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Cited by 276Global Maternal and Child HealthMaternal and Neonatal HealthcareChild Nutrition and Water Access

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Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

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Burstein, Roy, Henry, Nathaniel J., Collison, Michael L., Marczak, Laurie B., Sligar, Amber, Watson, Stefanie, Marquez, Neal, Abbasalizad-Farhangi, Mahdieh, Abbasi, Masoumeh, Abd-Allah, Foad, Abdoli, Amir, Abdollahi, Mohammad, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abrigo, Michael R. 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V., Ortiz, Alberto, Osarenotor, Osayomwanbo, Osei, Frank B., Osgood-Zimmerman, Aaron E., Otstavnov, Stanislav S., Owolabi, Mayowa Ojo, P. A., Mahesh, Pagheh, Abdol Sattar, Pakhale, Smita, Panda-Jonas, Songhomitra, Pandey, Animika, Park, Eun-Kee, Parsian, Hadi, Pashaei, Tahereh, Patel, Sangram Kishor, Pepito, Veincent Christian Filipino, Pereira, Alexandre, Perkins, Samantha, Pickering, Brandon V., Pilgrim, Thomas, Pirestani, Majid, Piroozi, Bakhtiar, Pirsaheb, Meghdad, Plana-Ripoll, Oleguer, Pourjafar, Hadi, Puri, Parul, Qorbani, Mostafa, Quintana, Hedley, Rabiee, Mohammad, Rabiee, Navid, Radfar, Amir, Rafiei, Alireza, Rahim, Fakher, Rahimi, Zohreh, Rahimi-Movaghar, Vafa, Rahimzadeh, Shadi, Rajati, Fatemeh, Raju, Sree Bhushan, Ramezankhani, Azra, Ranabhat, Chhabi Lal, Rasella, Davide, Rashedi, Vahid, Rawal, Lal, Reiner Jr, Robert C., Renzaho, Andre M. N., Rezaei, Satar, Rezapour, Aziz, Riahi, Seyed Mohammad, Ribeiro, Ana Isabel, Roever, Leonardo, Roro, Elias Merdassa, Roser, Max, Roshandel, Gholamreza, Roshani, Daem, Rostami, Ali, Rubagotti, Enrico, Rubino, Salvatore, Sabour, Siamak, Sadat, Nafis, Sadeghi, Ehsan, Saeedi, Reza, Safari, Yahya, Safari-Faramani, Roya, Safdarian, Mahdi, Sahebkar, Amirhossein, Salahshoor, Mohammad Reza, Salam, Nasir, Salamati, Payman, Salehi, Farkhonde, Zahabi, Saleh Salehi, Salimi, Yahya, Salimzadeh, Hamideh, Salomon, Joshua A., Sambala, Evanson Zondani, Samy, Abdallah M., Santric Milicevic, Milena M., Jose, Bruno Piassi Sao, Saraswathy, Sivan Yegnanarayana Iyer, Sarmiento-Suárez, Rodrigo, Sartorius, Benn, Sathian, Brijesh, Saxena, Sonia, Sbarra, Alyssa N., Schaeffer, Lauren E., Schwebel, David C., Sepanlou, Sadaf G., Seyedmousavi, Seyedmojtaba, Shaahmadi, Faramarz, Shaikh, Masood Ali, Shams-Beyranvand, Mehran, Shamshirian, Amir, Shamsizadeh, Morteza, Sharafi, Kiomars, Sharif, Mehdi, Sharif-Alhoseini, Mahdi, Sharifi, Hamid, Sharma, Jayendra, Sharma, Rajesh, Sheikh, Aziz, Shields, Chloe, Shigematsu, Mika, Shiri, Rahman, Shiue, Ivy, Shuval, Kerem, Siddiqi, Tariq J., Silva, João Pedro, Singh, Jasvinder A., Sinha, Dhirendra Narain, Sisay, Malede Mequanent, Sisay, Solomon, Sliwa, Karen, Smith, David L., Somayaji, Ranjani, Soofi, Moslem, Soriano, Joan B., Sreeramareddy, Chandrashekhar T., Sudaryanto, Agus, Sufiyan, Mu’awiyyah Babale, Sykes, Bryan L., Sylaja, P. N., Tabarés-Seisdedos, Rafael, Tabb, Karen M., Tabuchi, Takahiro, Taveira, Nuno, Temsah, Mohamad-Hani, Terkawi, Abdullah Sulieman, Tessema, Zemenu Tadesse, Thankappan, Kavumpurathu Raman, Thirunavukkarasu, Sathish, To, Quyen G., Tovani-Palone, Marcos Roberto, Tran, Bach Xuan, Tran, Khanh Bao, Ullah, Irfan, Usman, Muhammad