Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities.
Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities.
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DOI：
10.1371/journal.pmed.1001080
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发表时间：
2011-08
期刊：
影响因子：
15.8
通讯作者：
United Nations Inter-Agency Group for Child Mortality Estimation and the Child Health Epidemiology Reference Group
中科院分区：
文献类型：
--
作者：
Oestergaard MZ;Inoue M;Yoshida S;Mahanani WR;Gore FM;Cousens S;Lawn JE;Mathers CD;United Nations Inter-Agency Group for Child Mortality Estimation and the Child Health Epidemiology Reference Group
Mikkel Oestergaard 及其同事对 193 个国家 1990 年至 2009 年的新生儿死亡率和新生儿死亡情况进行了年度估计，并对未来进行了预测。从历史上看，儿童死亡率研究的主要焦点是婴儿和五岁以下儿童死亡率。新生儿死亡率（出生后 28 天以下的死亡）受到的关注有限，尽管此类死亡约占所有儿童死亡的 41%。为了更好地评估进展情况，我们对 193 个国家 1990 年至 2009 年期间的新生儿死亡率 (NMR) 和新生儿死亡情况进行了年度估计，并对未来进行了预测。我们编制了新生儿和儿童（<5 岁）死亡率数据库，包含 3,551 个国家/地区的信息。提供了 38 个国家 1990 年至 2009 年可靠的民事登记数据。开发了一个统计模型来估计其余 155 个国家的 NMR，其中 17 个国家没有国家数据。进行了国家磋商以确定数据输入并审查估计值。 2009 年，估计有 330 万婴儿在出生后第一个月死亡，而 1990 年有 460 万新生儿死亡，超过一半的新生儿死亡发生在世界五个国家（占全球活产儿的 44%）：印度 27.8%（占全球活产儿的 19.6%）、尼日利亚 7.2%（4.5%）、巴基斯坦 6.9%（4.0%）、中国6.4% (13.4%)，刚果民主共和国 4.6% (2.1%)。 1990 年至 2009 年间，全球 NMR 下降了 28%，从每 1,000 例活产死亡 33.2 例下降到 23.9 例。世界所有地区的新生儿期儿童死亡比例均有所增加，目前全球已达到 41%。虽然世界某些地区的 NMR 减少了一半，但非洲的 NMR 仅下降了 17.6%（43.6 至 35.9）。世界所有地区的新生儿死亡率均有所下降。核磁共振高的地区进展最慢。如果要实现千年发展目标 4（儿童死亡率降低三分之二），全球卫生计划需要更有效地解决新生儿死亡问题。 请参阅本文后面的编辑摘要 每年，超过 800 万儿童在五岁生日之前死亡。这些死亡大多数发生在发展中国家，并且大多数是由可预防或可治疗的疾病引起的。 2000年，世界领导人制定了千年发展目标4（MDG4），即到2015年将儿童死亡率降低至1990年水平的三分之一。这一目标与其他七个目标一起旨在帮助改善世界上最贫穷国家的社会、经济和健康状况。近年来，降低儿童死亡率的进展有所加快，但仍不足以实现千年发展目标 4。特别是，在减少新生儿死亡（生命前 28 天内的死亡）方面进展缓慢，与 1990 年相比，新生儿死亡目前在全球儿童死亡中所占的比例更高。目前，5 岁以下儿童所有死亡中近 41% 发生在新生儿时期。新生儿死亡的主要原因是早产并发症、分娩期间或分娩后的呼吸问题（出生窒息）以及血液感染（败血症）和肺部感染（肺炎）。改善出生时的卫生状况和母乳喂养建议等简单的干预措施可以大大减少新生儿死亡率。如果要实现千年发展目标 4，就必须采取更多措施来防止新生儿死亡。为了提高这一弱势群体的生存率并监测公共卫生干预措施的效果，对国家新生儿死亡率（NMR，每 1,000 名活产儿的新生儿死亡人数）进行准确、最新的估计至关重要。尽管联合国儿童死亡率估计机构间小组每年都会对各个国家的婴儿（一岁以下）和五岁以下儿童死亡率进行估计，但以前从未产生过年度 NMR 趋势估计。在许多发达国家，儿童死亡率可以直接根据重要的民事登记数据（所有出生和死亡的记录）计算出来。但许多发展中国家缺乏生命登记系统，必须使用人口和健康调查（帮助发展中国家收集健康和人口趋势数据的项目）等家庭调查中收集的数据来估计儿童死亡率。在这项研究中，研究人员利用现有数据估算了过去 20 年的年度全国核磁共振和新生儿死亡人数。研究人员利用民事登记系统、家庭调查和其他来源编制了 1990 年至 2009 年间 193 个国家的新生儿和 5 岁以下儿童死亡数据库。他们根据可靠的生命登记数据估算了 38 个国家的 NMR，并开发了一个统计模型来估算其余 155 个国家（其中发生了全球 92% 的活产）的 NMR。 2009 年，有 330 万婴儿在出生后第一个月内死亡，而 1990 年为 460 万。2009 年一半以上的新生儿死亡发生在五个国家：印度、尼日利亚、巴基斯坦、中国和刚果民主共和国。在整个研究中，印度的新生儿死亡人数最多。 1990 年至 2009 年间，尽管全球 NMR 死亡人数从每 1,000 名活产 33.2 例下降到 23.9 例（下降 28%），但 8 个国家的 NMR 有所增加，其中 5 个国家位于非洲。此外，在整个非洲，NMR 仅下降了 17.6%，从 1990 年的每 1,000 名活产儿 43.6 例下降到 2009 年的每 1,000 名活产儿 35.9 例。这些和其他研究结果表明，自 1990 年以来，世界所有地区的新生儿死亡率均有所下降，但在非洲等 NMR 值高的地区，进展最慢。尽管研究人员计算的估计值存在相当大的不确定性，但这些发现凸显了过去 20 年来在降低新生儿死亡风险方面进展缓慢，并表明新生儿死亡对儿童死亡的相对贡献在未来将会增加。因此，如果要实现千年发展目标 4，各国政府和国际卫生机构就必须投资改进新生儿死亡和死产的衡量方法，并增加对出生时和生命最初几周护理服务的投资。请通过此摘要的在线版本访问这些网站：http://dx.doi.org/10.1371/journal.pmed.1001080。联合国儿童基金会（UNICEF）致力于世界各地儿童的权利、生存、发展和保护；它提供有关千年发展目标 4 的信息，其 Childinfo 网站提供有关儿童生存和健康的详细统计数据，包括联合国儿童死亡率估计机构间小组的说明及其数据库的链接，以及有关新生儿护理的信息（一些信息有多种语言版本） 世界卫生组织还提供有关千年发展目标 4 的信息，提供有关新生儿死亡率的信息，并提供儿童死亡率的最新估计值 可提供有关千年发展目标的更多信息人口统计和健康调查
