Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: All-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019
Open accessAbstract
BACKGROUND: Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. METHODS: We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. FINDINGS: Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3-74·0) in 2000 to 37·1 (33·2-41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8-29·5) in 2000 to 17·9 (16·3-19·8) 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. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05-10·30) in 2000 and 5·05 million (4·27-6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53-4·02]) in 2000 to 48% (2·42 million; 2·06-2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. 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. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71-0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27-1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35-2·58; 37% [95% UI 32-43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier. INTERPRETATION: Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. FUNDING: Bill & Melinda Gates Foundation.
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Substantial barriers remain to reducing HIV mortality, such as stigma discouraging people from accessing treatment and care, insufficient health-care infrastructure, access to testing, coverage of antiretroviral therapy, and complications due to co-occurring diseases such as tuberculosis and HIV.
“Despite these successes, substantial barriers remain to reducing HIV mortality, such as stigma discouraging people from accessing treatment and care,67, 68 insufficient health-care infrastructure,69 access to testing,70 coverage of antiretroviral therapy,71 and complications due to co-occurring diseases such as tuberculosis and HIV.72”
From Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021 (2024) · cites this paper as [67]
The citation is attached to insufficient health-care infrastructure, not the other barriers listed in the sentence. The Discussion section, “Optimising health systems to scale up interventions” (page unavailable), says stronger facility infrastructure is needed to improve survival among children under 5, but does not establish it specifically as a barrier to reducing HIV mortality. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe fourth most cited article is "Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019", published in The Lancet in 2021 by the GBD 2019 Under-5 Mortality Collaborators.
“The fourth most cited article is entitled “Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019” [86], and was published in the Lancet in 2021 by the GBD 2019 Under-5 Mortality Collaborators.”
From Towards Green and Sustainable Healthcare: A Literature Review and Research Agenda for Green Leadership in the Healthcare Sector (2023) · cites this paper as [86]
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- Affiliations
- Institute for Health Metrics and Evaluation (US)
- Corresponding author
- Kassebaum, Nicholas J
- ORCID
- Paulson, Katherine R
- Kamath, Aruna M
- Bienhoff, Kelly
- Abbas, Jaffar
- Abbastabar, Hedayat
- Abd-Allah, Foad
- Abd-Elsalam, Sherief M
- Abdoli, Amir
- Abedi, Aidin
- Abolhassani, Hassan
- Abreu, Lucas Guimarães
- Abushouk, Abdelrahman I
- Adamu, Aishatu L
- Adebayo, Oladimeji M
- Adegbosin, Adeyinka Emmanuel
- Adekanmbi, Victor
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- Adeyinka, Daniel Adedayo
- Afshari, Khashayar
- Aghaali, Mohammad
- Ahinkorah, Bright Opoku
- Ahmad, Tauseef
- Ahmadi, Keivan
- Ahmed, Muktar Beshir
- Aji, Budi
- Akalu, Yonas
- Akinyemi, Oluwaseun Oladapo
- Aklilu, Addis
- Alam, Khurshid
- Alanezi, Fahad Mashhour
- Alanzi, Turki M
- Al-Eyadhy, Ayman
- Ali, Tilahun
- Alicandro, Gianfranco
- Alif, Sheikh Mohammad
- Alizade, Hesam
- Aljunid, Syed Mohamed
- Almasri, Nihad A
- Alonso, Jordi
- Al-Raddadi, Rajaa M
- Altirkawi, Khalid A
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- Aqeel, Muhammad
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- Aripov, Timur
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- Artanti, Kurnia Dwi
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- Asadi-Aliabadi, Mehran
- Athari, Seyyed Shamsadin
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- Hargono, Arief
- Hasaballah, Ahmed I
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- Hasan, Syed Shahzad
- Hassan, Amr
- Hassanipour, Soheil
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- Humayun, Ayesha
- Hwang, Bing-Fang
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- Iqbal, Usman
