelled cause-specific mortality fractions applying multinomial logistic regressions using adequate VR for low U5MR countries and verbal autopsy data for high U5MR countries. We updated the estimation to use Plasmodium falciparum parasite rate in place of malaria index in the modelling of malaria deaths; to use adjusted empirical estimates instead of modelled estimates for China; and to consider the effects of pneumococcal conjugate vaccine and rotavirus vaccine in the estimation.FindingsIn 2015, among the 5·9 million under-5 deaths, 2·7 million occurred in the neonatal period. The leading under-5 causes were preterm birth complications (1·055 million [95% uncertainty range (UR) 0·935–1·179]), pneumonia (0·921 million [0·812 −1·117]), and intrapartum-related events (0·691 million [0·598 −0·778]). In the two MDG regions with the most under-5 deaths, the leading cause was pneumonia in sub-Saharan Africa and preterm birth complications in southern Asia. Reductions in mortality rates for pneumonia, diarrhoea, neonatal intrapartum-related events, malaria, and measles were responsible for 61% of the total reduction of 35 per 1000 livebirths in U5MR in 2000–15. Stratified by U5MR, pneumonia was the leading cause in countries with very high U5MR. Preterm birth complications and pneumonia were both important in high, medium high, and medium child mortality countries; whereas congenital abnormalities was the most important cause in countries with low and very low U5MR.InterpretationIn the SDG era, countries are advised to prioritise child survival policy and programmes based on their child cause-of-death composition. Continued and enhanced efforts to scale up proven life-saving interventions are needed to achieve the SDG child survival target.FundingBill & Melinda Gates Foundation, WHO.
Highlights
The year 2015 marks the end of the Millennium Development Goals (MDGs) era, during which the under-5 mortality rate (U5MR) reduced by an impressive 53% globally, still falling short of the MDG 4 target of a two-thirds reduction from 1990 to 2015.1,2
We update our annual estimates of child mortality by cause to 2000–15; reflect on progress toward the MDG 4; and consider the implications for national and global priorities if the Sustainable Development Goals (SDG) target for child survival is to be achieved
We modelled cause-specific mortality fractions (CSMFs) using a multinomial logistic regression (MLR) applied to input CSMFs calculated from number of deaths by cause from vital registration (VR) countries and their distal and proximate determinates of child survival as model inputs.[9]
Summary
The year 2015 marks the end of the Millennium Development Goals (MDGs) era, during which the under-5 mortality rate (U5MR) reduced by an impressive 53% globally, still falling short of the MDG 4 target of a two-thirds reduction from 1990 to 2015.1,2. Year 2016 marks the beginning of the implementation of the Sustainable Development Goals (SDGs).[3] The SDGs target an U5MR of no more than 25 per 1000 livebirths in every country of the world in 2030.4 To plan how to eliminate preventable child deaths, information is needed about the current distribution of causes of child deaths and this has changed in recent decades. We update our annual estimates of child mortality by cause to 2000–15; reflect on progress toward the MDG 4; and consider the implications for national and global priorities if the SDG target for child survival is to be achieved
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