Can we achieve Millennium Development Goal 4? New analysis of country trends and forecasts of under-5 mortality to 2015
Can we achieve Millennium Development Goal 4? New analysis of country trends and forecasts of under-5 mortality to 2015
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DOI：
10.1016/s0140-6736(07)61478-0
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发表时间：
2007-09-22
期刊：
影响因子：
168.9
通讯作者：
Lopez, Alan D.
中科院分区：
文献类型：
--
作者：
Murray, Christopher J. L.;Loakso, Thomas;Lopez, Alan D.
全球努力提高了5岁以下儿童死亡率估计数的准确性和及时性;然而，这些估计数没有使用所有可用数据，没有使用透明和可重复的方法，没有区分预测和测量，也没有表明点估计数的不确定性。我们的目的是开发新的可重复的方法和重新分析现有的数据，以阐明详细的时间trends.Methods我们合并现有的数据库，添加到他们在可能的情况下，然后应用黄土回归估计过去的趋势和预测到2015年为172个国家。我们开发的不确定性估计的基础上，不同的模型规格和估计的水平和趋势在新生儿，新生儿后期，和childhood mortality.Findings全球5岁以下儿童死亡率已从110（109-110）每1000人在1980年下降到72（70-74）每1000人在2005年。全世界儿童死亡人数从1980年的1 350万（1 340 - 1 360万）下降到2005年的估计970万（950 - 1 000万）。从1990年到2015年，全球5岁以下儿童死亡率预计将下降27%，大大低于千年发展目标4的下降67%的具体目标。在拉丁美洲、北非、中东、欧洲和东南亚的几个地区，35年来的年下降率一直超过4%。全球在千年发展目标4方面取得的进展主要是撒哈拉以南非洲地区的缓慢下降，该地区的生育率下降速度也最慢。解读从全球来看，我们现在在降低儿童死亡率方面并没有比30年前做得更好。通过更充分地利用现有数据集和采用标准分析战略，应可进一步提高儿童死亡率计量的质量和及时性。
Background Global efforts have increased the accuracy and timeliness of estimates of under-5 mortality; however, these estimates fail to use all data available, do not use transparent and reproducible methods, do not distinguish predictions from measurements, and provide no indication of uncertainty around point estimates. We aimed to develop new reproducible methods and reanalyse existing data to elucidate detailed time trends.Methods We merged available databases, added to them when possible, and then applied Loess regression to estimate past trends and forecast to 2015 for 172 countries. We developed uncertainty estimates based on different model specifications and estimated levels and trends in neonatal, post-neonatal, and childhood mortality.Findings Global under-5 mortality has fallen from 110 (109-110) per 1000 in 1980 to 72 (70-74) per 1000 in 2005. Child deaths worldwide have decreased from 13.5 (13.4-13.6) million in 1980 to an estimated 9.7 (9.5-10.0) million in 2005. Global under-5 mortality is expected to decline by 27% from 1990 to 2015, substantially less than the target of Millennium Development Goal 4 (MDG4) of a 67% decrease. Several regions in Latin America, north Africa, the Middle East, Europe, and southeast Asia have had consistent annual rates of decline in excess of 4% over 35 years. Global progress on MDG4 is dominated by slow reductions in sub-Saharan Africa, which also has the slowest rates of decline in fertility.Interpretation Globally, we are not doing a better job of reducing child mortality now than we were three decades ago. Further improvements in the quality and timeliness of child-mortality measurements should be possible by more fully using existing datasets and applying standard analytical strategies.