Mikkel Oestergaard and colleagues develop annual estimates for neonatal mortality rates and neonatal deaths for 193 countries for 1990 to 2009, and forecasts into the future. Historically, the main focus of studies of childhood mortality has been the infant and under-five mortality rates. Neonatal mortality (deaths <28 days of age) has received limited attention, although such deaths account for about 41% of all child deaths. To better assess progress, we developed annual estimates for neonatal mortality rates (NMRs) and neonatal deaths for 193 countries for the period 1990–2009 with forecasts into the future. We compiled a database of mortality in neonates and children (<5 years) comprising 3,551 country-years of information. Reliable civil registration data from 1990 to 2009 were available for 38 countries. A statistical model was developed to estimate NMRs for the remaining 155 countries, 17 of which had no national data. Country consultation was undertaken to identify data inputs and review estimates. In 2009, an estimated 3.3 million babies died in the first month of life—compared with 4.6 million neonatal deaths in 1990—and more than half of all neonatal deaths occurred in five countries of the world (44% of global livebirths): India 27.8% (19.6% of global livebirths), Nigeria 7.2% (4.5%), Pakistan 6.9% (4.0%), China 6.4% (13.4%), and Democratic Republic of the Congo 4.6% (2.1%). Between 1990 and 2009, the global NMR declined by 28% from 33.2 deaths per 1,000 livebirths to 23.9. The proportion of child deaths that are in the neonatal period increased in all regions of the world, and globally is now 41%. While NMRs were halved in some regions of the world, Africa's NMR only dropped 17.6% (43.6 to 35.9). Neonatal mortality has declined in all world regions. Progress has been slowest in the regions with high NMRs. Global health programs need to address neonatal deaths more effectively if Millennium Development Goal 4 (two-thirds reduction in child mortality) is to be achieved. Please see later in the article for the Editors' Summary Every year, more than 8 million children die before their fifth birthday. Most of these deaths occur in developing countries and most are caused by preventable or treatable diseases. In 2000, world leaders set a target of reducing child mortality to one-third of its 1990 level by 2015 as Millennium Development Goal 4 (MDG4). This goal, together with seven others, is designed to help improve the social, economic, and health conditions in the world's poorest countries. In recent years, progress towards reducing child mortality has accelerated but remains insufficient to achieve MDG4. In particular, progress towards reducing neonatal deaths—deaths during the first 28 days of life—has been slow and neonatal deaths now account for a greater proportion of global child deaths than in 1990. Currently, nearly 41% of all deaths among children under the age of 5 years occur during the neonatal period. The major causes of neonatal deaths are complications of preterm delivery, breathing problems during or after delivery (birth asphyxia), and infections of the blood (sepsis) and lungs (pneumonia). Simple interventions such as improved hygiene at birth and advice on breastfeeding can substantially reduce neonatal deaths. If MDG4 is to be met, more must be done to prevent deaths among newborn babies. To improve survival rates and to monitor the effects of public-health interventions in this vulnerable group, accurate, up-to-date estimates of national neonatal mortality rates (NMRs, the number of neonatal deaths per 1,000 live births) are essential. Although infant (under-one) and under-five mortality rates are estimated annually for individual countries by the United Nations Interagency Group for Child Mortality Estimation, annual NMR trend estimates have not been produced before. In many developed countries, child mortality rates can be calculated directly from vital civil registration data—records of all births and deaths. But many developing countries lack vital registration systems and