Previous assessments have highlighted that less than a quarter of countries are on
track to achieve Millennium Development Goal 4 (MDG 4), which calls for a two-thirds
reduction in mortality in children younger than 5 years between 1990 and 2015. In
view of policy initiatives and investments made since 2000, it is important to see
if there is acceleration towards the MDG 4 target. We assessed levels and trends in
child mortality for 187 countries from 1970 to 2010.
We compiled a database of 16 174 measurements of mortality in children younger than
5 years for 187 countries from 1970 to 2009, by use of data from all available sources,
including vital registration systems, summary birth histories in censuses and surveys,
and complete birth histories. We used Gaussian process regression to generate estimates
of the probability of death between birth and age 5 years. This is the first study
that uses Gaussian process regression to estimate child mortality, and this technique
has better out-of-sample predictive validity than do previous methods and captures
uncertainty caused by sampling and non-sampling error across data types. Neonatal,
postneonatal, and childhood mortality was estimated from mortality in children younger
than 5 years by use of the 1760 measurements from vital registration systems and complete
birth histories that contained specific information about neonatal and postneonatal
Worldwide mortality in children younger than 5 years has dropped from 11.9 million
deaths in 1990 to 7.7 million deaths in 2010, consisting of 3.1 million neonatal deaths,
2.3 million postneonatal deaths, and 2.3 million childhood deaths (deaths in children
aged 1-4 years). 33.0% of deaths in children younger than 5 years occur in south Asia
and 49.6% occur in sub-Saharan Africa, with less than 1% of deaths occurring in high-income
countries. Across 21 regions of the world, rates of neonatal, postneonatal, and childhood
mortality are declining. The global decline from 1990 to 2010 is 2.1% per year for
neonatal mortality, 2.3% for postneonatal mortality, and 2.2% for childhood mortality.
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. Within
sub-Saharan Africa, rates of decline have increased by more than 1% in Angola, Botswana,
Cameroon, Congo, Democratic Republic of the Congo, Kenya, Lesotho, Liberia, Rwanda,
Senegal, Sierra Leone, Swaziland, and The Gambia.
Robust measurement of mortality in children younger than 5 years shows that accelerating
declines are occurring in several low-income countries. These positive developments
deserve attention and might need enhanced policy attention and resources.
Bill & Melinda Gates Foundation.
Copyright 2010 Elsevier Ltd. All rights reserved.