- Islam, Sheikh Mohammed Shariful
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- Kemmer, Laura
- Khalid, Nauman
- Khalilov, Rovshan
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- Khan, Gulfaraz
- Khan, Maseer
- Khan, Md Nuruzzaman
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- Khosravi, Ardeshir
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- Kim, Young-Eun
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- Koul, Parvaiz A
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- Krishan, Kewal
- Krishnamoorthy, Vijay
- Kulkarni, Vaman
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- Kumar, Manasi
- Kumar, Nithin
- Kurmi, Om P
- Kusuma, Dian
- Lacey, Ben
- Lalloo, Ratilal
- Lami, Faris Hasan
- Landires, Iván
- Lasrado, Savita
- Lassi, Zohra S
- Lauriola, Paolo
- Lee, Paul H
- Lee, Shaun Wen Huey
- Lee, Yo Han
- Leigh, James
- Leonardi, Matilde
- Lewycka, Sonia
- Li, Bingyu
- Li, Shanshan
- Liang, Juan
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- Limenih, Miteku Andualem
- Lin, Ro-Ting
- Liu, Xuefeng
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- Siddiqi, Tariq Jamal
- Silva, João Pedro
- Silverberg, Jonathan I S
- Simonetti, Biagio
- Singh, Balbir Bagicha
- Singhal, Deepika
- Sinha, Dhirendra Narain
- Skryabin, Valentin Yurievich
- Skryabina, Anna Aleksandrovna
- Sleet, David A
- Sobhiyeh, Mohammad Reza
- Soltani, Shahin
- Soriano, Joan B
- Spurlock, Emma Elizabeth
- Sreeramareddy, Chandrashekhar T
- Steiropoulos, Paschalis
- Stokes, Mark A
- Stortecky, Stefan
- Sufiyan, Mu'awiyyah Babale
- Sulo, Gerhard
- Swope, Carolyn B
- Sykes, Bryan L
- Szeto, Mindy D
- Szócska, Miklós
- Tadesse, Eyayou Girma
- Taherkhani, Amir
- Tamiru, Animut Tagele
- Tareque, Md Ismail
- Temsah, Mohamad-Hani
- Tesfay, Fisaha Haile
- Tessema, Gizachew Assefa
- Tessema, Zemenu Tadesse
- Thankappan, Kavumpurathu Raman
- Thapar, Rekha
- Tolani, Musliu Adetola
- Traini, Eugenio
- Tran, Bach Xuan
- Tripathy, Jaya Prasad
- Tsapparellas, Giorgos
- Tsatsakis, Aristidis
- Uddin, Riaz
- Ullah, Anayat
- Umeokonkwo, Chukwuma David
- Unim, Brigid
- Unnikrishnan, Bhaskaran
- Upadhyay, Era
- Usman, Muhammad Shariq
- Vacante, Marco
- Valdez, Pascual R
- Vasankari, Tommi Juhani
- Venketasubramanian, Narayanaswamy
- Verma, Madhur
- Violante, Francesco S
- Vlassov, Vasily
- Vu, Giang Thu
- Wado, Yohannes Dibaba
- Waheed, Yasir
- Wamai, Richard G
- Wang, Yanping
- Wang, Yanzhong
- Wang, Yuan-Pang
- Ward, Paul
- Werdecker, Andrea
- Westerman, Ronny
- Wickramasinghe, Nuwan Darshana
- Wilner, Lauren B
- Wiysonge, Charles Shey
- Wu, Chenkai
- Xie, Yang
- Yamagishi, Kazumasa
- Yandrapalli, Srikanth
- Yaya, Sanni
- Yip, Paul
- Yonemoto, Naohiro
- Yoon, Seok-Jun
- Younis, Mustafa Z
- Yousefi, Zabihollah
- Yu, Chuanhua
- Yusuf, Sifat Shahana
- Zaidi, Syed Saoud
- Zaman, Sojib Bin
- Zamani, Mohammad
- Zamanian, Maryam
- Zhang, Yunquan
- Zhang, Zhi-Jiang
- Zhao, Xiu-Ju George
- Ziapour, Arash
- Hay, Simon I
- Murray, Christopher J L
- Wang, Haidong
- Kassebaum, Nicholas J
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2021-09
- Volume
- 398
- Issue
- 10303
- Pages
- 870-905
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC8429803
- OpenAlex
- W3194309324
- Cited by
- 498
- References
- 32
- Citations by year
- 2026: 62 · 2025: 109 · 2024: 91 · 2023: 122 · 2022: 100 · 2021: 13
- FWCI
- 80.63
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DSPACE System - Metalibrary (University of the Coast) (publishedVersion, cc-by-nc-nd)
- SHURA (Sheffield Hallam University Research Archive) (Sheffield Hallam University) (acceptedVersion)
- City Research Online (City University London) (acceptedVersion)
- Research Open (London South Bank University) (acceptedVersion, cc-by)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- OPUS - Open Publications of UTS Scholars (University of Technology Sydney) (submittedVersion, other-oa)
- ResearchOnline - JCU (James Cook University) (submittedVersion)
- UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
- ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, cc-by)
- Ulster University Research Portal (Ulster University) (submittedVersion, cc-by)
- Pure (Coventry University) (submittedVersion, cc-by)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
- UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
- Charles Sturt University Research Output (CRO) (submittedVersion, cc-by)
- Murdoch University Research Portal (submittedVersion)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion, cc-by)
- BOA (University of Milano-Bicocca) (submittedVersion, cc-by)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by)