child mortality has to be estimated using data collected in household surveys such as the Demographic and Health Surveys (a project that helps developing countries collect data on health and population trends). In this study, the researchers estimate annual national NMRs and numbers of neonatal deaths for the past 20 years using the available data. The researchers used civil registration systems, household surveys, and other sources to compile a database of deaths among neonates and children under 5 years old for 193 countries between 1990 and 2009. They estimated NMRs for 38 countries from reliable vital registration data and developed a statistical model to estimate NMRs for the remaining 155 countries (in which 92% of global live births occurred). In 2009, 3.3 million babies died during their first month of life compared to 4.6 million in 1990. More than half the neonatal deaths in 2009 occurred in five countries—India, Nigeria, Pakistan, China, and the Democratic Republic of Congo. India had the largest number of neonatal deaths throughout the study. Between 1990 and 2009, although the global NMR decreased from 33.2 to 23.9 deaths per 1,000 live births (a decrease of 28%), NMRs increased in eight countries, five of which were in Africa. Moreover, in Africa as a whole, the NMR only decreased by 17.6%, from 43.6 per 1,000 live births in 1990 to 35.9 per 1,000 live births in 2009. These and other findings suggest that neonatal mortality has declined in all world regions since 1990 but that progress has been slowest in the regions with high NMRs such as Africa. Although there is considerable uncertainty around the estimates calculated by the researchers, these findings nevertheless highlight the slow progress in reducing the neonatal mortality risk over the past 20 years and suggest that the relative contribution of neonatal deaths to child deaths will increase into the future. Thus, if MDG4 is to be achieved, it is essential that national governments and international health bodies invest in improved methods for the measurement of neonatal deaths and stillbirths and increase their investment in the provision of care at birth and during the first few weeks of life. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001080. The United Nations Children's Fund (UNICEF) works for children's rights, survival, development, and protection around the world; it provides information on Millennium Development Goal 4, and its Childinfo Web site provides detailed statistics about child survival and health, including a description of the United Nations Interagency Group for Child Mortality Estimation and a link to its database, and information on newborn care (some information in several languages) The World Health Organization also has information about the Millennium Development Goal 4, provides information on newborn mortality, and provides the latest estimates of child mortality Further information about the Millennium Development Goals is available Information is also available about the Demographic and Health Surveys
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影响因子：
168.9
作者：
Rajaratnam, Julie Knoll;Marcus, Jake R.;Murray, Chnstopher J. L.
通讯作者：
Murray, Chnstopher J. L.
影响因子：
168.9
作者：
Lawn, Joy E.;Blencowe, Hannah;Stanton, Cynthia
通讯作者：
Stanton, Cynthia
影响因子：
12.7
作者：
MCCARTHY, BJ;TERRY, J;TYLER, CW
通讯作者：
TYLER, CW
影响因子：
168.9
作者：
Hogan, Margaret C.;Foreman, Kyle J.;Murray, Christopher J. L.
通讯作者：
Murray, Christopher J. L.
影响因子：
3.1
作者：
Lawn JE;Gravett MG;Nunes TM;Rubens CE;Stanton C;GAPPS Review Group
通讯作者：
GAPPS Review Group