Articles ∂@克 Neonatal,postneonatal,childhood,and under-5 mortality for 187 countries,1970-2010:a systematic analysis of progress towards Millennium Development Goal 4 Julie Knoll Rajaratnam,Jake R Marcus,AbrahamD Flaxman,Haidong Wang,Alison Levin-Rector,Laura Dwyer,Megan Costa,Alan DLopez, Christopher JL Murray Summary Lancet2010:375:1988-2008 Background Previous assessments have highlighted that less than a quarter of countries are on track to achieve This online publication has Millennium Development Goal 4(MDG 4),which calls for a two-thirds reduction in mortality in children younger been corrected. than 5 years between 1990 and 2015.In view of policy initiatives and investments made since 2000,it is important to The corrected version first appeared at TheLancet.com on see if there is acceleration towards the MDG 4 target.We assessed levels and trends in child mortality for 187 countries August 17,2010 from1970to2010. Published Online May24.2010 Methods We compiled a database of 16174 measurements of mortality in children younger than 5 years for D0t10.101650140 187 countries from 1970 to 2009,by use of data from all available sources,including vital registration systems, 6736(10)60703-9 summary birth histories in censuses and surveys,and complete birth histories.We used Gaussian process regression See Comment page 1941 to generate estimates of the probability of death between birth and age 5 years.This is the first study that uses Institute for Health Metrics Gaussian process regression to estimate child mortality,and this technique has better out-of-sample predictive validity and Evaluation,University of Washington,Seattle,WA,USA than do previous methods and captures uncertainty caused by sampling and non-sampling error across data types. (JK Rajaratnam PhD, Neonatal,postneonatal,and childhood mortality was estimated from mortality in children younger than 5 years by JR Marcus BAAD Flaxman PhD, use of the 1760 measurements from vital registration systems and complete birth histories that contained specific HWang PhD, information about neonatal and postneonatal mortality. A Levin-Rector BSPH, LDwyer BA,M Costa BA ProfC]L Murray MD);and Findings Worldwide mortality in children younger than 5 years has dropped from 11.9 million deaths in 1990 to School of Population Health, 7.7 million deaths in 2010,consisting of 3.1 million neonatal deaths,2.3 million postneonatal deaths,and 2.3 million University of Queensland, childhood deaths(deaths in children aged 1-4 years).33.0%of deaths in children younger than 5 years occur in south Brisbane,QLD,Australia (ProfA D Lopez PhD) Asia and 49.6%occur in sub-Saharan Africa,with less than 1%of deaths occurring in high-income countries.Across Correspondence to 21 regions of the world,rates of neonatal,postneonatal,and childhood mortality are declining.The global decline Prof Christopher ]L Murray. from 1990 to 2010 is 2.1%per year for neonatal mortality,2.3%for postneonatal mortality,and 2.2%for childhood nstitute for Health Metrics and mortality.In 13 regions of the world,including all regions in sub-Saharan Africa,there is evidence of accelerating Evaluation,University of declines from 2000 to 2010 compared with 1990 to 2000.Within sub-Saharan Africa,rates of decline have increased Washington,23015th Avenue, Suite 600 Seattle by more than 1%in Angola,Botswana,Cameroon,Congo,Democratic Republic of the Congo,Kenya,Lesotho,Liberia, WA 98121,USA Rwanda,Senegal,Sierra Leone,Swaziland,and The Gambia. cjlm@uw.edu Interpretation Robust measurement of mortality in children younger than 5 years shows that accelerating declines are occurring in several low-income countries.These positive developments deserve attention and might need enhanced policy attention and resources Funding Bill Melinda Gates Foundation. Introduction The MDG 4 target has shifted the focus from tracking There are only 5 years left to achieve Millennium levels of child mortality to assessing whether countries Development Goal 4(MDG 4),which calls for a two-thirds are reducing child mortality at the 4.4%rate per year reduction in mortality in children younger than 5 years needed to achieve the two-thirds reduction in 25 years. between 1990 and 2015.Regular assessment of levels and Accurate assessments of rates of change need more trends in child mortality is essential for countries to ascertain robust measurement with narrower uncertainty intervals their progress towards this goal and to take action to meet it. than do assessments of levels.Although there have been Previous appraisals of mortality in children younger than substantial investments in the collection of data such as 5 years suggest that few countries are on track to meet summary and complete birth histories to measure child MDG 4.In each of these studies,no more than 26%of mortality,assessments of trends have varied substantially low-income and middle-income countries examined were from year to year and from source to source.For example. deemed to be on track to reach this target.Groups such as the list of the ten countries with the fastest rates of decline the Countdown to 2015 Initiative'have therefore tried to in child mortality between 1990 and 2007,as reported by rally support to accelerate progress in child mortality UNICEF in 2008,*UNICEF in 2009,and the UN 1988 www.thelancet.com Vol 375 June 5,20101988 