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
Authors: Katherine R Paulson, Aruna M Kamath, Tahiya Alam, Kelly Bienhoff, Gdiom Gebreheat Abady, Jaffar Abbas, Mohsen Abbasi-Kangevari, Hedayat Abbastabar, Foad Abd-Allah, Sherief M Abd-Elsalam, Amir Abdoli, Aidin Abedi, Hassan Abolhassani, Lucas Guimarães Abreu, Eman Abu-Gharbieh, Niveen ME Abu-Rmeileh, Abdelrahman I Abushouk, Aishatu L Adamu, Oladimeji M Adebayo, Adeyinka Emmanuel Adegbosin, Victor Adekanmbi, Olatunji O Adetokunboh, Daniel Adedayo Adeyinka, Jose C Adsuar, Khashayar Afshari, Mohammad Aghaali, Marcela Agudelo-Botero, Bright Opoku Ahinkorah, Tauseef Ahmad, Keivan Ahmadi, Muktar Beshir Ahmed, Budi Aji, Yonas Akalu, Oluwaseun Oladapo Akinyemi, Addis Aklilu, Ziyad Al-Aly, Khurshid Alam, Fahad Mashhour Alanezi, Turki M Alanzi, Jacqueline Elizabeth Alcalde-Rabanal, Ayman Al-Eyadhy, Tilahun Ali, Gianfranco Alicandro, Sheikh Mohammad Alif, Vahid Alipour, Hesam Alizade, Syed Mohamed Aljunid, Amir Almasi-Hashiani, Nihad A Almasri, Hesham M Al-Mekhlafi, Jordi Alonso, Rajaa M Al-Raddadi, Khalid A Altirkawi, Arwa Khalid Alumran, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Edward Kwabena Ameyaw, Saeed Amini, Mostafa Amini-Rarani, Arianna Maever L Amit, Dickson A Amugsi, Robert Ancuceanu, Deanna Anderlini, Catalina Liliana Andrei, Fereshteh Ansari, Alireza Ansari-Moghaddam, Carl Abelardo T Antonio, Ernoiz Antriyandarti, Davood Anvari, Razique Anwer, Muhammad Aqeel, Jalal Arabloo, Morteza Arab-Zozani, Timur Aripov, Johan Ärnlöv, Kurnia Dwi Artanti, Afsaneh Arzani, Malke Asaad, Mehran Asadi-Aliabadi, Ali A Asadi-Pooya, Mohammad Asghari Jafarabadi, Seyyed Shamsadin Athari, Seyyede Masoume Athari, Desta Debalkie Atnafu, Alok Atreya, Madhu Sudhan Atteraya, Marcel Ausloos, Asma Tahir Awan, Beatriz Paulina Ayala Quintanilla, Getinet Ayano, Martin Amogre Ayanore, Yared Asmare Aynalem, Samad Azari, Ghasem Azarian, Zelalem Nigussie Azene, Darshan B B, Ebrahim Babaee, Ashish D Badiye, Atif Amin Baig, Maciej Banach, Palash Chandra Banik, Suzanne Lyn Barker-Collo, Hiba Jawdat Barqawi, Quique Bassat, Sanjay Basu, Bernhard T Baune, Mohsen Bayati, Neeraj Bedi, Ettore Beghi, Massimiliano Beghi, Michelle L Bell, Salaheddine Bendak, Derrick A Bennett, Isabela M Bensenor, Kidanemaryam Berhe, Adam E Berman, Yihienew Mequanint Bezabih, Akshaya Srikanth Bhagavathula, Dinesh Bhandari, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Suraj Bhattarai, Zulfiqar A Bhutta, Boris Bikbov, Antonio Biondi, Binyam Minuye Birihane, Raaj Kishore Biswas, Somayeh Bohlouli, Nicola Luigi Bragazzi, Alexey V Breusov, Andre R Brunoni, Katrin Burkart, Sharath Burugina Nagaraja, Reinhard Busse, Zahid A Butt, Florentino Luciano Caetano dos Santos, Lucero Cahuana-Hurtado, Paulo Camargos, Luis Alberto Cámera, Rosario Cárdenas, Giulia Carreras, Juan J Carrero, Felix