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

, Santosh Gaihre

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Abstract

Background: Sustainable 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.
Methods: We 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.
Findings: Global 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.
Interpretation: Global 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.
Original languageEnglish
Article number398
Pages (from-to)870-905
Number of pages36
JournalThe Lancet
Volume398
Issue number10303
Early online date17 Aug 2021
DOIs
Publication statusPublished - 4 Sep 2021

Bibliographical note

Funding Information:
Research reported in this publication was supported by the Bill & Melinda Gates Foundation, the University of Melbourne, Public Health England, the Norwegian Institute of Public Health, the National Institute on Aging of the National Institutes of Health (award P30AG047845), and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163). Aruna M Kamath is funded by the National Institutes of Health (T32GM086270). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Bill & Melinda Gates Foundation or the National Institutes of Health. Lucas Guimar?es Abreu acknowledges Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - Brasil (CAPES) - C?digo de Financiamento 001, Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico (CNPq) (404710/2018-2 and 310797/2019-5), Funda??o de Amparo ? Pesquisa de Minas Gerais (FAPEMIG), and Pr?-Reitoria de Pesquisa (PRPq) of Universidade Federal de Minas Gerais. Olatunji O Adetokunboh was supported by the National Research Foundation, and Department of Science and Innovation, South Africa. Syed Mohamed Aljunid would like to acknowledge the Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Kuwait and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia, Malaysia for the approval and support to participate in this research project. Marcel Ausloos, Adrian Pana, and Claudiu Herteliu are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Claudiu Herteliu and Adrian Pana are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P2-2.1-SOL-2020-2-0351. Derrick A Bennett receives support from the Oxford National Institute for Health Research (NIHR) Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR, or the Department of Health and Social Care. Felix Carvalho and Eduarda Fernandes acknowledge UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. Joao Conde acknowledges the European Research Council, ERC starting grant agreement No 848325. Vera Marisa Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Funda??o para a Ci?ncia e Tecnologia (FCT), IP, under the Norma Transit?ria DL57/2016/CP1334/CT0006. Sagnik Dey acknowledges the support of the Centre of Excellence for Research on Clean Air (CERCA) and IIT Delhi for the institute chair position. Santosh Gaihre acknowledges the GCRF SAFEWATER Project, Ulster University, Northern Ireland. Sheikh Mohammed Shariful Islam acknowledges support from fellowships and funding from NHMRC and National Heart Foundation of Australia. Oommen John is recipient of an UIPA scholarship through University of New South Wales (UNSW), Sydney, Australia. Md Nuruzzaman Khan acknowledges the support of Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh. Yun Jin Kim was supported by the Research Management Centre, Xiamen University Malaysia, Malaysia (XMUMRF/2020-C6/ITCM/0004). Sindhura Lakshmi Koulmane Laxminarayana acknowledges support provided by Manipal Academy of Higher Education, Manipal, India. Kewal Krishan is supported by the UGC Centre of Advanced Study (CAS II), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Manasi Kumar would like to acknowledge NIH/FIC k43 tw010716-04. Ben Lacey acknowledges support from UK Biobank, the NIHR Oxford Biomedical Research Centre, and the BHF Oxford Centre of Research Excellence. Iv?n Landires is a member of the Sistema Nacional de Investigaci?n (SNI), which is supported by the Panama's Secretar?a Nacional de Ciencia, Tecnolog?a e Innovaci?n (SENACYT). John J McGrath has been supported by the Danish National Research Foundation (Niels Bohr Professorship), and is employed by The Queensland Centre for Mental Health Research which receives core funding from the Queensland Health. Stefania Mondello acknowledges support from the Italian Ministry of Health (grant number GR-2013-02354960). Jonathan F Mosser acknowledges funding from BMGF (OPP1182474). Bruno Ramos Nascimento was supported in part by CNPq (Bolsa de produtividade em pesquisa, 312382/2019-7), by the Edwards Lifesciences Foundation (Every Heartbeat Matters programme 2020), and by FAPEMIG (grant APQ-000627-20). Shuhei Nomura acknowledges support from the Ministry of Education, Culture, Sports, Science and Technology of Japan (MEXT). Oluwakemi Ololade Odukoya was supported by the Fogarty International Center of the National Institutes of Health under award number K43TW010704. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Alberto Ortiz was supported by FIS/Fondos FEDER (PI18/01366, PI19/00588, PI19/00815, DTS18/00032, ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00064 and PERSTIGAN AC18/00071, ISCIII-RETIC REDinREN RD016/0009), Sociedad Espa?ola de Nefrolog?a, FRIAT, Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-CM. Jagadish Rao Padubidri acknowledges the Manipal Academy of Higher Education Mangalore, Mangalore, India for their constant support. George C Patton is supported by an NHMRC senior principal research fellowship. Alberto Raggi is supported by a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C. Besta, Linea 4 Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). Bhageerathy Reshmi acknowledges support from Manipal College of Health Professions, Manipal, India. Daniela Ribeiro acknowledges the financial support from the European Union [FEDER funds through COMPETE, POCI-01-0145-FEDER-029253). Abdallah M Samy acknowledges the support from the Egyptian Fulbright Mission Program, and being a member of the Egyptian Young Academy of Sciences and Technology. Davide Sattin and Silvia Schiavolin acknowledge support by a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4 Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). Francesca Giulia Magnani acknowledges support by a grant from the Italian Ministry of Health GR2016-02365049. Feng Sha and Bingyu Li acknowledge support by the Shenzhen Social Science Fund (Grant No SZ2020C015) and the Shenzhen Science and Technology Program (Grant KQTD20190929172835662). Aziz Sheikh acknowledges the support of the Health Data Research UK BREATHE Hub. Jo?o Pedro Silva acknowledges support from grant number UIDB/04378/2020 from the Applied Molecular Biosciences Unit (UCIBIO), supported through Portuguese national funds via FCT/MCTES. David A Sleet acknowledges support from the James F and Sarah T Fries Foundation, The Bizzell Group. Mohammad Reza Sobhiyeh acknowledges support from the Clinical Research Development center of Imam Reza Hospital Kermanshah University of Medical Sciences, Iran. Joan B Soriano acknowledges support from the Centro de Investigaci?n en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Gizachew Assefa Tessema is a recipient of the Australian National Health and Medical Research Council (NHMRC) investigator grant (APP1195716). Riaz Uddin is supported by an Alfred Deakin Postdoctoral Research Fellowship. Bhaskaran Unnikrishnan acknowledges Katurba Medical College, Mangalore, India. Charles Shey Wiysonge is supported by the South African Medical Research Council. Sojib Bin Zaman received a scholarship from the Australian Government Research Training Program (RTP) in support of his academic career. Yunquan Zhang acknowledges the Science and Technology Research Project of Hubei Provincial Department of Education (grant number Q20201104) and Middle Aged Technology Innovation Team Project of Hubei Provincial Department of Education (grant number T2020003). Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.

Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

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