Mapping under-5 and neonatal mortality in Africa, 2000-15: a baseline analysis for the Sustainable Development Goals.
Mapping under-5 and neonatal mortality in Africa, 2000-15: a baseline analysis for the Sustainable Development Goals.
复制标题
DOI：
10.1016/s0140-6736(17)31758-0
复制
发表时间：
2017-11-11
期刊：
影响因子：
--
通讯作者：
Hay SI
中科院分区：
文献类型：
--
作者：
Golding N;Burstein R;Longbottom J;Browne AJ;Fullman N;Osgood-Zimmerman A;Earl L;Bhatt S;Cameron E;Casey DC;Dwyer-Lindgren L;Farag TH;Flaxman AD;Fraser MS;Gething PW;Gibson HS;Graetz N;Krause LK;Kulikoff XR;Lim SS;Mappin B;Morozoff C;Reiner RC Jr;Sligar A;Smith DL;Wang H;Weiss DJ;Murray CJL;Moyes CL;Hay SI
在千年发展目标时期，非洲许多国家实现了5岁以下儿童和新生儿死亡率的显著下降。然而，在国家一级，实现这些目标的进展速度差异很大，这表明必须跟踪更多的地方儿童死亡率趋势。随着2015年可持续发展目标（SDG）的通过，该目标制定了到2030年改善儿童生存的宏伟目标，最佳干预规划和目标定位将需要以更高的空间分辨率了解趋势和进展速度。在这项研究中，我们的目标是对非洲46个国家的5岁以下儿童和新生儿全因死亡率进行高分辨率估计。我们收集了235个按地理位置划分的家庭调查和人口普查儿童死亡数据源，以产生2000年、2005年、2010年和2015年46个非洲国家5岁以下儿童和新生儿死亡率的估计值，分辨率为5 × 5 km网格单元。 我们使用贝叶斯地质统计分析框架来生成这些估计值，并进行预测有效性测试。除了报告5 × 5 km的估计值外，我们还将这些估计值的结果汇总到三个不同的级别-国家和次国家行政级别1和2-以提供地方，国家和全球决策者可能需要的全方位地理空间分辨率。 在改善非洲儿童生存率的同时，2015年5岁以下儿童和新生儿死亡率的绝对水平以及2000年至2015年实现的年化下降率存在很大差异。博茨瓦纳、卢旺达和埃塞俄比亚等国家的国家以下地区的儿童死亡率自2000年以来出现了最大幅度的下降，使它们能够在2030年或更早实现可持续发展目标。然而，这些地区是非洲的例外，因为许多地区，特别是中非和西非，必须在2015年至2030年期间每年将5岁以下儿童死亡率至少降低8.8%，才能在2030年前实现可持续发展目标3.2中关于5岁以下儿童死亡率的目标。在缺乏前所未有的政治承诺、财政支持和医疗进步的情况下，非洲实现可持续发展目标3.2的可行性充其量也是不稳定的。这项研究通过在多个地理空间分辨率水平上得出一段时间内5岁以下儿童和新生儿死亡率，为决策者提供了关键信息，以便针对最需要的人群采取干预措施。在精准公共卫生越来越有可能改变卫生规划的设计、实施和影响的时代，我们对非洲儿童死亡率的5×5公里估计提供了一个基线，地方、国家和全球利益相关者可以据此绘制到2030年结束可预防儿童死亡的路径。 比尔和梅林达·盖茨基金会。
During the Millennium Development Goal (MDG) era, many countries in Africa achieved marked reductions in under-5 and neonatal mortality. Yet the pace of progress toward these goals substantially varied at the national level, demonstrating an essential need for tracking even more local trends in child mortality. With the adoption of the Sustainable Development Goals (SDGs) in 2015, which established ambitious targets for improving child survival by 2030, optimal intervention planning and targeting will require understanding of trends and rates of progress at a higher spatial resolution. In this study, we aimed to generate high-resolution estimates of under-5 and neonatal all-cause mortality across 46 countries in Africa. We assembled 235 geographically resolved household survey and census data sources on child deaths to produce estimates of under-5 and neonatal mortality at a resolution of 5 × 5 km grid cells across 46 African countries for 2000, 2005, 2010, and 2015. We used a Bayesian geostatistical analytical framework to generate these estimates, and implemented predictive validity tests. In addition to reporting 5 × 5 km estimates, we also aggregated results obtained from these estimates into three different levels—national, and subnational administrative levels 1 and 2—to provide the full range of geospatial resolution that local, national, and global decision makers might require. Amid improving child survival in Africa, there was substantial heterogeneity in absolute levels of under-5 and neonatal mortality in 2015, as well as the annualised rates of decline achieved from 2000 to 2015. Subnational areas in countries such as Botswana, Rwanda, and Ethiopia recorded some of the largest decreases in child mortality rates since 2000, positioning them well to achieve SDG targets by 2030 or earlier. Yet these places were the exception for Africa, since many areas, particularly in central and western Africa, must reduce under-5 mortality rates by at least 8·8% per year, between 2015 and 2030, to achieve the SDG 3.2 target for under-5 mortality by 2030. In the absence of unprecedented political commitment, financial support, and medical advances, the viability of SDG 3.2 achievement in Africa is precarious at best. By producing under-5 and neonatal mortality rates at multiple levels of geospatial resolution over time, this study provides key information for decision makers to target interventions at populations in the greatest need. In an era when precision public health increasingly has the potential to transform the design, implementation, and impact of health programmes, our 5 × 5 km estimates of child mortality in Africa provide a baseline against which local, national, and global stakeholders can map the pathways for ending preventable child deaths by 2030. Bill & Melinda Gates Foundation.