Carvalho, Joao Mauricio Castaldelli-Maia, Carlos A Castañeda-Orjuela, Giulio Castelpietra, Ester Cerin, Jung-Chen Chang, Wagaye Fentahun Chanie, Jaykaran Charan, Souranshu Chatterjee, Soosanna Kumary Chattu, Vijay Kumar Chattu, Sarika Chaturvedi, Simiao Chen, Daniel Youngwhan Cho, Jee-Young Jasmine Choi, Dinh-Toi Chu, Liliana G Ciobanu, Massimo Cirillo, Joao Conde, Vera Marisa Costa, Rosa A S Couto, Berihun Assefa Dachew, Saad M A Dahlawi, Hancheng Dai, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Parnaz Daneshpajouhnejad, Gary L Darmstadt, Jai K Das, Claudio Alberto Dávila-Cervantes, Adrian C Davis, Kairat Davletov, Fernando Pio De la Hoz, Diego De Leo, Farah Deeba, Edgar Denova-Gutiérrez, Nikolaos Dervenis, Assefa Desalew, Keshab Deuba, Sagnik Dey, Samath Dhamminda Dharmaratne, Sameer Dhingra, Govinda Prasad Dhungana, Diana Dias da Silva, Daniel Diaz, Fariba Dorostkar, Leila Doshmangir, Eleonora Dubljanin, Andre Rodrigues Duraes, Arielle Wilder Eagan, Hisham Atan Edinur, Ferry Efendi, Sahar Eftekharzadeh, Iman El Sayed, Maha El Tantawi, Iffat Elbarazi, Islam Y Elgendy, Shaimaa I El-Jaafary, Amir Emami, Shymaa Enany, Oghenowede Eyawo, Sayeh Ezzikouri, Pawan Sirwan Faris, Farshad Farzadfar, Nazir Fattahi, Nelsensius Klau Fauk, Mehdi Fazlzadeh, Valery L Feigin, Tomas Y Ferede, Seyed-Mohammad Fereshtehnejad, Eduarda Fernandes, Pietro Ferrara, Irina Filip, Florian Fischer, James L Fisher, Nataliya A Foigt, Morenike Oluwatoyin Folayan, Masoud Foroutan, Richard Charles Franklin, Marisa Freitas, Sara D Friedman, Takeshi Fukumoto, Mohamed M Gad, Abhay Motiramji Gaidhane, Shilpa Gaidhane, Santosh Gaihre, Silvano Gallus, Alberto L Garcia-Basteiro, MA Garcia-Gordillo, William M Gardner, Mariana Gaspar Fonseca, Ketema Bizuwork Gebremedhin, Lemma Getacher, Ahmad Ghashghaee, Asadollah Gholamian, Syed Amir Gilani, Tiffany K Gill, Giorgia Giussani, Elena V Gnedovskaya, Myron Anthony Godinho, Amit Goel, Mahaveer Golechha, Philimon N Gona, Sameer Vali Gopalani, Houman Goudarzi, Michal Grivna, Harish Chander Gugnani, Davide Guido, Rafael Alves Guimarães, Rajat Das Gupta, Rajeev Gupta, Nima Hafezi-Nejad, Mohammad Rifat Haider, Arvin Haj-Mirzaian, Samer Hamidi, Asif Hanif, Graeme J Hankey, Arief Hargono, Ahmed I Hasaballah, Md Mehedi Hasan, Syed Shahzad Hasan, Amr Hassan, Soheil Hassanipour, Hadi Hassankhani, Rasmus J Havmoeller, Khezar Hayat, Reza Heidari-Soureshjani, Nathaniel J Henry, Claudiu Herteliu, Michael K Hole, Ramesh Holla, Naznin Hossain, Mostafa Hosseini, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mowafa Househ, Junjie Huang, Ayesha Humayun, Bing-Fang Hwang, Ivo Iavicoli, Segun Emmanuel Ibitoye, Kevin S Ikuta, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Sumant Inamdar, Leeberk Raja Inbaraj, Khalid Iqbal, Usman Iqbal, M Mofizul Islam, Sheikh Mohammed Shariful Islam, Hiroyasu Iso, Masao