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

GBD 2019 Under-5 Mortality Collaborators, Edward Kwabena AMEYAW

Research output: Journal PublicationsJournal Article (refereed)peer-review

72 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)870-905
Number of pages36
JournalThe Lancet
Volume398
Issue number10303
DOIs
Publication statusPublished - 4 Sep 2021
Externally publishedYes

Bibliographical note

Funding Information:
Research reported in this publication was supported by the Bill & Melinda Gates Foundation, the University of Melbourne, Public Health England, the Norwegian Institute of Public Health, the National Institute on Aging of the National Institutes of Health (award P30AG047845), and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163). Aruna M Kamath is funded by the National Institutes of Health (T32GM086270). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Bill & Melinda Gates Foundation or the National Institutes of Health. Lucas Guimarães Abreu acknowledges Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Código de Financiamento 001, Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (404710/2018-2 and 310797/2019-5), Fundação de Amparo à Pesquisa de Minas Gerais (FAPEMIG), and Pró-Reitoria de Pesquisa (PRPq) of Universidade Federal de Minas Gerais. Olatunji O Adetokunboh was supported by the National Research Foundation, and Department of Science and Innovation, South Africa. Syed Mohamed Aljunid would like to acknowledge the Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Kuwait and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia, Malaysia for the approval and support to participate in this research project. Marcel Ausloos, Adrian Pana, and Claudiu Herteliu are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Claudiu Herteliu and Adrian Pana are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P2-2.1-SOL-2020-2-0351. Derrick A Bennett receives support from the Oxford National Institute for Health Research (NIHR) Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR, or the Department of Health and Social Care. Felix Carvalho and Eduarda Fernandes acknowledge UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. Joao Conde acknowledges the European Research Council, ERC starting grant agreement No 848325. Vera Marisa Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. Sagnik Dey acknowledges the support of the Centre of Excellence for Research on Clean Air (CERCA) and IIT Delhi for the institute chair position. Santosh Gaihre acknowledges the GCRF SAFEWATER Project, Ulster University, Northern Ireland. Sheikh Mohammed Shariful Islam acknowledges support from fellowships and funding from NHMRC and National Heart Foundation of Australia. Oommen John is recipient of an UIPA scholarship through University of New South Wales (UNSW), Sydney, Australia. Md Nuruzzaman Khan acknowledges the support of Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh. Yun Jin Kim was supported by the Research Management Centre, Xiamen University Malaysia, Malaysia (XMUMRF/2020-C6/ITCM/0004). Sindhura Lakshmi Koulmane Laxminarayana acknowledges support provided by Manipal Academy of Higher Education, Manipal, India. Kewal Krishan is supported by the UGC Centre of Advanced Study (CAS II), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Manasi Kumar would like to acknowledge NIH/FIC k43 tw010716-04. Ben Lacey acknowledges support from UK Biobank, the NIHR Oxford Biomedical Research Centre, and the BHF Oxford Centre of Research Excellence. Iván Landires is a member of the Sistema Nacional de Investigación (SNI), which is supported by the Panama's Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). John J McGrath has been supported by the Danish National Research Foundation (Niels Bohr