www.thelancet.com Vol 375 June 5, 2010 Articles Lancet 2010; 375: 1988–2008 This online publication has been corrected. The corrected version fi rst appeared at TheLancet.com on August 17, 2010 Published Online May 24, 2010 DOI:10.1016/S0140- 6736(10)60703-9 See Comment page 1941 Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA (J K Rajaratnam PhD, J R Marcus BA, A D Flaxman PhD, H Wang PhD, A Levin-Rector BSPH, L Dwyer BA, M Costa BA, Prof C J L Murray MD); and School of Population Health, University of Queensland, Brisbane, QLD, Australia (Prof A D Lopez PhD) Correspondence to: Prof Christopher J L Murray, Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA cjlm@uw.edu Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970–2010: a systematic analysis of progress towards Millennium Development Goal 4 Julie Knoll Rajaratnam, Jake R Marcus, Abraham D Flaxman, Haidong Wang, Alison Levin-Rector, Laura Dwyer, Megan Costa, Alan D Lopez, Christopher J L Murray Summary Background Previous assessments have highlighted that less than a quarter of countries are on track to achieve Millennium Development Goal 4 (MDG 4), which calls for a two-thirds reduction in mortality in children younger than 5 years between 1990 and 2015. In view of policy initiatives and investments made since 2000, it is important to see if there is acceleration towards the MDG 4 target. We assessed levels and trends in child mortality for 187 countries from 1970 to 2010. Methods We compiled a database of 16 174 measurements of mortality in children younger than 5 years for 187 countries from 1970 to 2009, by use of data from all available sources, including vital registration systems, summary birth histories in censuses and surveys, and complete birth histories. We used Gaussian process regression to generate estimates of the probability of death between birth and age 5 years. This is the fi rst study that uses Gaussian process regression to estimate child mortality, and this technique has better out-of-sample predictive validity than do previous methods and captures uncertainty caused by sampling and non-sampling error across data types. Neonatal, postneonatal, and childhood mortality was estimated from mortality in children younger than 5 years by use of the 1760 measurements from vital registration systems and complete birth histories that contained specifi c information about neonatal and postneonatal mortality. Findings Worldwide mortality in children younger than 5 years has dropped from 11·9 million deaths in 1990 to 7·7 million deaths in 2010, consisting of 3·1 million neonatal deaths, 2·3 million postneonatal deaths, and 2·3 million childhood deaths (deaths in children aged 1–4 years). 33·0% of deaths in children younger than 5 years occur in south Asia and 49·6% occur in sub-Saharan Africa, with less than 1% of deaths occurring in high-income countries. Across 21 regions of the world, rates of neonatal, postneonatal, and childhood mortality are declining. The global decline from 1990 to 2010 is 2·1% per year for neonatal mortality, 2·3% for postneonatal mortality, and 2·2% for childhood mortality. In 13 regions of the world, including all regions in sub-Saharan Africa, there is evidence of accelerating declines from 2000 to 2010 compared with 1990 to 2000. Within sub-Saharan Africa, rates of decline have increased by more than 1% in Angola, Botswana, Cameroon, Congo, Democratic Republic of the Congo, Kenya, Lesotho, Liberia, Rwanda, Senegal, Sierra Leone, Swaziland, and The Gambia. Interpretation Robust measurement of mortality in children younger than 5 years shows that accelerating declines are occurring in several low-income countries. These positive developments deserve attention and might need enhanced policy attention and resources. Funding Bill & Melinda Gates Foundation. Introduction There are only 5 years left to achieve Millennium Development Goal 4 (MDG 4), which calls for a two-thirds reduction in mortality in children younger than 5 years between 1990 and 2015. Regular assessment of levels and trends in child mortality is essential for countries to ascertain their progress towards this goal and to take action to meet it. Previous appraisals of mortality in children younger than 5 years suggest that few countries are on track to meet MDG 4.1–3 In each of these studies,1–3 no more than 26% of low-income and middle-income countries examined were deemed to be on track to reach this target. Groups such as the Countdown to 2015 Initiative3 have therefore tried to rally support to accelerate progress in child mortality.4–7 The MDG 4 target has shifted the focus from tracking levels of child mortality to assessing whether countries are reducing child mortality at the 4·4% rate per year needed to achieve the two-thirds reduction in 25 years. Accurate assessments of rates of change need more robust measurement with narrower uncertainty intervals than do assessments of levels. Although there have been substantial investments in the collection of data such as summary and complete birth histories to measure child mortality, assessments of trends have varied substantially from year to year and from source to source. For example, the list of the ten countries with the fastest rates of decline in child mortality between 1990 and 2007, as reported by UNICEF in 2008,8 UNICEF in 2009,9 and the UN