Iwagami, Chidozie C D Iwu, Jalil Jaafari, Kathryn H Jacobsen, Jagnoor Jagnoor, Vardhmaan Jain, Manthan Dilipkumar Janodia, Tahereh Javaheri, Fatemeh Javanmardi, Shubha Jayaram, Achala Upendra Jayatilleke, Ensiyeh Jenabi, Ravi Prakash Jha, John S Ji, Oommen John, Jost B Jonas, Tamas Joo, Nitin Joseph, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Ali Kabir, Zubair Kabir, Leila R Kalankesh, Naser Kamyari, Tanuj Kanchan, Neeti Kapoor, Behzad Karami Matin, André Karch, Salah Eddin Karimi, Getinet Kassahun, Gbenga A Kayode, Ali Kazemi Karyani, Laura Kemmer, Nauman Khalid, Rovshan Khalilov, Mohammad Khammarnia, Ejaz Ahmad Khan, Gulfaraz Khan, Maseer Khan, Md Nuruzzaman Khan, Young-Ho Khang, Khaled Khatab, Amir M Khater, Mona M Khater, Maryam Khayamzadeh, Ardeshir Khosravi, Daniel Kim, Young-Eun Kim, Yun Jin Kim, Ruth W Kimokoti, Adnan Kisa, Sezer Kisa, Niranjan Kissoon, Jacek A Kopec, Soewarta Kosen, Parvaiz A Koul, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Kewal Krishan, Vijay Krishnamoorthy, Barthelemy Kuate Defo, Burcu Kucuk Bicer, Vaman Kulkarni, G Anil Kumar, Manasi Kumar, Nithin Kumar, Om P Kurmi, Dian Kusuma, Carlo La Vecchia, Ben Lacey, Ratilal Lalloo, Faris Hasan Lami, Iván Landires, Anders O Larsson, Savita Lasrado, Zohra S Lassi, Paolo Lauriola, Paul H Lee, Shaun Wen Huey Lee, Yo Han Lee, James Leigh, Matilde Leonardi, Sonia Lewycka, Bingyu Li, Shanshan Li, Juan Liang, Lee-Ling Lim, Miteku Andualem Limenih, Ro-Ting Lin, Xuefeng Liu, Rakesh Lodha, Alan D Lopez, Rafael Lozano, Alessandra Lugo, Raimundas Lunevicius, Mark T Mackay, Shilpashree Madhava Kunjathur, Francesca Giulia Magnani, D R Mahadeshwara Prasad, Mina Maheri, Morteza Mahmoudi, Azeem Majeed, Venkatesh Maled, Afshin Maleki, Shokofeh Maleki, Reza Malekzadeh, Ahmad Azam Malik, Deborah Carvalho Malta, Abdullah A Mamun, Borhan Mansouri, Mohammad Ali Mansournia, Gabriel Martinez, Santi Martini, Francisco Rogerlândio Martins-Melo, Seyedeh Zahra Masoumi, Pallab K Maulik, Colm McAlinden, John J McGrath, Carlo Eduardo Medina-Solís, Entezar Mehrabi Nasab, Fabiola Mejia-Rodriguez, Ziad A Memish, Walter Mendoza, Ritesh G Menezes, Endalkachew Worku Mengesha, George A Mensah, Atte Meretoja, Tuomo J Meretoja, Abera M Mersha, Tomislav Mestrovic, Bartosz Miazgowski, Tomasz Miazgowski, Irmina Maria Michalek, Ted R Miller, GK Mini, Mohammad Miri, Andreea Mirica, Erkin M Mirrakhimov, Hamed Mirzaei, Maryam Mirzaei, Babak Moazen, Masoud Moghadaszadeh, Bahram Mohajer, Osama Mohamad, Yousef Mohammad, Seyyede Momeneh Mohammadi, Abdollah Mohammadian-Hafshejani, Shafiu Mohammed, Ali H Mokdad, Mariam Molokhia, Lorenzo Monasta, Stefania Mondello, Mohammad Ali Moni, Catrin E Moore, Ghobad Moradi, Masoud Moradi, Rahmatollah Moradzadeh, Paula Moraga, Lidia Morawska, Shane Douglas Morrison, Jonathan F Mosser, Amin Mousavi Khaneghah, Ghulam