- Institutional Repository University of Extremadura (University of Extremadura) (submittedVersion, other-oa)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
- DR-NTU (Nanyang Technological University) (submittedVersion, cc-by)
- Deakin Research Online (Deakin University) (submittedVersion)
- ePrints Soton (University of Southampton) (submittedVersion, cc-by)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Figshare (submittedVersion, cc-by)
- Työväentutkimus Vuosikirja (submittedVersion)
- YUHSpace (Yonsei University Medical Library) (submittedVersion, cc-by-nc-nd)
- Institutional Repositories DataBase (IRDB) (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, cc-by)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Huddersfield Research Portal (University of Huddersfield) (submittedVersion, cc-by)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion, cc-by)
- King Abdullah University of Science and Technology Repository (King Abdullah University of Science and Technology) (submittedVersion, other-oa)
- Griffith Research Online (submittedVersion, cc-by)
- Seoul National University Open Repository (Seoul National University) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion, other-oa)
- Terrestrial Environment Research Center (University of Tsukuba) (submittedVersion, cc-by)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Open Access CRIS of the University of Bern
- Funders
- Manipal Academy of Higher Education
- Sociedad Española de Nefrología
- Research Management Centre, International Islamic University Malaysia
- Public Health England
- Norwegian Institute of Public Health
- Fundação de Amparo à Pesquisa do Estado de Minas Gerais
- British Heart Foundation
- NIHR Oxford Biomedical Research Centre
- South African Medical Research Council
- University Grants Commission
- Queensland Health
- Ulster University
- Pro-Reitoria de Pesquisa, Universidade de São Paulo
- National Heart Foundation of Australia
- Secretaría Nacional de Ciencia, Tecnología e Innovación
- GIST Cancer Research Fund
- Universidade Federal de Minas Gerais
- Deakin University
- Applied Molecular Biosciences Unit
- Instituto de Salud Carlos III
- Autoritatea Natională pentru Cercetare Stiintifică
- Sistema Nacional de Investigadores
- Edwards Lifesciences (APQ-000627-20)
- Bill and Melinda Gates Foundation (OPP1182474, 312382/2019-7)
- Chandigarh University
- Danmarks Grundforskningsfond
- Secretaria Nacional de Ciencia y Tecnología
- European Commission
- National Institute on Handicapped Research
- Department of Anthropology, University of California, Los Angeles
- University of Melbourne
- National Institute for Health and Care Research
- Universiti Kebangsaan Malaysia
- Hubei Provincial Department of Education (T2020003)
- National Institutes of Health (P30AG047845)
- Engineering Research Centers (SFRH/BHD/110001/2015)
- Science, Technology and Innovation Commission of Shenzhen Municipality (KQTD20190929172835662)
- Conselho Nacional de Desenvolvimento Científico e Tecnológico (404710/2018-2, 310797/2019-5)
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (001)
- Programa Operacional Temático Factores de Competitividade (POCI-01-0145-FEDER-029253)
- Ministero della Salute (GR-2013-02354960)
- NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research (UID/MULTI/04378/2019, UID/QUI/50006/2019)
- National Health and Medical Research Council (APP1195716)
- Fogarty International Center (k43 tw010716-04, PI18/01366, PERSTIGAN AC18/00071, ERA-PerMed-JTC2018, PI19/00815, ISCIII-RETIC REDinREN RD016/0009, DTS18/00032, K43TW010704, AC18/00064, PI19/00588)
- European Research Council (848325, WO2019054891)
- Ministry of Education, Culture, Sports, Science and Technology
- Fundação para a Ciência e a Tecnologia (DL57/2016/CP1334/CT0006)
- National Research Foundation
- National Institute on Aging
- Ministério da Ciência, Tecnologia e Ensino Superior
- University of New South Wales
- National Institute of Mental Health (R01MH110163, T32GM086270)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Keywords
- neonatal mortality, under-five mortality, child mortality, cause-specific mortality, mortality trends, stochastic frontier analysis, Global Burden of Disease Study 2019, newborn health
- MeSH terms
- Sustainable Development, COVID-19, SARS-CoV-2, Cause of Death, Child, Child, Preschool, Female, Humans, Infant, Infant Mortality, Infant, Newborn, Male, Global Health, Life Tables, Child Mortality
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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