Professorship), and is employed by The Queensland Centre for Mental Health Research which receives core funding from the Queensland Health. Stefania Mondello acknowledges support from the Italian Ministry of Health (grant number GR-2013-02354960). Jonathan F Mosser acknowledges funding from BMGF (OPP1182474). Bruno Ramos Nascimento was supported in part by CNPq (Bolsa de produtividade em pesquisa, 312382/2019-7), by the Edwards Lifesciences Foundation (Every Heartbeat Matters programme 2020), and by FAPEMIG (grant APQ-000627-20). Shuhei Nomura acknowledges support from the Ministry of Education, Culture, Sports, Science and Technology of Japan (MEXT). Oluwakemi Ololade Odukoya was supported by the Fogarty International Center of the National Institutes of Health under award number K43TW010704. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Alberto Ortiz was supported by FIS/Fondos FEDER (PI18/01366, PI19/00588, PI19/00815, DTS18/00032, ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00064 and PERSTIGAN AC18/00071, ISCIII-RETIC REDinREN RD016/0009), Sociedad Española de Nefrología, FRIAT, Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-CM. Jagadish Rao Padubidri acknowledges the Manipal Academy of Higher Education Mangalore, Mangalore, India for their constant support. George C Patton is supported by an NHMRC senior principal research fellowship. Alberto Raggi is supported by a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C. Besta, Linea 4 Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). Bhageerathy Reshmi acknowledges support from Manipal College of Health Professions, Manipal, India. Daniela Ribeiro acknowledges the financial support from the European Union [FEDER funds through COMPETE, POCI-01-0145-FEDER-029253). Abdallah M Samy acknowledges the support from the Egyptian Fulbright Mission Program, and being a member of the Egyptian Young Academy of Sciences and Technology. Davide Sattin and Silvia Schiavolin acknowledge support by a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4 Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). Francesca Giulia Magnani acknowledges support by a grant from the Italian Ministry of Health GR2016-02365049. Feng Sha and Bingyu Li acknowledge support by the Shenzhen Social Science Fund (Grant No SZ2020C015) and the Shenzhen Science and Technology Program (Grant KQTD20190929172835662). Aziz Sheikh acknowledges the support of the Health Data Research UK BREATHE Hub. João Pedro Silva acknowledges support from grant number UIDB/04378/2020 from the Applied Molecular Biosciences Unit (UCIBIO), supported through Portuguese national funds via FCT/MCTES. David A Sleet acknowledges support from the James F and Sarah T Fries Foundation, The Bizzell Group. Mohammad Reza Sobhiyeh acknowledges support from the Clinical Research Development center of Imam Reza Hospital Kermanshah University of Medical Sciences, Iran. Joan B Soriano acknowledges support from the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Gizachew Assefa Tessema is a recipient of the Australian National Health and Medical Research Council (NHMRC) investigator grant (APP1195716). Riaz Uddin is supported by an Alfred Deakin Postdoctoral Research Fellowship. Bhaskaran Unnikrishnan acknowledges Katurba Medical College, Mangalore, India. Charles Shey Wiysonge is supported by the South African Medical Research Council. Sojib Bin Zaman received a scholarship from the Australian Government Research Training Program (RTP) in support of his academic career. Yunquan Zhang acknowledges the Science and Technology Research Project of Hubei Provincial Department of Education (grant number Q20201104) and Middle Aged Technology Innovation Team Project of Hubei Provincial Department of Education (grant number T2020003).

