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Abstract
Global efforts have increased the accuracy and timeliness of estimates of under-5
mortality; however, these estimates fail to use all data available, do not use transparent
and reproducible methods, do not distinguish predictions from measurements, and provide
no indication of uncertainty around point estimates. We aimed to develop new reproducible
methods and reanalyse existing data to elucidate detailed time trends.
We merged available databases, added to them when possible, and then applied Loess
regression to estimate past trends and forecast to 2015 for 172 countries. We developed
uncertainty estimates based on different model specifications and estimated levels
and trends in neonatal, post-neonatal, and childhood mortality.
Global under-5 mortality has fallen from 110 (109-110) per 1000 in 1980 to 72 (70-74)
per 1000 in 2005. Child deaths worldwide have decreased from 13.5 (13.4-13.6) million
in 1980 to an estimated 9.7 (9.5-10.0) million in 2005. Global under-5 mortality is
expected to decline by 27% from 1990 to 2015, substantially less than the target of
Millennium Development Goal 4 (MDG4) of a 67% decrease. Several regions in Latin America,
north Africa, the Middle East, Europe, and southeast Asia have had consistent annual
rates of decline in excess of 4% over 35 years. Global progress on MDG4 is dominated
by slow reductions in sub-Saharan Africa, which also has the slowest rates of decline
in fertility.
Globally, we are not doing a better job of reducing child mortality now than we were
three decades ago. Further improvements in the quality and timeliness of child-mortality
measurements should be possible by more fully using existing datasets and applying
standard analytical strategies.