Articles ☐<1% 2 一4% ☐5% Figure 6:Yearly percentage dedine mortality in children younger than 5 years between 1990 and 2010 frequency distribution of yearly rates of change,calculated rate of 4.4%per year.This proportion increased to 34%of at each single year increment,across all countries from country-years in 2000-10.Figure 8 shows the yearly 1970 to 2010.The median yearly rate of decline was 3.3% percentage decline(median across countries)in under-5 and the 10th percentile and 90th percentile rates of mortality in 1990-2000 compared with 2000-10 for the change were 0.8%and 6.4%,respectively.The empirical 21 regions.Regions below the 45 equivalence line are distribution of rates of change also shows that the MDG 4 showing deceleration and regions above the 45line are target rate of change corresponds to the 67th percentile. showing acceleration.In 13 regions of the world,including In 1970-90,the median rate of change across all country- all regions in sub-Saharan Africa,there is evidence of years was 3.2%,whereas in 1990-2010,the median rate accelerating declines from 2000 to 2010 compared with of change was 3.3%.Yearly rates of change by country 1990 to 2000.Three high-income regions are showing a from 1990 to 2010(calculated over the entire period)are slowdown in decline.but 11 developing country regions shown in figure 6.Across all developing countries,the are showing accelerations.This finding is particularly yearly rate of decline in under-5 mortality is 2.1%.a 35% important since policy attention for the MDGs since the decline overall.The fastest rates of decline occurred in Millennium Declaration in 2000 might be leading to many Latin American and north African countries.Some accelerations.The marked accelerations in decline in east countries in sub-Saharan Africa have had yearly rates of Asia and central Asia deserve note since several studies decline of more than 3%-Comoros,Eritrea,Ethiopia, have reported the slow rate of improvement,especially in Liberia,Madagascar,Malawi,and Niger. China,in the 1990s.From the perspective of the countries Figure 7 shows,for each of the 21 regions,the yearly with the highest rates of mortality,the accelerations in rate of decline in under-5,neonatal,postneonatal,and rates of decline seen in all regions in sub-Saharan Africa childhood mortality from 1990 to 2010.In regions that are the most encouraging.Clearly these regions are far consist of developing countries,the yearly rate of decline from the MDG 4 rate of decline,but there are signs of has been faster for childhood mortality than for improving progress.Webappendix p 210 provides the rate postneonatal mortality,and slowest for neonatal mortality. of decline for each country in sub-Saharan Africa.Rates of The fastest rates of decline have been more than 6%per decline have increased in 34 countries in sub-Saharan year for childhood mortality in Latin America Andean, Africa for 2000-10 compared with 1990-2000 and have Latin America tropical.Latin America central.and north increased by 1%or more in Angola,Botswana,Cameroon, Africa and the Middle East.The lowest rates of decline Congo,Democratic Republic ofthe Congo,Kenya,Lesotho, during the MDG 4 target window have been in Oceania Liberia,Rwanda,Senegal,Sierra Leone,Swaziland,and and southern sub-Saharan Africa.In regions with The Gambia.In 25 countries in sub-Saharan Africa,rates developed countries,rates of decline are more uniform of decline now exceed 2%per year,11 countries have rates across neonatal,postneonatal,and childhood mortality of decline in 1990-2000 and 2000-10 that are faster than and have stayed between 3%and 5%per year.Rates of the global median. decline in high-income countries in North America have however,been notably lower. Discussion During the MDG period (1990 to 2010).there is clear Our analysis of 16 174 measurements of child mortality in evidence of acceleration and deceleration in rates of decline 187 countries shows that the number of deaths in children in child mortality.Between 1990 and 2000,31%of country- younger than 5 years dropped from 16 million in 1970 to years had rates of decline that were above the MDG 4target 7.7 million in 2010.In developing countries,mortality in 2004 www.thelancet.com Vol 375 June 5,2010Articles 2004 www.thelancet.com Vol 375 June 5, 2010 frequency distribution of yearly rates of change, calculated at each single year increment, across all countries from 1970 to 2010. The median yearly rate of decline was 3·3% and the 10th percentile and 90th percentile rates of change were 0·8% and 6·4%, respectively. The empirical distribution of rates of change also shows that the MDG 4 target rate of change corresponds to the 67th percentile. In 1970–90, the median rate of change across all country￾years was 3·2%, whereas in 1990–2010, the median rate of change was 3·3%. Yearly rates of change by country from 1990 to 2010 (calculated over the entire period) are shown in fi gure 6. Across all developing countries, the yearly rate of decline in under-5 mortality is 2·1%, a 35% decline overall. The fastest rates of decline occurred in many Latin American and north African countries. Some countries in sub-Saharan Africa have had yearly rates of decline of more than 3%—Comoros, Eritrea, Ethiopia, Liberia, Madagascar, Malawi, and Niger. Figure 7 shows, for each of the 21 regions, the yearly rate of decline in under-5, neonatal, postneonatal, and childhood mortality from 1990 to 2010. In regions that consist of developing countries, the yearly rate of decline has been faster for childhood mortality than for postneonatal mortality, and slowest for neonatal mortality. The fastest rates of decline have been more than 6% per year for childhood mortality in Latin America Andean, Latin America tropical, Latin America central, and north Africa and the Middle East. The lowest rates of decline during the MDG 4 target window have been in Oceania and southern sub-Saharan Africa. In regions with developed countries, rates of decline are more uniform across neonatal, postneonatal, and childhood mortality and have stayed between 3% and 5% per year. Rates of decline in high-income countries in North America have, however, been notably lower. During the MDG period (1990 to 2010), there is clear evidence of acceleration and deceleration in rates of decline in child mortality. Between 1990 and 2000, 31% of country￾years had rates of decline that were above the MDG 4 target rate of 4·4% per year. This proportion increased to 34% of country-years in 2000–10. Figure 8 shows the yearly percentage decline (median across countries) in under-5 mortality in 1990–2000 compared with 2000–10 for the 21 regions. Regions below the 45° equivalence line are showing deceleration and regions above the 45° line are showing acceleration. 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. Three high-income regions are showing a slowdown in decline, but 11 developing country regions are showing accelerations. This fi nding is particularly important since policy attention for the MDGs since the Millennium Declaration in 2000 might be leading to accelerations. The marked accelerations in decline in east Asia and central Asia deserve note since several studies39–41 have reported the slow rate of improvement, especially in China, in the 1990s. From the perspective of the countries with the highest rates of mortality, the accelerations in rates of decline seen in all regions in sub-Saharan Africa are the most encouraging. Clearly these regions are far from the MDG 4 rate of decline, but there are signs of improving progress. Webappendix p 210 provides the rate of decline for each country in sub-Saharan Africa. Rates of decline have increased in 34 countries in sub-Saharan Africa for 2000–10 compared with 1990–2000 and have increased by 1% or more in Angola, Botswana, Cameroon, Congo, Democratic Republic of the Congo, Kenya, Lesotho, Liberia, Rwanda, Senegal, Sierra Leone, Swaziland, and The Gambia. In 25 countries in sub-Saharan Africa, rates of decline now exceed 2% per year; 11 countries have rates of decline in 1990–2000 and 2000–10 that are faster than the global median. Discussion Our analysis of 16 174 measurements of child mortality in 187 countries shows that the number of deaths in children younger than 5 years dropped from 16 million in 1970 to 7·7 million in 2010. In developing countries, mortality in Figure 6: Yearly percentage decline in mortality in children younger than 5 years between 1990 and 2010 <1% 1–2% 2–3% 3–4% 4–5% ≥5%