Shariq, Uthman, Olalekan A., Vahedian-Azimi, Amir, Valdez, Pascual R., van Boven, Job F. M., Vasankari, Tommi Juhani, Vasseghian, Yasser, Veisani, Yousef, Venketasubramanian, Narayanaswamy, Violante, Francesco S., Vladimirov, Sergey Konstantinovitch, Vlassov, Vasily, Vos, Theo, Vu, Giang Thu, Vujcic, Isidora S., Waheed, Yasir, Wakefield, Jon, Wang, Haidong, Wang, Yafeng, Wang, Yuan-Pang, Ward, Joseph L., Weintraub, Robert G., Weldegwergs, Kidu Gidey, Weldesamuel, Girmay Teklay, Westerman, Ronny, Wiysonge, Charles Shey, Wondafrash, Dawit Zewdu, Woyczynski, Lauren, Wu, Ai-Min, Xu, Gelin, Yadegar, Abbas, Yamada, Tomohide, Yazdi-Feyzabadi, Vahid, Yilgwan, Christopher Sabo, Yip, Paul, Yonemoto, Naohiro, Lebni, Javad Yoosefi, Younis, Mustafa Z., Yousefifard, Mahmoud, Yousof, Hebat-Allah Salah A., Yu, Chuanhua, Yusefzadeh, Hasan, Zabeh, Erfan, Moghadam, Telma Zahirian, Bin Zaman, Sojib, Zamani, Mohammad, Zandian, Hamed, Zangeneh, Alireza, Zerfu, Taddese Alemu, Zhang, Yunquan, Ziapour, Arash, Zodpey, Sanjay, Murray, Christopher J. L., Hay, Simon I.·2019·Nature
DOI 10.1038/s41586-019-1545-0PMC PMC6800389
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Abstract

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

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Fig. 1 U5MR estimates in 99 LMICs. a, U5MR at the second administrative level in 2000. b, U5MR at the second administrative level in 2017. c, Modelled posterior exceedance probability that a given second administrative unit had achieved the SDG 3.2 target of 25 deaths per 1,000 live births for children under 5 in 2017. d, Proportion of mortality of children under 5 occurring in the neonatal (0–28 days) group at the second administrative level in 2017.
Fig. 1 U5MR estimates in 99 LMICs. a, U5MR at the second administrative level in 2000. b, U5MR at the second administrative level in 2017. c, Modelled posterior exceedance probability that a given second administrative unit had achieved the SDG 3.2 target of 25 deaths per 1,000 live births for children under 5 in 2017. d, Proportion of mortality of children under 5 occurring in the neonatal (0–28 days) group at the second administrative level in 2017.CC BY · PubMed Central
Fig. 2 Geographical inequality in U5MR across 99 countries for 2000 and 2017. a, Absolute inequalities. Range of U5MR estimates in second administrative-level units across 99 LMICs. b, Relative inequalities. Range of ratios of U5MR estimates in second administrative-level units relative to country means. Each dot represents a second administrative-level unit. The lower bound of each bar represents the second administrative-level unit with the lowest U5MR in each country. The upper end of each bar represents the second administrative-level unit with the highest U5MR in each country. Thus, each bar represents the extent of geographical inequality in U5MRs estimated for each country. Bars indicating the range in 2017 are coloured according to their Global Burden of Disease super-region. Grey bars indicate the range in U5MR in 2000. The diamond in each bar represents the median U5MR estimated across second administrative-level units in each country and year. A coloured bar that is shorter than its grey counterpart indicates that geographical inequality has narrowed.