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Funding Information:
Robert Ancuceanu reports consulting fees from AbbVie and AstraZeneca; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Sandoz and AbbVie; support for attending meetings and/or travel from AbbVie and AstraZeneca, all outside the submitted work. Marcel Ausloos reports grants or contracts from Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084, outside the submitted work. Ettore Beghi reports grants or contracts paid to their institutions from ALSA, the Italian Ministry of Health and SOBI; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Arvell Therapeutics; support for attending meetings and/or travel from ILAE and EAN, all outside the submitted work. Reinhard Busse reports leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid with the Robert Koch Institute as member of the scientific advisory committee, German Burden 2020 project, all outside the submitted work. Joao Conde reports grants or contracts from the European Research Council grant agreement No 848325 (ERC starting grant); patents planned issued or pending for TRPV2 antagonists WO2019054891 - Instituto de Medicina Molecular (PT), Hydrogel Particles, Compositions, and Methods- WO US US20170333304A1 - Massachusetts Institute of Technology (USA), and Theranostic nanoprobes for overcoming cancer multidrug resistance and methods- WO US WO2016134232A1 - Massachusetts Institute Of Technology (USA), all outside the submitted work. Irina Filip reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Avicenna Medical and Clinical Research Institute. Claudiu Herteliu reports grants or contracts from Romanian National Authority for scientific research and innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084, research grant (October, 2018, to September, 2022), understanding and modelling time–space patterns of psychology-related inequalities and polarisation, and project number PN-III-P2-2.1-SOL-2020-2-0351, research grant (June, 2021, to October, 2021), approaches within public health management in the context of COVID-19 pandemic, and from the Ministry of Labour and Social Justice Romania, project number 30/PSCD/2018, research grant (September, 2018 to June, 2019), agenda for skills Romania 2020–25, all outside the submitted work. Sheikh Mohammed Shariful Islam reports grants or contracts from National Health and Medical Research Council (NHMRC) and National Heart Foundation of Australia Fellowships, outside the submitted work. Jacek Jerzy Jozwiak reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Teva, Amgen, Synexus, Boehringer Ingelheim, ALAB Laboratories, and Zentiva, all outside the submitted work. Nicholas J Kassebaum reports support for the present manuscript from the Bill & Melinda Gates Foundation as grant funding for the GBD. Kewal Krishan reports non-financial support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. Morteza Mahmoudi reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events for his published books, plenary lectures, and licensed patent to Seer; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid with the Academic Parity Movement, a non-profit organisation dedicated to addressing academic discrimination, violence, and incivility, as a cofounder, all outside the submitted work. Shuhei Nomura reports support for the present manuscript from Ministry of Education, Culture, Sports, Science and Technology of Japan (MEXT) as grant funding. Adrian Pana reports grants or contracts from Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084, research grant (October, 2018, to September, 2022), understanding and modelling time-space patterns of psychology-related inequalities and polarisation, and project number PN-III-P2-2.1-SOL-2020-2-0351, research grant (June, 2021, to October, 2021), approaches within public health management in the context of COVID-19 pandemic, all outside the submitted work. Seithikurippu R Pandi-Perumal reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events for the volumes he edited; leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, with Somnogen Canada, Toronto, Canada, as the President and Chief Executive Officer, all outside the submitted work. Thomas Pilgrim reports grants or contracts from Biotronik, Boston Scientific, and Edwards Lifesciences; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Biotronik, Boston Scientific, and HighLifeSAS; and being proctor for Medtronic and Boston Scientific, all outside the submitted work. Maarten J Postma reports grants or contacts from Merck, Sharp & Dohme, GlaxoSmithKline, Pfizer, Boehringer Ingelheim, Novavax, Bayer, Bristol Myers Squibb, AstraZeneca, Sanofi, IQVIA, BioMerieux, WHO, EU, Seqirus, FIND, Antilope, DIKTI, LPDP, and Budi; consulting fees from Merck, Sharp & Dohme, GlaxoSmithKline, Pfizer, Boehringer Ingelheim, Novavax, Quintiles, Bristol Myers Squibb, AstraZeneca, Sanofi, Novartis, Pharmerit, IQVIA, and Seqirus; participation on a data safety monitoring board or advisory board to Asc Academics as adviser; stock or stock options in Health-Ecore and PAG, all outside the submitted work. Amir Radfar reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Avicenna Medical and Clinical Research Institute. Jasvinder A Singh reports consulting fees from Crealta/Horizon, Medisys, Fidia, Two labs, Adept Field Solutions, Clinical Care options, Clearview health-care partners, Putnam associates, Focus forward, Navigant consulting, Spherix, MedIQ, UBM, Trio Health, Medscape, WebMD, and Practice Point communications, and the National Institutes of Health and the American College of Rheumatology; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Simply Speaking; support for attending meetings and travel from OMERACT, an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies, when travelling biannually to OMERACT meetings; leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, with OMERACT as a member of the steering committee, with the US Food and Drug Administration (FDA) Arthritis Advisory Committee, with the Veterans Affairs Rheumatology Field Advisory Committee as a member, and with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as a director and editor; stock or stock options in TPT Global Tech, Vaxart pharmaceuticals, Charlotte's Web Holdings, and previously owned stock options in Amarin, Viking, and Moderna pharmaceuticals, all outside the submitted work. Mark A Stokes reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events at the Autism Teaching Institute (Victoria, Australia); unpaid participation on a data safety monitoring board or advisory board with the Deakin University Human Research Ethics Committee; leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, with the Australasian Society for Autism Research as a past president, with the Australasian Society for Autism Research as a board member, with Kidsafe (Victoria, Australia) as vice president, with Mindful as a member of the research advisory board, and with Autism Teaching Institute as chair of the research advisory board; stock or stock options in Cochlear and Medical Developments, all outside the submitted work. Stefan Stortecky reports grants or contracts to their institute from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott; consulting fees from BTG and Teleflex; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from BTG and Boston Scientific; support for attending meetings and/or travel from BTG, all outside the submitted work. Carolyn B Swope reports support for the present manuscript from Delos Living as a former employee; and consulting fees from Delos Living, outside the submitted work. Riaz Uddin reports grants or contracts from Alfred Deakin Postdoctoral Research Fellowship, Deakin University, Australia; support for attending meetings and/or travel from Deakin University Institute for Physical Activity and Nutrition, all outside the submitted work.

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© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

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