Articles A Norway B日Salvador ☐Vital registration 200 Demographic and Health Surveys Centers for Disease Control 14 and Prevention Reproductive 150 Health Surveys Census 100 50 的型 ☐Vital registration ▣Other 。。 ◆。◆。。 0+ D Liberia □Census 3507 ☐Other 250 300 250 200 150 150 1。 200 100 100 Demographicand Health Surveys Census Household deaths Other Malaria indicator survey 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Year Year Figure 1:Empirical data sources and estimated under-5 mortality from 1970 to 2010 for selected countries Dashed lines indicate uncertainty intervals.Hollow cirdes represent outliers.Under-5 mortality is defined as the probability of death between birth and age 5years Upward-pointing triangles are direct estimates from complete birth histories.Downward-pointing triangles are indirect estimates from summary birth histories. Population Division (UNPD)in 2009,have only three development assistance for health,'the expansion of countries in common:Portugal,Vietnam,and the insecticide-treated net coverage,activity of the GAVI Maldives.In 2008,UNICEF reported that Thailand had Alliance,and rollout of antiretroviral drugs,"there are the fastest rate of decline in the world,leading researchers many reasons to hope that accelerations might be to undertake a case study of this success."But in 2009. occurring in some countries. UNICEF reported that Thailand had only the 47th fastest In this study,we examined levels,rates of decline,and rate of decline;in a UNPD report,the country had the accelerations and decelerations in rates of decline in fourth fastest rate of decline.Such confusion about the neonatal,postneonatal,childhood,and under-5 mortality true extent of progress can foster policy inaction in from 1970 to 2010 in 187 countries.This study was aided countries,precisely at a time when targeted,effective by four important developments since the previous programmes are needed most.Variation in the studies were done.First,we made use of data that have assessments of rates of decline indicates the availability been newly released or acquired during an intensive and use of different datasets,different analytical methods, 3-year effort to obtain access to microdata (individual and different decisions about data quality by the analysts. level data)and tabulated data sources.Second,we used Evidence from several low-income countries suggests new methods to analyse data from summary birth that in some countries,declines in mortality in children histories with reduced bias and measurement error. younger than 5 years might have accelerated since Third,we applied new data synthesis methods with 2000,-#whereas in others,the rate of decline might be enhanced predictive validity to combine data from slowing.During the 25 years of the MDG 4 target, several sources and capture both sampling and non- countries are likely to experience accelerations and sampling error patterns.This new method requires decelerations in rates of decline.Acceleration matters many fewer subjective inputs to estimation,ensuring because it could be an early indication of policy or that the output is strongly grounded in empirical data programme success.The need to use the best datasets and is as reproducible as possible.Finally,we took and the most valid methods for assessing child mortality advantage of more data and better models with improved over time is only intensified when trying to detect such predictive validity to analyse country patterns of accelerations and decelerations.In view of the scale-up in neonatal,postneonatal,and childhood mortality. www.thelancet.com Vol 375 June 5,2010 1989Articles www.thelancet.com Vol 375 June 5, 2010 1989 Population Division (UNPD) in 2009,10 have only three countries in common: Portugal, Vietnam, and the Maldives. In 2008, UNICEF reported that Thailand had the fastest rate of decline in the world, leading researchers to undertake a case study of this success.11 But in 2009, UNICEF reported that Thailand had only the 47th fastest rate of decline;9 in a UNPD report, the country had the fourth fastest rate of decline.10 Such confusion about the true extent of progress can foster policy inaction in countries, precisely at a time when targeted, eff ective programmes are needed most. Variation in the assessments of rates of decline indicates the availability and use of diff erent datasets, diff erent analytical methods, and diff erent decisions about data quality by the analysts. Evidence from several low-income countries suggests that in some countries, declines in mortality in children younger than 5 years might have accelerated since 2000,12–14 whereas in others, the rate of decline might be slowing. During the 25 years of the MDG 4 target, countries are likely to experience accelerations and decelerations in rates of decline. Acceleration matters because it could be an early indication of policy or programme success. The need to use the best datasets and the most valid methods for assessing child mortality over time is only intensifi ed when trying to detect such accelerations and decelerations. In view of the scale-up in development assistance for health,15 the expansion of insecticide-treated net coverage,16 activity of the GAVI Alliance,17 and rollout of antiretroviral drugs,18 there are many reasons to hope that accelerations might be occurring in some countries. In this study, we examined levels, rates of decline, and accelerations and decelerations in rates of decline in neonatal, post neonatal, childhood, and under-5 mortality from 1970 to 2010 in 187 countries. This study was aided by four important developments since the previous studies were done. First, we made use of data that have been newly released or acquired during an intensive 3-year eff ort to obtain access to microdata (individual￾level data) and tabulated data sources. Second, we used new methods to analyse data from summary birth histories with reduced bias and measurement error.19 Third, we applied new data synthesis methods with enhanced predictive validity to combine data from several sources and capture both sampling and non￾sampling error patterns. This new method requires many fewer subjective inputs to estimation, ensuring that the output is strongly grounded in empirical data and is as reproducible as possible. Finally, we took advantage of more data and better models with improved predictive validity to analyse country patterns of neonatal, postneonatal, and childhood mortality. Figure 1: Empirical data sources and estimated under-5 mortality from 1970 to 2010 for selected countries Dashed lines indicate uncertainty intervals. Hollow circles represent outliers. Under-5 mortality is defi ned as the probability of death between birth and age 5 years. Upward-pointing triangles are direct estimates from complete birth histories. Downward-pointing triangles are indirect estimates from summary birth histories. Under-5 mortality (per 1000) Under-5 mortality (per 1000) Year Vital registration Census Other Norway 16 0 1970 1980 1990 2000 2010 4 6 8 12 14 10 300 0 50 100 150 250 200 A Year Demographic and Health Surveys Centers for Disease Control and Prevention Reproductive Health Surveys Census Vital registration Other El Salvador 0 1970 1980 1990 2000 2010 50 150 100 200 B C Laos D Liberia ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● Demographic and Health Surveys Census Household deaths Other Malaria indicator survey 350 0 50 100 150 250 200 300