Mustafa, Mehdi Naderi, Ahamarshan Jayaraman Nagarajan, Shankar Prasad Nagaraju, Mohsen Naghavi, Behshad Naghshtabrizi, Mukhammad David Naimzada, Vinay Nangia, Sreenivas Narasimha Swamy, Bruno Ramos Nascimento, Muhammad Naveed, Javad Nazari, Rawlance Ndejjo, Ionut Negoi, Ruxandra Irina Negoi, Evangelia Nena, Samata Nepal, Henok Biresaw Netsere, Georges Nguefack-Tsague, Josephine W Ngunjiri, Chi Thi Yen Nguyen, Cuong Tat Nguyen, Huong Lan Thi Nguyen, Yeshambel T Nigatu, Samuel Negash Nigussie, Molly R Nixon, Chukwudi A Nnaji, Shuhei Nomura, Nurulamin M Noor, Jean Jacques Noubiap, Virginia Nuñez-Samudio, Vincent Ebuka Nwatah, Bogdan Oancea, Oluwakemi Ololade Odukoya, Felix Akpojene Ogbo, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Ahmed Omar Bali, Obinna E Onwujekwe, Alberto Ortiz, Adrian Otoiu, Nikita Otstavnov, Stanislav S Otstavnov, Mayowa O Owolabi, Mahesh P A, Jagadish Rao Padubidri, Smita Pakhale, Keyvan Pakshir, Pramod Kumar Pal, Raffaele Palladino, Adrian Pana, Songhomitra Panda-Jonas, Anamika Pandey, Ashok Pandey, Seithikurippu R Pandi-Perumal, Helena Ullyartha Pangaribuan, Ana Melisa Pardo-Montaño, Eun-Kee Park, Sangram Kishor Patel, George C Patton, Shrikant Pawar, Hamidreza Pazoki Toroudi, Amy E Peden, Veincent Christian Filipino Pepito, Emmanuel K Peprah, Jeevan Pereira, Jorge Pérez-Gómez, Norberto Perico, Konrad Pesudovs, Thomas Pilgrim, Marina Pinheiro, Michael A Piradov, Meghdad Pirsaheb, James A Platts-Mills, Khem Narayan Pokhrel, Maarten J Postma, Hadi Pourjafar, Sergio I Prada, Sanjay Prakash, Elisabetta Pupillo, Zahiruddin Quazi Syed, Navid Rabiee, Amir Radfar, Ata Rafiee, Alireza Rafiei, Alberto Raggi, Shadi Rahimzadeh, Mohammad Hifz Ur Rahman, Amir Masoud Rahmani, Kiana Ramezanzadeh, Juwel Rana, Chhabi Lal Ranabhat, Sowmya J Rao, Davide Rasella, Prateek Rastogi, Priya Rathi, David Laith Rawaf, Salman Rawaf, Wasiq Faraz Rawasia, Reza Rawassizadeh, Robert C Reiner Jr, Giuseppe Remuzzi, Andre M N Renzaho, Bhageerathy Reshmi, Serge Resnikoff, Negar Rezaei, Nima Rezaei, Aziz Rezapour, Seyed Mohammad Riahi, Daniela Ribeiro, Jennifer Rickard, Leonardo Roever, Luca Ronfani, Dietrich Rothenbacher, Enrico Rubagotti, Susan Fred Rumisha, Paul MacDaragh Ryan, Basema Saddik, Ehsan Sadeghi, Sahar Saeedi Moghaddam, Rajesh Sagar, Amirhossein Sahebkar, Mohammad Reza Salahshoor, Sana Salehi, Marwa Rashad Salem, Hamideh Salimzadeh, Joshua A Salomon, Yoseph Leonardo Samodra, Abdallah M Samy, Juan Sanabria, Milena M Santric-Milicevic, Sivan Yegnanarayana Iyer Saraswathy, Abdur Razzaque Sarker, Nizal Sarrafzadegan, Arash Sarveazad, Brijesh Sathian, Thirunavukkarasu Sathish, Davide Sattin, Sonia Saxena, Ganesh Kumar Saya, Mete Saylan, Silvia Schiavolin, Markus P Schlaich, David C Schwebel, Falk Schwendicke, Subramanian Senthilkumaran, Sadaf G Sepanlou, Edson Serván-Mori, Feng Sha, Omid