Fig. 2 Geographical inequality in U5MR across 99 countries for 2000 and 2017. a, Absolute inequalities. Range of U5MR estimates in second administrative-level units across 99 LMICs. b, Relative inequalities. Range of ratios of U5MR estimates in second administrative-level units relative to country means. Each dot represents a second administrative-level unit. The lower bound of each bar represents the second administrative-level unit with the lowest U5MR in each country. The upper end of each bar represents the second administrative-level unit with the highest U5MR in each country. Thus, each bar represents the extent of geographical inequality in U5MRs estimated for each country. Bars indicating the range in 2017 are coloured according to their Global Burden of Disease super-region. Grey bars indicate the range in U5MR in 2000. The diamond in each bar represents the median U5MR estimated across second administrative-level units in each country and year. A coloured bar that is shorter than its grey counterpart indicates that geographical inequality has narrowed.CC BY · PubMed Central
Fig. 3 Estimated number of children under 5 who died within 99 countries in 2017. a, Number of deaths of children under 5 in each country. b, Number of deaths in each first administrative-level unit. c, Number of deaths in each second administrative-level unit. d, Number of deaths of children under 5 in each 5 × 5-km grid cell. Note that scales vary for each aggregation unit.
Fig. 3 Estimated number of children under 5 who died within 99 countries in 2017. a, Number of deaths of children under 5 in each country. b, Number of deaths in each first administrative-level unit. c, Number of deaths in each second administrative-level unit. d, Number of deaths of children under 5 in each 5 × 5-km grid cell. Note that scales vary for each aggregation unit.CC BY · PubMed Central
Fig. 4 Number of deaths of children under 5, distributed across level of U5MR, in 2000 and in 2017, across 99 countries. Bar heights represent the total number of deaths of children under 5 within all second administrative-level units with corresponding U5MR. Bins are a width of 5 deaths per 1,000 live births. The colour of each bar represents the global region as defined by the subset legend map. As such, the sum of heights of all bars represents the total number of deaths across the 99 countries. a, Deaths of children under 5 in 2000. b, Deaths of children under 5 in 2017. The dotted line in the 2000 plot is the shape of the distribution in 2017, and the dotted line in the 2017 plot represents the distribution in 2000.
Fig. 4 Number of deaths of children under 5, distributed across level of U5MR, in 2000 and in 2017, across 99 countries. Bar heights represent the total number of deaths of children under 5 within all second administrative-level units with corresponding U5MR. Bins are a width of 5 deaths per 1,000 live births. The colour of each bar represents the global region as defined by the subset legend map. As such, the sum of heights of all bars represents the total number of deaths across the 99 countries. a, Deaths of children under 5 in 2000. b, Deaths of children under 5 in 2017. The dotted line in the 2000 plot is the shape of the distribution in 2017, and the dotted line in the 2017 plot represents the distribution in 2000.CC BY · PubMed Central
Extended Data Fig. 1 Neonatal and infant mortality rates in 2017. a, b, Maps showing the mortality rates of neonates (a; birth to 28 days of age) and infants (b; under 1 year of age) across second administrative-level units in 2017. Note that the ranges in the keys are different for the two maps.
Extended Data Fig. 1 Neonatal and infant mortality rates in 2017. a, b, Maps showing the mortality rates of neonates (a; birth to 28 days of age) and infants (b; under 1 year of age) across second administrative-level units in 2017. Note that the ranges in the keys are different for the two maps.CC BY · PubMed Central
Extended Data Fig. 2 Impact of inequality on U5MR. a, Potential reduction in the number of deaths that would have occurred if all second administrative-level units in the 20 countries with the greatest number of deaths of children under 5 in 2017 realized a homogenous U5MR that was equal to that of the lowest observed mortality rate in that country. In total, 66% of under-5 deaths could have been averted if all countries maintained mortality rates equal to the second administrative-level unit with lowest mortality. If this reference rate is set to the lowest observed rate across all of the 99 countries that were included in this study, 95% of under-5 deaths could have been averted. The size of each bar represents the total number of under-5 deaths in each country. The red portion of each bar indicates the number of deaths ‘attributed’ to geographical inequality in mortality rates, whereas the blue portion represents the number of deaths that would remain in the scenario in which all second administrative-level units within countries had the same mortality rate as the best-performing unit. b, Locations of under-5 deaths ‘attributable’ to geographical inequality, across all second administrative-level units in each country. Each country has one unit highlighted with a green diamond, which is the reference unit, or the location with the lowest mortality rate in the country in 2017.
