Third, we aim to better define a holistic focus of preventable mortality by exploring two different measures of optimal child survival that can both inform global progress and provide a benchmark for intermediate progress evaluation in high-mortality settings. Second, we aim to evaluate comparative progress in cause-specific mortality in neonates and children from 2000 to 2019 to highlight successes and potential focus areas for improvement. First, we aim to present a detailed, comprehensive numerical assessment of progress towards SDG 3.2 targets for all-cause NMR and U5MR at the global, regional, and national level, including a series of scenarios that reflect possible trends over the next decade including the potential effects of the COVID-19 pandemic on young children. In this study, based on GBD 2019, we have three objectives. The latter allows for comparing performance between similar countries, and specifically helps those countries with high mortality to establish intermediate goals. Within this framework are two complementary cause-specific benchmarks: a global optimum, based on the lowest observed neonatal and under-5 mortality, and a survival potential frontier, based on stochastic frontier analysis of observed mortality and the Healthcare Access and Quality Index. Therefore, based on all-cause and cause-specific mortality estimates from GBD 2019, this study introduces a novel, reproducible, and holistic heuristic for quantifying optimal child survival. ![]() ![]() SDG 3.2 explicitly prioritises ending preventable child deaths. Additionally, this study presents for the first time all-cause mortality estimates for granular age groups of 0–6 days, 7–27 days, 1–5 months, 6–11 months, 12–23 months, and 2–4 years. Multiple future health scenarios for child mortality in 2030 were constructed to represent potential trajectories, including the potential impacts of the COVID-19 pandemic and scenarios with targeted improvements in neonatal survival. This analysis presents levels and trends in all-cause and cause-specific neonatal and under-5 mortality from 2000 to 2019. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is the only annual assessment of trends in all-cause mortality and cause-specific mortality by detailed age groups for all locations with a population greater than 50 000 people from 1990 to the present that is compliant with the Guidelines for Accurate and Transparent Health Estimates Reporting. The most recent child mortality report from the UN Inter-agency Group for Child Mortality Estimation (UNIGME), published in 2017 for the year 2015, reports on all-cause mortality only. Past preventable mortality analyses have focused on health-care delivery, or were limited to high-income countries and adult populations. Interpretationĭuring the Millennium Development Goal (MDG) era (2000–15), numerous organisations comprehensively described global progress in reducing child and neonatal mortality (MDG 4), but the early Sustainable Development Goal (SDG) period has seen few comparable efforts to track progress and none to date have attempted to quantify the preventable portion of child mortality (SDG 3.2). The global optimum analysis suggests NMR could be reduced to as low as 0♸0 (95% UI 0♷1–0♸6) deaths per 1000 livebirths and U5MR to 1♴4 (95% UI 1♲7–1♵8) deaths per 1000 livebirths, and in 2019, there were as many as 1♸7 million (95% UI 1♳5–2♵8 37% ) of 5♰5 million more deaths of children younger than 5 years than the survival potential frontier. 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. ![]() NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. ![]() Deaths of children younger than 5 years totalled 9♶5 million (95% UI 9♰5–10♳0) in 2000 and 5♰5 million (4♲7–6♰2) in 2019, with the neonatal fraction of these deaths increasing from 39% (3♷6 million ) in 2000 to 48% (2♴2 million 2♰6–2♸6) 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. Global U5MR decreased from 71♲ deaths per 1000 livebirths (95% uncertainty interval 68♳–74♰) in 2000 to 37♱ (33♲–41♷) in 2019 while global NMR correspondingly declined more slowly from 28♰ deaths per 1000 live births (26♸–29♵) in 2000 to 17♹ (16♳–19♸) in 2019. The Lancet Regional Health – Western Pacific.The Lancet Regional Health – Southeast Asia.The Lancet Gastroenterology & Hepatology.
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