Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals.
Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals.
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DOI：
10.1016/s0140-6736(16)31593-8
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发表时间：
2016-12-17
期刊：
影响因子：
168.9
通讯作者：
Black, Robert E.
中科院分区：
文献类型：
--
作者：
Liu, Li;Oza, Shefali;Hogan, Dan;Chu, Yue;Perin, Jamie;Zhu, Jun;Lawn, Joy E.;Cousens, Simon;Mathers, Colin;Black, Robert E.
尽管1990年至2015年期间在改善儿童存活率方面取得了显著进展，但千年发展目标4关于将5岁以下儿童死亡率降低三分之二的具体目标在全球仍未实现。在本文中，我们更新了2000- 2015年儿童死亡率的年度估计，以反映千年发展目标4的进展情况，并考虑对可持续发展目标（SDG）儿童生存目标的影响。我们将新生儿死亡原因的估计输入数据增加了43%，1-59个月大的婴儿死亡原因的估计输入数据增加了23%。我们使用了足够的生命登记（VR）数据（如果可用），并使用适当的VR（5岁以下儿童死亡率低的国家）和死因推断数据（5岁以下儿童死亡率高的国家），采用多项logistic回归模型对死因特异性死亡率分数进行建模。我们更新了估计值，在疟疾死亡模型中使用恶性疟原虫寄生虫率代替疟疾指数;使用调整后的经验估计值代替中国的模型估计值;并在估计中考虑肺炎球菌结合疫苗和轮状病毒疫苗的影响。2015年，在590万5岁以下儿童死亡中，有270万发生在新生儿时期。5岁以下儿童的主要原因是早产并发症（10.55亿[95%不确定性范围（UR）0.935 - 1.179]）、肺炎（9.21亿[0.812 - 1.117]）和产时相关事件（6.91亿[0.598 - 0.778]）。在5岁以下儿童死亡最多的两个千年发展目标区域，主要原因是撒哈拉以南非洲的肺炎和南亚的早产并发症。2000- 2015年，五岁以下儿童死亡率每1 000例活产减少35例，其中61%是由于肺炎、腹泻、新生儿产时相关事件、疟疾和麻疹死亡率的减少。按五岁以下幼儿死亡率分层，在五岁以下幼儿死亡率很高的国家，肺炎是主要原因。早产并发症和肺炎在儿童死亡率高、中高和中等的国家都很重要;而在五岁以下幼儿死亡率低和极低的国家，先天畸形是最重要的原因。在可持续发展目标时代，建议各国根据儿童死亡原因构成优先考虑儿童生存政策和计划。为了实现可持续发展目标的儿童生存目标，需要继续加强努力，扩大已被证明的救生干预措施。比尔和梅林达·盖茨基金会，卫生组织。
Despite 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. We 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. In 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. In 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. Bill & Melinda Gates Foundation, WHO.