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Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

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Title: Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019
Authors: Paulson, KR
Kamath, AM
Alam, T
Bienhoff, K
Abady, GG
Abbas, J
Abbasi-Kangevari, M
Abbastabar, H
Abd-Allah, F
Abd-Elsalam, SM
Abdoli, A
Desalew, A
Deuba, K
Dey, S
Dharmaratne, SD
Dhingra, S
Dhungana, GP
Dias da Silva, D
Diaz, D
Dorostkar, F
Adegbosin, AE
Banik, PC
Doshmangir, L
Dubljanin, E
Duraes, AR
Eagan, AW
Edinur, HA
Efendi, F
Eftekharzadeh, S
El Sayed, I
El Tantawi, M
Elbarazi, I
Barker-Collo, SL
Adekanmbi, V
Elgendy, IY
El-Jaafary, SI
Emami, A
Enany, S
Eyawo, O
Ezzikouri, S
Faris, PS
Farzadfar, F
Fattahi, N
Barqawi, HJ
Fauk, NK
Adetokunboh, OO
Fazlzadeh, M
Feigin, VL
Ferede, TY
Fereshtehnejad, S-M
Fernandes, E
Ferrara, P
Filip, I
Fischer, F
Bassat, Q
Fisher, JL
Foigt, NA
Adeyinka, DA
Folayan, MO
Foroutan, M
Franklin, RC
Freitas, M
Friedman, SD
Fukumoto, T
Gad, MM
Basu, S
Gaidhane, AM
Gaidhane, S
Gaihre, S
Adsuar, JC
Gallus, S
Garcia-Basteiro, AL
Garcia-Gordillo, MA
Gardner, WM
Gaspar Fonseca, M
Gebremedhin, KB
Baune, BT
Getacher, L
Ghashghaee, A
Gholamian, A
Gilani, SA
Afshari, K
Gill, TK
Giussani, G
Gnedovskaya, EV
Godinho, MA
Goel, A
Bayati, M
Golechha, M
Gona, PN
Gopalani, SV
Goudarzi, H
Grivna, M
Aghaali, M
Gugnani, HC
Guido, D
Guimarães, RA
Gupta, RD
Bedi, N
Gupta, R
Hafezi-Nejad, N
Haider, MR
Haj-Mirzaian, A
Hamidi, S
Hanif, A
Agudelo-Botero, M
Hankey, GJ
Hargono, A
Hasaballah, AI
Beghi, E
Hasan, MM
Hasan, SS
Hassan, A
Hassanipour, S
Hassankhani, H
Havmoeller, RJ
Hayat, K
Ahinkorah, BO
Heidari-Soureshjani, R
Henry, NJ
Beghi, M
Herteliu, C
Hole, MK
Holla, R
Hossain, N
Hosseini, M
Hosseinzadeh, M
Hostiuc, M
Hostiuc, S
Ahmad, T
Househ, M
Abedi, A
Huang, J
Humayun, A
Hwang, B-F
Iavicoli, I
Ibitoye, SE
Ikuta, KS
Ilesanmi, OS
Ilic, IM
Ilic, MD
Ahmadi, K
Bell, ML
Inamdar, S
Inbaraj, LR
Iqbal, K
Iqbal, U
Islam, MM
Islam, SMS
Iso, H
Iwagami, M
Iwu, CCD
Jaafari, J
Bendak, S
Ahmed, MB
Jacobsen, KH
Jagnoor, J
Jain, V
Janodia, MD
Javaheri, T
Javanmardi, F
Jayaram, S
Jayatilleke, AU
Jenabi, E
Bennett, DA
Jha, RP
Aji, B
Ji, JS
John, O
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Joo, T
Joseph, N
Joukar, F
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Bensenor, IM
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Kapoor, N
Karami Matin, B
Karch, A
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Berhe, K
Kassahun, G
Kayode, GA
Kazemi Karyani, A
Akinyemi, OO
Kemmer, L
Khalid, N
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Khammarnia, M
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Khang, Y-H
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Khater, AM
Khater, MM
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Kim, D
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Item Type: Journal Article
Abstract: Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3–74·0) in 2000 to 37·1 (33·2–41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8–29·5) in 2000 to 17·9 (16·3–19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05–10·30) in 2000 and 5·05 million (4·27–6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53–4·02]) in 2000 to 48% (2·42 million; 2·06–2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71–0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27–1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35–2·58; 37% [95% UI 32–43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Funding Bill & Melinda Gates Foundation.
Issue Date: 4-Sep-2021
Date of Acceptance: 1-Aug-2021
URI: http://hdl.handle.net/10044/1/91163
DOI: 10.1016/s0140-6736(21)01207-1
ISSN: 0140-6736
Publisher: Elsevier BV
Start Page: 870
End Page: 905
Journal / Book Title: The Lancet
Volume: 398
Issue: 1030
Copyright Statement: © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
SYSTEMATIC ANALYSIS
UNDER-5 MORTALITY
STILLBIRTHS
COUNTRIES
DEATHS
INFORM
INFANT
TRENDS
COVID-19
Cause of Death
Child
Child Mortality
Child, Preschool
Female
Global Health
Humans
Infant
Infant Mortality
Infant, Newborn
Life Tables
Male
SARS-CoV-2
Sustainable Development
GBD 2019 Under-5 Mortality Collaborators
Humans
Life Tables
Cause of Death
Child Mortality
Infant Mortality
Child
Child, Preschool
Infant
Infant, Newborn
Female
Male
Global Health
Sustainable Development
COVID-19
SARS-CoV-2
General & Internal Medicine
11 Medical and Health Sciences
Publication Status: Published
Open Access location: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01207-1/fulltext#
Online Publication Date: 2021-08-17
Appears in Collections:Imperial College Business School
Faculty of Medicine
School of Public Health



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