Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis
Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis
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DOI：
10.1016/s0140-6736(11)61337-8
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发表时间：
2011-09-24
期刊：
影响因子：
168.9
通讯作者：
Murray, Christopher J. L.
中科院分区：
文献类型：
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作者：
Lozano, Rafael;Wang, Haidong;Murray, Christopher J. L.
在距离2015年还有4年的时间里，必须监测实现千年发展目标4和5的进展情况。虽然2010年公布了孕产妇和儿童死亡率估计数，但鉴于已有更多的数据来源和新的方法，更新估计数是及时的。我们的目标是使用更好的数据和更可靠的方法更新以前的孕产妇和儿童死亡率估计，为跟踪千年发展目标4和5的进展情况提供最佳证据。方法我们更新了对2010年以来千年发展目标4和5进展情况的分析，增加了调查，人口普查，生命登记和死因推断数据。对于儿童，我们估计了早期新生儿（0-6天），晚期新生儿（7-28天），新生儿后期（29-364天），儿童（1-4岁）和5岁以下死亡率。我们使用一个改进的模型来估计5岁以下儿童的死亡率。对于孕产妇死亡率，我们的最新分析包括超过1000个额外的研究中心-年的数据。我们测试了大量的产妇死亡率替代模型;我们使用了一个基于样本外预测有效性最好的模型的集成模型，以生成1990年至2011年的新估计。结果5岁以下儿童死亡人数持续下降，2011年达到720万，其中220万为早期新生儿，70万为晚期新生儿，210万为新生儿后期，儿童期（1-4岁）为220万人。将1990年至2000年的下降率与2000年至2011年的下降率进行比较，可以看出，在过去十年中，有106个国家的儿童死亡率加速下降。孕产妇死亡率也持续下降，从1990年的409 100人（不确定区间382 900-437 900）下降到2011年的273 500人（256 300-291 700）。我们估计，2011年有56 100例孕产妇死亡是怀孕期间与艾滋病毒有关的死亡。根据发展中国家的最新趋势，31个国家将实现千年发展目标4，13个国家将实现千年发展目标5，9个国家将同时实现这两项目标。解释尽管大多数国家在降低孕产妇和儿童死亡率方面的进展正在加快，但大多数发展中国家在2015年之后仍将需要多年时间才能实现千年发展目标4和5的具体目标。同样，虽然在降低孕产妇死亡率方面继续取得进展，但步伐缓慢，没有任何加速的总体证据。许多国家需要立即采取协调一致的行动，以实现千年发展目标4和5。
Background With 4 years until 2015, it is essential to monitor progress towards Millennium Development Goals (MDGs) 4 and 5. Although estimates of maternal and child mortality were published in 2010, an update of estimates is timely in view of additional data sources that have become available and new methods developed. Our aim was to update previous estimates of maternal and child mortality using better data and more robust methods to provide the best available evidence for tracking progress on MDGs 4 and 5.Methods We update the analyses of the progress towards MDGs 4 and 5 from 2010 with additional surveys, censuses, vital registration, and verbal autopsy data. For children, we estimate early neonatal (0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (ages 1-4 years), and under-5 mortality. We use an improved model for estimating mortality by age under 5 years. For maternal mortality, our updated analysis includes greater than 1000 additional site-years of data. We tested a large set of alternative models for maternal mortality; we used an ensemble model based on the models with the best out-of-sample predictive validity to generate new estimates from 1990 to 2011.Findings Under-5 deaths have continued to decline, reaching 7.2 million in 2011 of which 2.2 million were early neonatal, 0.7 million late neonatal, 2.1 million postneonatal, and 2.2 million during childhood (ages 1-4 years). Comparing rates of decline from 1990 to 2000 with 2000 to 2011 shows that 106 countries have accelerated declines in the child mortality rate in the past decade. Maternal mortality has also continued to decline from 409 100 (uncertainty interval 382 900-437 900) in 1990 to 273 500 (256 300-291 700) deaths in 2011. We estimate that 56 100 maternal deaths in 2011 were HIV-related deaths during pregnancy. Based on recent trends in developing countries, 31 countries will achieve MDG 4, 13 countries MDG 5, and nine countries will achieve both.Interpretation Even though progress on reducing maternal and child mortality in most countries is accelerating, most developing countries will take many years past 2015 to achieve the targets of the MDGs 4 and 5. Similarly, although there continues to be progress on maternal mortality the pace is slow, without any overall evidence of acceleration. Immediate concerted action is needed for a large number of countries to achieve MDG 4 and MDG 5.