Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Abstract

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017 Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low-and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations. Gains in child survival have long served as an important proxy measure for improvements in overall population health and development 1,2. Global progress in reducing child deaths has been heralded as one of the greatest success stories of global health 3. The annual global number of deaths of children under 5 years of age (under 5) 4 has declined from 19.6 million in 1950 to 5.4 million in 2017. Nevertheless, these advances in child survival have been far from universally achieved, particularly in low-and middle-income countries (LMICs) 4. Previous subnational child mortality assessments at the first (that is, states or provinces) or second (that is, districts or counties) administrative level indicate that extensive geographical inequalities persist 5-7. Progress in child survival also diverges across age groups 4. Global reductions in mortality rates of children under 5-that is, the under-5 mortality rate (U5MR)-among post-neonatal age groups are greater than those for mortality of neonates (0-28 days) 4,8. It is relatively unclear how these age patterns are shifting at a more local scale, posing challenges to ensuring child survival. To pursue the ambitious Sustainable Development Goal (SDG) of the United Nations 9 to "end preventable deaths of newborns and children under 5" by 2030, it is vital for decision-makers at all levels to better understand where, and at what ages, child survival remains most tenuous.

Focus on paediatrics

“…(a) Resource poor settings. An international study mapped 123 million child deaths, demonstrating that 93% occur in LMIC [1]. Although mortality under the age of 5 years fell (as we shown in Fig.…”

“…Although mortality under the age of 5 years fell (as we shown in Fig. 1), '58% of deaths could have been averted in the absence of geographical inequalities' [1]. While many of these deaths might be from vaccine preventable infectious diseases, a significant proportion might also be prevented by better acute care, hence the focus of this editorial.…”

Nationally and regionally representative analysis of 1.65 million children aged under 5 years using a child-based human development index: A multi-country cross-sectional study

“…Likewise, it can be replicated with alternative outcomes (e.g., child growth failure [44][45][46]) to examine progress along the development spectrum with specific prevention programs across and within countries (e.g., nutrition programs, vaccination coverage). Our results can also be mapped for geographical regions within countries (as illustrated in Fig 2), to point decision-makers and public health practitioners to more targeted efforts to improve outcomes among populations in at-risk regions [47,48]. Despite the overwhelming evidence of the associations between the core dimensions of human capabilities, few comprehensive measures presently exist to track investments in all 3 dimensions of the HDI jointly.…”

Measuring child survival for the Millennium Development Goals in Africa: what have we learned and what more is needed to evaluate the Sustainable Development Goals?

“…In addition, generalized international measurements and goals may be less useful than country-specific goals that consider a country's baseline and inequities. Supplementing quantitative indicator data with qualitative, policy information, and even geo-spatial data, as we and others [4,30] have done, is time-intensive and challenging. It is also necessary to fully understand a country's progress towards their goals, and challenges requiring targeted inputs.…”