Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: a systematic analysis of progress towards Millennium Development Goal 4
Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: a systematic analysis of progress towards Millennium Development Goal 4
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DOI：
10.1016/s0140-6736(10)60703-9
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发表时间：
2010-06-05
期刊：
影响因子：
168.9
通讯作者：
Murray, Chnstopher J. L.
中科院分区：
文献类型：
--
作者：
Rajaratnam, Julie Knoll;Marcus, Jake R.;Murray, Chnstopher J. L.
背景以往的评估强调指出，只有不到四分之一的国家有望实现千年发展目标4，该目标要求在1990年至2015年期间将5岁以下儿童死亡率降低三分之二。鉴于自2000年以来的政策举措和投资，重要的是要看看是否有加速实现千年发展目标4的目标。我们评估了1970年至2010年187个国家儿童死亡率的水平和趋势。方法我们汇编了1970年至2009年187个国家5岁以下儿童死亡率的16174个测量数据库，利用所有现有来源的数据，包括人口动态登记系统、人口普查和调查中的出生记录摘要以及完整的出生记录。我们使用高斯过程回归来估计出生到5岁之间的死亡概率。这是第一个使用高斯过程回归来估计儿童死亡率的研究，这种技术比以前的方法具有更好的样本外预测有效性，并捕获了由不同数据类型的采样和非采样误差引起的不确定性。新生儿、新生儿后期和儿童死亡率是根据5岁以下儿童的死亡率估算的，方法是使用来自生命登记系统的1760个测量值和完整的出生史，其中包含有关新生儿和新生儿后期死亡率的具体信息。包括310万新生儿死亡、230万新生儿后期死亡和230万儿童死亡（1-4岁儿童死亡）。5岁以下儿童死亡的33.0%发生在南亚，49.6%发生在撒哈拉以南非洲，不到1%的死亡发生在高收入国家。在世界21个地区，新生儿、新生儿后期和儿童死亡率正在下降。从1990年到2010年，全球新生儿死亡率每年下降2.1%，新生儿后期死亡率下降2.3%，儿童死亡率下降2.2%。在世界13个区域，包括撒哈拉以南非洲的所有区域，有证据表明，与1990年至2000年相比，2000年至2010年的下降速度加快。在撒哈拉以南非洲地区，安哥拉、博茨瓦纳、喀麦隆、刚果、刚果民主共和国、肯尼亚、莱索托、利比里亚、卢旺达、塞内加尔、塞拉利昂、斯威士兰和冈比亚的下降率上升了1%以上。这些积极的事态发展值得关注，可能需要加强政策关注和资源。
Background Previous assessments have highlighted that less than a quarter of countries are on track to achieve Millennium Development Goal 4 (MDG 4), which calls for a two-thirds reduction in mortality in children younger than 5 years between 1990 and 2015. In view of policy initiatives and investments made since 2000, it is important to see if there is acceleration towards the MDG 4 target We assessed levels and trends in child mortality for 187 countries from 1970 to 2010.Methods We compiled a database of 16174 measurements of mortality in children younger than 5 years for 187 countries from 1970 to 2009, by use of data from all available sources, including vital registration systems, summary birth histories in censuses and surveys, and complete birth histories. We used Gaussian process regression to generate estimates of the probability of death between birth and age 5 years. This is the first study that uses Gaussian process regression to estimate child mortality, and this technique has better out-of-sample predictive validity than do previous methods and captures uncertainty caused by sampling and non-sampling error across data types. Neonatal, postneonatal, and childhood mortality was estimated from mortality in children younger than 5 years by use of the 1760 measurements from vital registration systems and complete birth histories that contained specific information about neonatal and postneonatal mortality.Findings Worldwide mortality in children younger than 5 years has dropped from 11.9 million deaths in 1990 to 7.7 million deaths in 2010, consisting of 3 1 million neonatal deaths, 2.3 million postneonatal deaths, and 2.3 million childhood deaths (deaths in children aged 1-4 years). 33.0% of deaths in children younger than 5 years occur in south Asia and 49.6% occur in sub-Saharan Africa, with less than 1% of deaths occurring in high-income countries. Across 21 regions of the world, rates of neonatal, postneonatal, and childhood mortality are declining. The global decline from 1990 to 2010 is 2.1% per year for neonatal mortality, 2.3% for postneonatal mortality, and 2.2% for childhood mortality. In 13 regions of the world, including all regions in sub-Saharan Africa, there is evidence of accelerating declines from 2000 to 2010 compared with 1990 to 2000. Within sub-Saharan Africa, rates of decline have increased by more than 1% in Angola, Botswana, Cameroon, Congo, Democratic Republic of the Congo, Kenya, Lesotho, Liberia, Rwanda, Senegal, Sierra Leone, Swaziland, and The Gambia.Interpretation Robust measurement of mortality in children younger than 5 years shows that accelerating declines are occurring in several low-income countries. These positive developments deserve attention and might need enhanced policy attention and resources.