Shafaat, Saeed Shahabi, Mohammad Shahbaz, Amira A Shaheen, Izza Shahid, Masood Ali Shaikh, Saeed Shakiba, Ali S Shalash, Mehran Shams-Beyranvand, Mohammed Shannawaz, Kiomars Sharafi, Aziz Sheikh, Sara Sheikhbahaei, Wondimeneh Shibabaw Shiferaw, Mika Shigematsu, Jae Il Shin, Rahman Shiri, Ivy Shiue, Kerem Shuval, Tariq Jamal Siddiqi, Negussie Boti Sidemo, Inga Dora Sigfusdottir, Rannveig Sigurvinsdottir, João Pedro Silva, Jonathan I S Silverberg, Biagio Simonetti, Balbir Bagicha Singh, Jasvinder A Singh, Deepika Singhal, Dhirendra Narain Sinha, Eirini Skiadaresi, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, David A Sleet, Badr Hasan Sobaih, Mohammad Reza Sobhiyeh, Shahin Soltani, Joan B Soriano, Emma Elizabeth Spurlock, Chandrashekhar T Sreeramareddy, Paschalis Steiropoulos, Mark A Stokes, Stefan Stortecky, Mu'awiyyah Babale Sufiyan, Rizwan Suliankatchi Abdulkader, Gerhard Sulo, Carolyn B Swope, Bryan L Sykes, Mindy D Szeto, Miklós Szócska, Rafael Tabarés-Seisdedos, Eyayou Girma Tadesse, Amir Taherkhani, Animut Tagele Tamiru, Md Ismail Tareque, Arash Tehrani-Banihashemi, Mohamad-Hani Temsah, Fisaha Haile Tesfay, Gizachew Assefa Tessema, Zemenu Tadesse Tessema, Kavumpurathu Raman Thankappan, Rekha Thapar, Musliu Adetola Tolani, Marcos Roberto Tovani-Palone, Eugenio Traini, Bach Xuan Tran, Jaya Prasad Tripathy, Giorgos Tsapparellas, Aristidis Tsatsakis, Lorainne Tudor Car, Riaz Uddin, Anayat Ullah, Chukwuma David Umeokonkwo, Brigid Unim, Bhaskaran Unnikrishnan, Era Upadhyay, Muhammad Shariq Usman, Marco Vacante, Maryam Vaezi, Sahel Valadan Tahbaz, Pascual R Valdez, Tommi Juhani Vasankari, Narayanaswamy Venketasubramanian, Madhur Verma, Francesco S Violante, Vasily Vlassov, Bay Vo, Giang Thu Vu, Yohannes Dibaba Wado, Yasir Waheed, Richard G Wamai, Yanping Wang, Yanzhong Wang, Yuan-Pang Wang, Paul Ward, Andrea Werdecker, Ronny Westerman, Nuwan Darshana Wickramasinghe, Lauren B Wilner, Charles Shey Wiysonge, Ai-Min Wu, Chenkai Wu, Yang Xie, Seyed Hossein Yahyazadeh Jabbari, Kazumasa Yamagishi, Srikanth Yandrapalli, Sanni Yaya, Vahid Yazdi-Feyzabadi, Paul Yip, Naohiro Yonemoto, Seok-Jun Yoon, Mustafa Z Younis, Zabihollah Yousefi, Taraneh Yousefinezhadi, Chuanhua Yu, Sifat Shahana Yusuf, Syed Saoud Zaidi, Sojib Bin Zaman, Mohammad Zamani, Maryam Zamanian, Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, Yunquan Zhang, Zhi-Jiang Zhang, Xiu-Ju George Zhao, Arash Ziapour, Simon I Hay, Christopher J L Murray, Haidong Wang, Nicholas J Kassebaum
Journal: The Lancet (2021)

BackgroundSustainable 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.MethodsWe 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.FindingsGlobal 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.InterpretationGlobal 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.FundingBill & Melinda Gates Foundation.