Dataset Information

Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities.

ABSTRACT: BACKGROUND: Historically, the main focus of studies of childhood mortality has been the infant and under-five mortality rates. Neonatal mortality (deaths <28 days of age) has received limited attention, although such deaths account for about 41% of all child deaths. To better assess progress, we developed annual estimates for neonatal mortality rates (NMRs) and neonatal deaths for 193 countries for the period 1990-2009 with forecasts into the future. METHODS AND FINDINGS: We compiled a database of mortality in neonates and children (<5 years) comprising 3,551 country-years of information. Reliable civil registration data from 1990 to 2009 were available for 38 countries. A statistical model was developed to estimate NMRs for the remaining 155 countries, 17 of which had no national data. Country consultation was undertaken to identify data inputs and review estimates. In 2009, an estimated 3.3 million babies died in the first month of life-compared with 4.6 million neonatal deaths in 1990-and more than half of all neonatal deaths occurred in five countries of the world (44% of global livebirths): India 27.8% (19.6% of global livebirths), Nigeria 7.2% (4.5%), Pakistan 6.9% (4.0%), China 6.4% (13.4%), and Democratic Republic of the Congo 4.6% (2.1%). Between 1990 and 2009, the global NMR declined by 28% from 33.2 deaths per 1,000 livebirths to 23.9. The proportion of child deaths that are in the neonatal period increased in all regions of the world, and globally is now 41%. While NMRs were halved in some regions of the world, Africa's NMR only dropped 17.6% (43.6 to 35.9). CONCLUSIONS: Neonatal mortality has declined in all world regions. Progress has been slowest in the regions with high NMRs. Global health programs need to address neonatal deaths more effectively if Millennium Development Goal 4 (two-thirds reduction in child mortality) is to be achieved.

SUBMITTER: Oestergaard MZ

PROVIDER: S-EPMC3168874 | biostudies-literature | 2011 Aug

REPOSITORIES: biostudies-literature

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Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities.

Oestergaard Mikkel Zahle MZ Inoue Mie M Yoshida Sachiyo S Mahanani Wahyu Retno WR Gore Fiona M FM Cousens Simon S Lawn Joy E JE Mathers Colin Douglas CD

PLoS medicine 20110830 8

<h4>Background</h4>Historically, the main focus of studies of childhood mortality has been the infant and under-five mortality rates. Neonatal mortality (deaths <28 days of age) has received limited attention, although such deaths account for about 41% of all child deaths. To better assess progress, we developed annual estimates for neonatal mortality rates (NMRs) and neonatal deaths for 193 countries for the period 1990-2009 with forecasts into the future.<h4>Methods and findings</h4>We compile ...[more]

PMID: 21918640

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Project description:BackgroundArmed conflict can indirectly affect population health through detrimental impacts on political and social institutions and destruction of infrastructure. This study aimed to quantify indirect mortality impacts of armed conflict in civilian populations globally and explore differential effects by armed conflict characteristics and population groups.MethodsWe included 193 countries between 1990 and 2017 and constructed fixed effects panel regression models using data from the Uppsala Conflict Data Program and Global Burden of Disease study. Mortality rates were corrected to exclude battle-related deaths. We assessed separately four different armed conflict variables (capturing binary, continuous, categorical, and quintile exposures) and ran models by cause-specific mortality stratified by age groups and sex. Post-estimation analyses calculated the number of civilian deaths.ResultsWe identified 1118 unique armed conflicts. Armed conflict was associated with increases in civilian mortality-driven by conflicts categorised as wars. Wars were associated with an increase in age-standardised all-cause mortality of 81.5 per 100,000 population (β 81.5, 95% CI 14.3-148.8) in adjusted models contributing 29.4 million civilian deaths (95% CI 22.1-36.6) globally over the study period. Mortality rates from communicable, maternal, neonatal, and nutritional diseases (β 51.3, 95% CI 2.6-99.9); non-communicable diseases (β 22.7, 95% CI 0.2-45.2); and injuries (β 7.6, 95% CI 3.4-11.7) associated with war increased, contributing 21.0 million (95% CI 16.3-25.6), 6.0 million (95% CI 4.1-8.0), and 2.4 million deaths (95% CI 1.7-3.1) respectively. War-associated increases in all-cause and cause-specific mortality were found across all age groups and both genders, but children aged 0-5 years had the largest relative increases in mortality.ConclusionsArmed conflict, particularly war, is associated with a substantial indirect mortality impact among civilians globally with children most severely burdened.

Project description:BackgroundReducing neonatal mortality is an essential part of the third Sustainable Development Goal (SDG), to end preventable child deaths. To achieve this aim will require an understanding of the levels of and trends in neonatal mortality. We therefore aimed to estimate the levels of and trends in neonatal mortality by use of a statistical model that can be used to assess progress in the SDG era. With these estimates of neonatal mortality between 1990 and 2017, we then aimed to assess how different targets for neonatal mortality could affect the burden of neonatal mortality from 2018 to 2030.MethodsIn this systematic analysis, we used nationally-representative empirical data related to neonatal mortality, including data from vital registration systems, sample registration systems, and household surveys, to estimate country-specific neonatal mortality rates (NMR; the probability of dying during the first 28 days of life) for all countries between 1990 (or the earliest year of available data) and 2017. For our analysis, we used all publicly available data on neonatal mortality from databases compiled annually by the UN Inter-agency Group for Child Mortality Estimation, which were extracted on or before July 31, 2018, for data relating to the period between 1950 and 2017. All nationally representative data were assessed. We used a Bayesian hierarchical penalised B-splines regression model, which allowed for data from different sources to be weighted differently, to account for variable biases and for the uncertainty in NMR to be assessed. The model simultaneously estimated a global association between NMR and under-5 mortality rate and country-specific and time-specific effects, which enabled us to identify countries with an NMR that was higher or lower than expected. Scenario-based projections were made at the county level by use of current levels of and trends in neonatal mortality and historic or annual rates of reduction that would be required to achieve national targets. The main outcome that we assessed was the levels of and trends in neonatal mortality and the global and regional NMRs from 1990 to 2017.FindingsBetween 1990 and 2017, the global NMR decreased by 51% (90% uncertainty interval [UI] 46-54), from 36·6 deaths per 1000 livebirths (35·5-37·8) in 1990, to 18·0 deaths per 1000 livebirths (17·0-19·9) in 2017. The estimated number of neonatal deaths during the same period decreased from 5·0 million (4·9 million-5·2 million) to 2·5 million (2·4 million-2·8 million). Annual NMRs vary widely across the world, but west and central Africa and south Asia had the highest NMRs in 2017. All regions have reported reductions in NMRs since 1990, and most regions accelerated progress in reducing neonatal mortality in 2000-17 versus 1990-2000. Between 2018 and 2030, we project that 27·8 million children will die in their first month of life if each country maintains its current rate of reduction in NMR. If each country achieves the SDG neonatal mortality target of 12 deaths per 1000 livebirths or fewer by 2030, we project 22·7 million cumulative neonatal deaths by 2030. More than 60 countries need to accelerate their progress to reach the neonatal mortality SDG target by 2030.InterpretationAlthough substantial progress has been made in reducing neonatal mortality since 1990, increased efforts to improve progress are still needed to achieve the SDG target by 2030. Accelerated improvements are most needed in the regions and countries with high NMR, particularly in sub-Saharan Africa and south Asia.FundingBill & Melinda Gates Foundation, United States Agency for International Development.

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Dataset Information

Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities.

Publications

Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities.

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