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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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.

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The record

Venue

The Lancet

Topic

Global Maternal and Child Health

Field

Medicine

Canadian institutions

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Funders

Department of Anthropology, University of California, Los AngelesDivision of Mathematical SciencesFogarty International CenterNational Institute of General Medical SciencesNational Institute of Mental HealthDivision of Human Resource DevelopmentNational Institute on AgingNorwegian Institute of Public HealthResearch Management Centre, International Islamic University MalaysiaLee Kong Chian School of Medicine, Nanyang Technological UniversityPro-Reitoria de Pesquisa, Universidade de São PauloQueensland Brain InstituteInstituto de Salud Carlos IIIFundação para a Ciência e a TecnologiaNational Health and Medical Research CouncilResearch Executive AgencyEuropean Research CouncilUniversity of Massachusetts AmherstUniversity of California, IrvineUniversity of Central FloridaDirectorate for Biological SciencesSistema Nacional de InvestigadoresNational Institutes of HealthNorth South UniversityEngineering Research CentersWestern Sydney UniversityAl-Farabi Kazakh National UniversityUniversidad de ExtremaduraImam Abdulrahman Bin Faisal UniversityHáskólinn í ReykjavíkUniversity of BernBaker Heart and Diabetes InstituteEngineering and Physical Sciences Research CouncilIsfahan University of Medical SciencesSabzevar University of Medical SciencesPrograma Operacional Temático Factores de CompetitividadeHormozgan University of Medical SciencesAlexandria UniversityAfrican Population and Health Research CenterUniversity of PeradeniyaChildren's Hospital of PhiladelphiaXiamen UniversityUniversitas AirlanggaShiraz University of Medical SciencesFakultet Medicinskih Nauka, Univerziteta U KragujevcuUniversitatea de Medicină şi Farmacie "Carol Davila" BucureştiIndian Institute of Technology DelhiUniversity of the PhilippinesUniversidade Federal de Minas GeraisUniversitatea din BucureștiNational Research University Higher School of EconomicsNational Taiwan UniversityBahir Dar UniversityNational Taiwan University HospitalQueensland HealthHubei Provincial Department of EducationShahrekord University of Medical SciencesUniversity of HaifaHögskolan DalarnaUniversità degli Studi di UdineBabol University of Medical SciencesUniversity of New South WalesAutoritatea Natională pentru Cercetare StiintificăRajshahi UniversityKermanshah University of Medical SciencesBirjand University of Medical SciencesUniversitair Medisch Centrum GroningenCancer Research UKShiraz UniversityMazandaran University of Medical SciencesShahrekord UniversityHaramaya UniversityUniversità degli Studi di PaviaCentral University of KeralaMassachusetts General HospitalMashhad University of Medical SciencesUniversiti Sains MalaysiaMinistry of Education, Culture, Sports, Science and TechnologyAlzahra UniversityUniversity College LondonUniversiti Kebangsaan MalaysiaHawassa UniversityKuwait UniversityTabriz University of Medical SciencesSeoul National University HospitalLiverpool John Moores UniversityStudent Research Committee, Tabriz University of Medical SciencesUniversità degli Studi di Napoli Federico IIFrankfurt University of Applied SciencesAustralian GovernmentKashan University of Medical SciencesKarolinska InstitutetUniversity of CreteKing Khalid UniversityConselho Nacional de Desenvolvimento Científico e TecnológicoFundación Valle del LiliMinistero della SaluteCambridge University HospitalsAlborz University of Medical SciencesUniversidade do PortoTrakya ÜniversitesiUniversidad Nacional de ColombiaUniversity of JordanU.S. Department of Veterans AffairsKosin UniversityUniversidad Autónoma de SinaloaNIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer ResearchNational Research FoundationUniversidad ICESIYonsei UniversityRijksuniversiteit GroningenSharif University of TechnologyQueensland University of TechnologyInternational Medical UniversityAristotle University of ThessalonikiUniversity of Central PunjabJames Cook UniversityUniversitas Sebelas MaretSecretaría Nacional de Ciencia, Tecnología e InnovaciónCairo UniversityThomas Jefferson UniversityLaboratório Associado para a Química VerdeUniversity of MelbourneScience, Technology and Innovation Commission of Shenzhen MunicipalityJawaharlal Institute Of Postgraduate Medical Education and ResearchDepartment of Social Services, Australian GovernmentFlinders UniversityCoordenação de Aperfeiçoamento de Pessoal de Nível SuperiorAteneo de Manila UniversityUniversity of CambridgeAuckland University of Technology, New ZealandKeio UniversityMinistério da Ciência, Tecnologia e Ensino SuperiorUlster UniversityGIST Cancer Research FundRazi Vaccine and Serum Research InstituteFundação de Amparo à Pesquisa do Estado de Minas GeraisNanyang Technological UniversitySouth African Medical Research CouncilMedical Research CouncilNational Institute of Pharmaceutical Education and Research, RaebareliUniversity Grants CommissionIndian Council of Medical ResearchDepartment of Health and Social CareBritish Heart FoundationCenters for Disease Control and PreventionUniversity of QueenslandManipal Academy of Higher EducationNational Institute for Health and Care ResearchAustralian Catholic UniversityMiddlesex UniversityKaiser PermanenteUniversity of AlbertaJamia Millia IslamiaJazan UniversityGriffith UniversityUniversitat Pompeu FabraNIHR Oxford Biomedical Research CentreUniversität UlmKing Abdullah University of Science and TechnologyUniversity of EmbuZahedan University of Medical SciencesUnitatea Executiva pentru Finantarea Invatamantului Superior, a Cercetarii, Dezvoltarii si InovariiUniversity of TabrizEuropean CommissionAhmadu Bello UniversitySociedad Española de NefrologíaPublic Health EnglandApplied Molecular Biosciences UnitPublic Health Foundation of IndiaUniversity Of Nigeria NsukkaAn-Najah National UniversityUniversity of OttawaNational Authority for Scientific Research and InnovationCentres de Recerca de CatalunyaIstituto di Ricerche Farmacologiche Mario Negri - IRCCSNational Heart Foundation of AustraliaComunidad de MadridMoscow Institute of Physics and TechnologyEmory UniversityInstitute for Clinical Evaluative SciencesBill and Melinda Gates FoundationArak University of Medical SciencesUniversità degli Studi di MilanoWellcome TrustChandigarh UniversityIran University of Medical SciencesKing Abdulaziz UniversityBrien Holden Vision InstituteDepartment of Science and Innovation, South AfricaTrường Đại học Duy TânOhio State UniversityJohns Hopkins UniversityUniversidade de São PauloDeakin UniversityTufts Medical CenterUniversidade de LisboaKing Saud UniversityOttawa Hospital Research InstituteNational Institute of Allergy and Infectious DiseasesUniversitat de ValènciaUniversitas Kristen Duta WacanaPeking UniversitySecretaria Nacional de Ciencia y TecnologíaSeoul National UniversityNational Institute of Mental Health and NeurosciencesEdwards LifesciencesCase Western Reserve UniversityDanmarks GrundforskningsfondHamad Medical CorporationUniversité Mohammed VI PolytechniqueUniversity of MinnesotaOhio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteGeorge Washington UniversityBournemouth UniversityNational Institute on Handicapped ResearchYork UniversityCleveland ClinicMonash UniversityFoundation for Advancement of International Medical Education and Research

Keywords

Burden of diseaseDiseaseMedicineEnvironmental healthGlobal healthDisease burdenSustainable developmentCause of deathIntensive care medicinePublic healthPolitical scienceNursing

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