Abstract
Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
| Original language | English |
|---|---|
| Pages (from-to) | 353-358 |
| Number of pages | 6 |
| Journal | Nature |
| Volume | 574 |
| Issue number | 7778 |
| DOIs | |
| State | Published - 17 Oct 2019 |
Bibliographical note
Funding Information:Competing interests This study was funded by the Bill & Melinda Gates
Funding Information:
593Medical Parasitology Department, Cairo University, Cairo, Egypt. 594Global Health Institute, Wuhan University, Wuhan, China. 595Department of Health Management and Economics, A.C.S. Medical College and Hospital, Tehran, Iran. 596Department of Electrical Engineering, Sharif University of Technology, Tehran, Iran. 597Electrical Engineering, Institute for Research in Fundamental Sciences, Tehran, Iran. 598Social Determinants of Health Research Center, Ardabil University of Medical Science, Ardabil, Iran. 599Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh. 600Department of Medicine, Monash University, Melbourne, Victoria, Australia. 601Student Research Committee, Babol University of Medical Sciences, Babol, Iran. 602Department of Community Medicine, Ardabil University of Medical Science, Ardabil, Iran. 603Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. 604Maternal and Child Wellbeing Unit, African Population Health Research Centre, Nairobi, Kenya. 605Public Health Department, Dilla University, Dilla, Ethiopia. 606Department of Preventative Medicine, Wuhan University, Wuhan, China. 607School of Public Health, Wuhan University of Science and Technology, Wuhan, China. 608Indian Institute of Public Health, Public Health Foundation of India, Gurugram, India. 609School of BioSciences, University of Melbourne, Parkville, Victoria, Australia. 610State University of Semarang, Public Health Science Department, Kota Semarang, Indonesia. 611Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan. 612These authors contributed equally: Roy Burstein, Nathaniel J. Henry. 613These authors jointly supervised this work: Christopher J. L. Murray, Simon I. Hay. *e-mail: sihay@uw.edu
Funding Information:
399Public Health Science Department, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. 400Department of Community and Family Medicine, Iran University of Medical Sciences, Tehran, Iran. 401University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. 402Department of Health Economics, Tabriz University of Medical Sciences, Tabriz, Iran. 403Department of Medicine, University of Cape Town, Cape Town, South Africa. 404Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia. 405Independent Consultant, Accra, Ghana. 406Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia. 407Center for the Aid Program of Research in South Africa (CAPRISA) TB and HIV Pathogenesis Unit, United Nations Programme on HIV/AIDS (UNAIDS), Durban, South Africa. 408Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada. 409Department of Psychiatry, University of Lagos, Lagos, Nigeria. 410Gastroenterology and Liver Disease Research Center, A.C.S. Medical College and Hospital, Tehran, Iran. 411Department of Food Science and Postharvest Technology, Gulu University, Gulu, Uganda. 412Ghent University, Ghent, Belgium. 413Centre for Healthy Start Initiative, Lagos, Nigeria. 414Department of Health Promotion and Education, University of Ibadan, Ibadan, Nigeria. 415Department of Pharmacology and Therapeutics, University of Nigeria Nsukka, Enugu, Nigeria. 416University of Washington, Seattle, WA, USA. 417Graduate School of Public Health, San Diego State University, San Diego, CA, USA. 418Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico. 419School of Medicine, Autonomous University of Madrid, Madrid, Spain. 420Department of Nephrology and Hypertension, The Institute for Health Research Foundation Jiménez Díaz University Hospital, Madrid, Spain. 421Environmental Management and Toxicology, University of Benin, Benin City, Nigeria. 422Faculty of Geoinformation Science and Earth Observation, University of Twente, Enschede, The Netherlands. 423Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana. 424Analytical Center, Moscow Institute of Physics and Technology, Dolgoprudny, Russia. 425Committee for the Comprehensive Assessment of Medical Devices and Information Technology, Health Technology Assessment Association, Moscow, Russia. 426Institute for Advanced Medical Research and Training, University of Ibadan, Ibadan, Nigeria. 427Department of Tb & Respiratory Medicine, Jagadguru Sri Shivarathreeswara University, Mysore, India. 428Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 429Heidelberg University, Heidelberg, Germany. 430Department of Medical Humanities and Social Medicine, Kosin University, Busan, South Korea. 431Research and Evaluation, Population Council, New Delhi, India. 432Indian Institute of Health Management Research University, Jaipur, India. 433Center for Research and Innovation, Ateneo De Manila University, Pasig City, The Philippines. 434Department of Genetics, Harvard University, Boston, MA, USA. 435Laboratory of Genetics and Molecular Cardiology, University of São Paulo, Sao Paulo, Brazil. 436Department of Cardiology, University of Bern, Bern, Switzerland. 437Parasitology and Entomology Department, Tarbiat Modares University, Tehran, Iran. 438National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark. 439Department of Nutrition and Food Sciences, Maragheh University of Medical Sciences, Maragheh, Iran. 440Department of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran. 441Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran. 442Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran. 443College of Graduate Health Sciences, A.T. Still University, Mesa, AZ, USA. 444Medichem, Barcelona, Spain. 445Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran. 446Department of Immunology, Mazandaran University of Medical Sciences, Sari, Iran. 447Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 448Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. 449Department of Clinical Biochemistry, Kermanshah University of Medical Sciences, Kermanshah, Iran. 450Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Funding Information:
380Department of Pediatrics & Pediatric Pulmonology, Institute of Mother & Child Care, Multan, Pakistan. 381Department of Urology, Tehran University of Medical Sciences, Tehran, Iran. 382Operating Room Department, Kermanshah University of Medical Sciences, Kermanshah, Iran. 383Research and Analytics, Initiative for Financing Health and Human Development, Chennai, India. 384Research and Analytics, Bioinsilico Technologies, Chennai, India. 385Cancer Research Center of Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran. 386Department of Epidemiology & Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran. 387Suraj Eye Institute, Nagpur, India. 388Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa. 389Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. 390General Surgery Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Publisher Copyright:
© 2019, The Author(s).
ASJC Scopus subject areas
- General
