@article{20783,
  author = {Prabhakaran Dorairaj and Wang Haidong and Liddell Chelsea and Coates Matthew and Mooney Meghan and Levitz Carly and Schumacher Austin and Apfel Henry and Iannarone Marissa and Phillips Bryan and Lofgren Katherine and Sandar Logan and Dorrington Rob and Rakovac Ivo and Jacobs Troy and Liang Xiaofeng and Zhou Maigeng and Zhu Jun and Yang Gonghuan and Wang Yanping and Liu Shiwei and Li Yichong and Ozgoren Ayse and Abera Semaw and Abubakar Ibrahim and Achoki Tom and Adelekan Ademola and Ademi Zanfina and Alemu Zewdie and Allen Peter and Almazroa Mohammad and Alvarez Elena and Amankwaa Adansi and Amare Azmeraw and Ammar Walid and Anwari Palwasha and Cunningham Solveig and Asad Majed and Assadi Reza and Banerjee Amitava and Basu Sanjay and Bedi Neeraj and Bekele Tolesa and Bell Michelle and Bhutta Zulfiqar and Blore Jed and Basara Berrak and Boufous Soufiane and Breitborde Nicholas and Bruce Nigel and Bui Linh and Carapetis Jonathan and Cárdenas Rosario and Carpenter David and Caso Valeria and Castro Ruben and Catalá-Lopéz Ferrán and Cavlin Alanur and Che Xuan and Chiang Peggy and Chowdhury Raj iv and Christophi Costas and Chuang Ting-Wu and Cirillo Massimo and Leite Iuri and Courville Karen and Dandona Lalit and Dandona Rakhi and Davis Adrian and Dayama Anand and Deribe Kebede and Dharmaratne Samath and Dherani Mukesh and Dilmen Uğur and Ding Eric and Edmond Karen and Ermakov Sergei and Farzadfar Farshad and Fereshtehnejad Seyed-Mohammad and Fijabi Daniel and Foigt Nataliya and Forouzanfar Mohammad and Garcia Ana and Geleijnse Johanna and Gessner Bradford and Goginashvili Ketevan and Gona Philimon and Goto Atsushi and Gouda Hebe and Green Mark and Greenwell Karen and Gugnani Harish and Gupta Rahul and Hamadeh Randah and Hammami Mouhanad and Harb Hilda and Hay Simon and Hedayati Mohammad and H Hosgood Dean and Hoy Damian and Idrisov Bulat and Islami Farhad and Ismayilova Samaya and Jiang Guohong and Jonas Jost and Juel Knud and Kabagambe Edmond and Kazi Dhruv and Kengne Andre and Kereselidze Maia and Khader Yousef and Khalifa Shams and Khang Young-Ho and Kim Daniel and Kinfu Yohannes and Kinge Jonas and Kokubo Yoshihiro and Kosen Soewarta and Defo Barthelemy and G Kumar Anil and Kumar Kaushalendra and Kumar Ravi and Lai Taavi and Lan Qing and Larsson Anders and Lee Jong-Tae and Leinsalu Mall and Lim Stephen and Lipshultz Steven and Logroscino Giancarlo and Lotufo Paulo and Lunevicius Raimundas and Lyons Ronan and Ma Stefan and Mahdi Abbas and Marzan Melvin and Mashal Mohammad and Mazorodze Tasara and McGrath John and Memish Ziad and Mendoza Walter and Mensah George and Meretoja Atte and Miller Ted and Mills Edward and Mohammad Karzan and Mokdad Ali and Monasta Lorenzo and Montico Marcella and Moore Ami and Moschandreas Joanna and Msemburi William and Mueller Ulrich and Muszynska Magdalena and Naghavi Mohsen and Naidoo Kovin and Narayan Km and Nejjari Chakib and Ng Marie and Ngirabega Jean and Nieuwenhuijsen Mark and Nyakarahuka Luke and Ohkubo Takayoshi and Omer Saad and Caicedo Angel and van Wyk Victoria and Pope Dan and Rahman Sajjad and Rana Saleem and Reilly Robert and Rojas-Rueda David and Ronfani Luca and Rushton Lesley and Saeedi Mohammad and Salomon Joshua and Sampson Uchechukwu and Santos Itamar and Sawhney Monika and Schmidt Jürgen and Shakh-Nazarova Marina and She Jun and Sheikhbahaei Sara and Shibuya Kenji and Shin Hwashin and Shishani Kawkab and Shiue Ivy and Sigfusdottir Inga and Singh Jasvinder and Skirbekk Vegard and Sliwa Karen and Soshnikov Sergey and Sposato Luciano and Stathopoulou Vasiliki and Stroumpoulis Konstantinos and Tabb Karen and Talongwa Roberto and Teixeira Carolina and Terkawi Abdullah and Thomson Alan and Thorne-Lyman Andrew and Toyoshima Hideaki and Dimbuene Zacharie and Uwaliraye Parfait and Uzun Selen and Vasankari Tommi and Vasconcelos Ana and Vlassov Vasiliy and Vollset Stein and Vos Theo and Waller Stephen and Wan Xia and Weichenthal Scott and Weiderpass Elisabete and Weintraub Robert and Westerman Ronny and Wilkinson James and Williams Hywel and Yang Yang and Yentur Gokalp and Yip Paul and Yonemoto Naohiro and Younis Mustafa and Yu Chuanhua and Jin Kim and Zaki Maysaa and Zhu Shankuan and Lopez Alan and Murray Christopher and Jha V.},
  title = {Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.},
  abstract = {<p>
<b>BACKGROUND: </b>Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.
</p>

<p>
<b>METHODS: </b>We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29 000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030.
</p>

<p>
<b>FINDINGS: </b>We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone.
</p>

<p>
<b>INTERPRETATION: </b>Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030.
</p>

<p>
<b>FUNDING: </b>Bill &amp; Melinda Gates Foundation, US Agency for International Development.
</p>
},
  year = {2014},
  journal = {Lancet},
  volume = {384},
  chapter = {957-79},
  issn = {1474-547X},
  doi = {10.1016/S0140-6736(14)60497-9},
  language = {eng},
}