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      2014                            d1 aPrabhakaran Dorairaj1 aWang Haidong1 aLiddell Chelsea1 aCoates Matthew1 aMooney Meghan1 aLevitz Carly1 aSchumacher Austin1 aApfel Henry1 aIannarone Marissa1 aPhillips Bryan1 aLofgren Katherine1 aSandar Logan1 aDorrington Rob1 aRakovac Ivo1 aJacobs Troy1 aLiang Xiaofeng1 aZhou Maigeng1 aZhu Jun1 aYang Gonghuan1 aWang Yanping1 aLiu Shiwei1 aLi Yichong1 aOzgoren Ayse1 aAbera Semaw1 aAbubakar Ibrahim1 aAchoki Tom1 aAdelekan Ademola1 aAdemi Zanfina1 aAlemu Zewdie1 aAllen Peter1 aAlmazroa Mohammad1 aAlvarez Elena1 aAmankwaa Adansi1 aAmare Azmeraw1 aAmmar Walid1 aAnwari Palwasha1 aCunningham Solveig1 aAsad Majed1 aAssadi Reza1 aBanerjee Amitava1 aBasu Sanjay1 aBedi Neeraj1 aBekele Tolesa1 aBell Michelle1 aBhutta Zulfiqar1 aBlore Jed1 aBasara Berrak1 aBoufous Soufiane1 aBreitborde Nicholas1 aBruce Nigel1 aBui Linh1 aCarapetis Jonathan1 aCárdenas Rosario1 aCarpenter David1 aCaso Valeria1 aCastro Ruben1 aCatalá-Lopéz Ferrán1 aCavlin Alanur1 aChe Xuan1 aChiang Peggy1 aChowdhury Raj iv1 aChristophi Costas1 aChuang Ting-Wu1 aCirillo Massimo1 aLeite Iuri1 aCourville Karen1 aDandona Lalit1 aDandona Rakhi1 aDavis Adrian1 aDayama Anand1 aDeribe Kebede1 aDharmaratne Samath1 aDherani Mukesh1 aDilmen Uğur1 aDing Eric1 aEdmond Karen1 aErmakov Sergei1 aFarzadfar Farshad1 aFereshtehnejad Seyed-Mohammad1 aFijabi Daniel1 aFoigt Nataliya1 aForouzanfar Mohammad1 aGarcia Ana1 aGeleijnse Johanna1 aGessner Bradford1 aGoginashvili Ketevan1 aGona Philimon1 aGoto Atsushi1 aGouda Hebe1 aGreen Mark1 aGreenwell Karen1 aGugnani Harish1 aGupta Rahul1 aHamadeh Randah1 aHammami Mouhanad1 aHarb Hilda1 aHay Simon1 aHedayati Mohammad1 aH Hosgood Dean1 aHoy Damian1 aIdrisov Bulat1 aIslami Farhad1 aIsmayilova Samaya1 aJiang Guohong1 aJonas Jost1 aJuel Knud1 aKabagambe Edmond1 aKazi Dhruv1 aKengne Andre1 aKereselidze Maia1 aKhader Yousef1 aKhalifa Shams1 aKhang Young-Ho1 aKim Daniel1 aKinfu Yohannes1 aKinge Jonas1 aKokubo Yoshihiro1 aKosen Soewarta1 aDefo Barthelemy1 aG Kumar Anil1 aKumar Kaushalendra1 aKumar Ravi1 aLai Taavi1 aLan Qing1 aLarsson Anders1 aLee Jong-Tae1 aLeinsalu Mall1 aLim Stephen1 aLipshultz Steven1 aLogroscino Giancarlo1 aLotufo Paulo1 aLunevicius Raimundas1 aLyons Ronan1 aMa Stefan1 aMahdi Abbas1 aMarzan Melvin1 aMashal Mohammad1 aMazorodze Tasara1 aMcGrath John1 aMemish Ziad1 aMendoza Walter1 aMensah George1 aMeretoja Atte1 aMiller Ted1 aMills Edward1 aMohammad Karzan1 aMokdad Ali1 aMonasta Lorenzo1 aMontico Marcella1 aMoore Ami1 aMoschandreas Joanna1 aMsemburi William1 aMueller Ulrich1 aMuszynska Magdalena1 aNaghavi Mohsen1 aNaidoo Kovin1 aNarayan Km1 aNejjari Chakib1 aNg Marie1 aNgirabega Jean1 aNieuwenhuijsen Mark1 aNyakarahuka Luke1 aOhkubo Takayoshi1 aOmer Saad1 aCaicedo Angel1 avan Wyk Victoria1 aPope Dan1 aRahman Sajjad1 aRana Saleem1 aReilly Robert1 aRojas-Rueda David1 aRonfani Luca1 aRushton Lesley1 aSaeedi Mohammad1 aSalomon Joshua1 aSampson Uchechukwu1 aSantos Itamar1 aSawhney Monika1 aSchmidt Jürgen1 aShakh-Nazarova Marina1 aShe Jun1 aSheikhbahaei Sara1 aShibuya Kenji1 aShin Hwashin1 aShishani Kawkab1 aShiue Ivy1 aSigfusdottir Inga1 aSingh Jasvinder1 aSkirbekk Vegard1 aSliwa Karen1 aSoshnikov Sergey1 aSposato Luciano1 aStathopoulou Vasiliki1 aStroumpoulis Konstantinos1 aTabb Karen1 aTalongwa Roberto1 aTeixeira Carolina1 aTerkawi Abdullah1 aThomson Alan1 aThorne-Lyman Andrew1 aToyoshima Hideaki1 aDimbuene Zacharie1 aUwaliraye Parfait1 aUzun Selen1 aVasankari Tommi1 aVasconcelos Ana1 aVlassov Vasiliy1 aVollset Stein1 aVos Theo1 aWaller Stephen1 aWan Xia1 aWeichenthal Scott1 aWeiderpass Elisabete1 aWeintraub Robert1 aWesterman Ronny1 aWilkinson James1 aWilliams Hywel1 aYang Yang1 aYentur Gokalp1 aYip Paul1 aYonemoto Naohiro1 aYounis Mustafa1 aYu Chuanhua1 aJin Kim1 aZaki Maysaa1 aZhu Shankuan1 aLopez Alan1 aMurray Christopher1 aJha V.00aGlobal, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.0 v3843 a<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.
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<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.
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<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.
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<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.
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<b>FUNDING: </b>Bill &amp; Melinda Gates Foundation, US Agency for International Development.
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