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NEONATAL MORTALITY LEVELS FOR 193 COUNTRIES IN 2009 WITH TRENDS SINCE 1990

Sunday, 25th of September 2011

 

• NEONATAL MORTALITY LEVELS FOR 193 COUNTRIES IN 2009 WITH TRENDS SINCE 1990

 

Since neonatal mortality has increased as a proportion of under-five mortality, a focused attack on deaths in the first 28 days of life is indicated to achieve MDG 4.

 

Excerpt and abstract below; full text, with figures, is at

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001080

 

‘As the risk of children dying before the age of five has fallen, the proportion of child deaths that occur in the neonatal period has increased. This increase is primarily a consequence of decreasing non-neonatal mortality in children under five from infectious diseases such as measles, pneumonia, diarrhea, malaria, and AIDS. Globally, 41% of under-five deaths now occur in the neonatal period. Over the 20 y between 1990 and 2009, the proportion of global neonatal deaths that occurred in Africa increased. Although Africa is now the region with the highest

NMR, the proportion of under-five child deaths that are neonatal remains relatively low in Africa—the fraction increased from 26% to 29% between 1990 and 2009. This apparent anomaly reflects the fact that Africa accounts for approximately 90% of child deaths due to malaria (0.7 million under-five deaths) and HIV/AIDS (0.2 million under-five deaths) [4], resulting in relativelyhigher post-neonatal child mortality than other regions.’

 

Authors’ abstract:

‘ Background: Historically, the main focus of studies of childhood mortality has been the infant and under-five mortality rates. Neonatal mortality (deaths ,28 days of age) has received limited attention, although such deaths account for about 41% of all child deaths. To better assess progress, we developed annual estimates for neonatal mortality rates (NMRs) and neonatal deaths for 193 countries for the period 1990–2009 with forecasts into the future.

 

Methods and Findings: We compiled a database of mortality in neonates and children (<5 years) comprising 3,551 countryyears of information. Reliable civil registration data from 1990 to 2009 were available for 38 countries. A statistical model was developed to estimate NMRs for the remaining 155 countries, 17 of which had no national data. Country consultation was undertaken to identify data inputs and review estimates. In 2009, an estimated 3.3 million babies died in the first month of life—compared with 4.6 million neonatal deaths in 1990—and more than half of all neonatal deaths occurred in five countries of the world (44% of global livebirths): India 27.8% (19.6% of global livebirths), Nigeria 7.2% (4.5%), Pakistan 6.9% (4.0%), China 6.4% (13.4%), and Democratic Republic of the Congo 4.6% (2.1%). Between 1990 and 2009, the global NMR declined by 28% from 33.2 deaths per 1,000 livebirths to 23.9. The proportion of child deaths that are in the neonatal period increased in all regions of the world, and globally is now 41%. While NMRs were halved in some regions of the world, Africa’s

NMR only dropped 17.6% (43.6 to 35.9).

 

Conclusions: Neonatal mortality has declined in all world regions. Progress has been slowest in the regions with high NMRs.

 

Global health programs need to address neonatal deaths more effectively if Millennium Development Goal 4 (two-thirds reduction in child mortality) is to be achieved.