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GLOBAL PROGRESS TOWARDS MDG 4 AND MDG 5

Sunday, 25th of September 2011

'In sub-Saharan Africa, Madagascar is likely to achieve MDG 4 by 2015, whereas eight countries (Eritrea, Ethiopia, Ghana, Liberia, Malawi, Rwanda, São Tomé and Príncipe, and Sierra Leone) are likely to achieve it by 2025. 23 countries in sub-Saharan Africa are unlikely at the present pace to achieve MDG 4 before 2040.'

• GLOBAL PROGRESS TOWARDS MDG4  AND MDG5

‘Under-5 deaths have continued to decline, reaching 7·2 million in 2011 of which 2·2 million were early neonatal, 0·7 million late neonatal, 2·1 million postneonatal, and 2·2 million during childhood (ages 1—4 years). Comparing rates of decline from 1990 to 2000 with 2000 to 2011 shows that 106 countries have accelerated declines in the child mortality rate in the past decade. Maternal mortality has also continued to decline from 409 100 (uncertainty interval 382 900—437 900) in 1990 to 273 500 (256 300—291 700) deaths in 2011. We estimate that 56 100 maternal deaths in 2011 were HIV-related deaths during pregnancy. Based on recent trends in developing countries, 31 countries will achieve MDG 4, 13 countries MDG 5, and nine countries will achieve both.’

 ‘. . . Immediate concerted action is needed for a large number of countries to achieve MDG 4 and MDG 5.’

Summary below; full text, with graphics, is at

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61337-8/fulltext

Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis

Original Text

Prof Rafael Lozano MD a , Haidong Wang PhD a, Kyle J Foreman MPH a, Julie Knoll Rajaratnam PhD a, Mohsen Naghavi MD a, Jake R Marcus MPH a, Laura Dwyer-Lindgren BA a, Katherine T Lofgren BA a, David Phillips BS a, Charles Atkinson BS a, Prof Alan D Lopez PhD b, Prof Christopher JL Murray MD a

Background

With 4 years until 2015, it is essential to monitor progress towards Millennium Development Goals (MDGs) 4 and 5. Although estimates of maternal and child mortality were published in 2010, an update of estimates is timely in view of additional data sources that have become available and new methods developed. Our aim was to update previous estimates of maternal and child mortality using better data and more robust methods to provide the best available evidence for tracking progress on MDGs 4 and 5.

Methods

We update the analyses of the progress towards MDGs 4 and 5 from 2010 with additional surveys, censuses, vital registration, and verbal autopsy data. For children, we estimate early neonatal (0—6 days), late neonatal (7—28 days), postneonatal (29—364 days), childhood (ages 1—4 years), and under-5 mortality. We use an improved model for estimating mortality by age under 5 years. For maternal mortality, our updated analysis includes greater than 1000 additional site-years of data. We tested a large set of alternative models for maternal mortality; we used an ensemble model based on the models with the best out-of-sample predictive validity to generate new estimates from 1990 to 2011.

Findings

Under-5 deaths have continued to decline, reaching 7·2 million in 2011 of which 2·2 million were early neonatal, 0·7 million late neonatal, 2·1 million postneonatal, and 2·2 million during childhood (ages 1—4 years). Comparing rates of decline from 1990 to 2000 with 2000 to 2011 shows that 106 countries have accelerated declines in the child mortality rate in the past decade. Maternal mortality has also continued to decline from 409 100 (uncertainty interval 382 900—437 900) in 1990 to 273 500 (256 300—291 700) deaths in 2011. We estimate that 56 100 maternal deaths in 2011 were HIV-related deaths during pregnancy. Based on recent trends in developing countries, 31 countries will achieve MDG 4, 13 countries MDG 5, and nine countries will achieve both.

Interpretation

Even though progress on reducing maternal and child mortality in most countries is accelerating, most developing countries will take many years past 2015 to achieve the targets of the MDGs 4 and 5. Similarly, although there continues to be progress on maternal mortality the pace is slow, without any overall evidence of acceleration. Immediate concerted action is needed for a large number of countries to achieve MDG 4 and MDG 5.

Funding

Bill & Melinda Gates Foundation.

a Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA

b University of Queensland, School of Population Health, Herston, QLD, Australia

Correspondence to: Prof Rafael Lozano, Institute for Health Metrics and Evaluation, 2301 Fifth Avenue, Suite 600, Seattle, WA 98121, USA