Extended Data Fig. 2 Impact of inequality on U5MR. a, Potential reduction in the number of deaths that would have occurred if all second administrative-level units in the 20 countries with the greatest number of deaths of children under 5 in 2017 realized a homogenous U5MR that was equal to that of the lowest observed mortality rate in that country. In total, 66% of under-5 deaths could have been averted if all countries maintained mortality rates equal to the second administrative-level unit with lowest mortality. If this reference rate is set to the lowest observed rate across all of the 99 countries that were included in this study, 95% of under-5 deaths could have been averted. The size of each bar represents the total number of under-5 deaths in each country. The red portion of each bar indicates the number of deaths ‘attributed’ to geographical inequality in mortality rates, whereas the blue portion represents the number of deaths that would remain in the scenario in which all second administrative-level units within countries had the same mortality rate as the best-performing unit. b, Locations of under-5 deaths ‘attributable’ to geographical inequality, across all second administrative-level units in each country. Each country has one unit highlighted with a green diamond, which is the reference unit, or the location with the lowest mortality rate in the country in 2017.CC BY · PubMed Central
Extended Data Fig. 3 Relative uncertainty in U5MR estimates for 2017. Relative uncertainty in second administrative-level estimates compared with mean estimated U5MRs in each second administrative-level unit for 2017. Mean rates and relative uncertainty are split into population-weighted quartiles. These cut-off points indicate the relative uncertainty minimum, 25th, 50th and 75th percentiles, and maximum, which are 0.29, 0.51, 0.63 and 0.86, and 3.12, respectively. The under-5 mortality minimum, 25th, 50th and 75th percentiles, and maximum are 1.4, 13.0, 22.9 and 44.8, and 190.6 deaths per 1,000 live births. Areas in which our estimates are more uncertain are coloured with a scale of increasing blue hue, whereas areas in which the mean estimates of U5MR are high are coloured with a scale of increasing red hue. Purple areas have high, but uncertain, estimates of U5MRs. White areas have low relative mortality, with fairly certain estimates. Relative uncertainty is defined as the ratio of the width of the 95% uncertainty interval to the mean estimate.
Extended Data Fig. 3 Relative uncertainty in U5MR estimates for 2017. Relative uncertainty in second administrative-level estimates compared with mean estimated U5MRs in each second administrative-level unit for 2017. Mean rates and relative uncertainty are split into population-weighted quartiles. These cut-off points indicate the relative uncertainty minimum, 25th, 50th and 75th percentiles, and maximum, which are 0.29, 0.51, 0.63 and 0.86, and 3.12, respectively. The under-5 mortality minimum, 25th, 50th and 75th percentiles, and maximum are 1.4, 13.0, 22.9 and 44.8, and 190.6 deaths per 1,000 live births. Areas in which our estimates are more uncertain are coloured with a scale of increasing blue hue, whereas areas in which the mean estimates of U5MR are high are coloured with a scale of increasing red hue. Purple areas have high, but uncertain, estimates of U5MRs. White areas have low relative mortality, with fairly certain estimates. Relative uncertainty is defined as the ratio of the width of the 95% uncertainty interval to the mean estimate.CC BY · PubMed Central
Extended Data Fig. 4 Lower and upper uncertainty interval boundaries for U5MR mortality estimates in 2017. a, b, Lower (a) and upper (b) 95% uncertainty intervals for U5MR estimates across the second administrative-level units in 99 countries.
Extended Data Fig. 4 Lower and upper uncertainty interval boundaries for U5MR mortality estimates in 2017. a, b, Lower (a) and upper (b) 95% uncertainty intervals for U5MR estimates across the second administrative-level units in 99 countries.CC BY · PubMed Central
Extended Data Fig. 5 The counteracting forces of population change and mortality rate decline on total number of under-5 deaths. Arrow plots show the mortality rate strata (bins of 10 per 1,000 livebirths) in 2000.
Extended Data Fig. 5 The counteracting forces of population change and mortality rate decline on total number of under-5 deaths. Arrow plots show the mortality rate strata (bins of 10 per 1,000 livebirths) in 2000.CC BY · PubMed Central
Extended Data Fig. 6 Flowchart summarizing analytical process. Standard demographic notation were used. n, length of age bin; x, starting age of age bin; d, number of deaths; q, probability of death; a, average time lived in age bin by those who died in the age bin.
Extended Data Fig. 6 Flowchart summarizing analytical process. Standard demographic notation were used. n, length of age bin; x, starting age of age bin; d, number of deaths; q, probability of death; a, average time lived in age bin by those who died in the age bin.CC BY · PubMed Central

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Burstein, R., Henry, N. J., Collison, M. L., Marczak, L. B., Sligar, A., Watson, S., Marquez, N., Abbasalizad-Farhangi, M., Abbasi, M., Abd-Allah, F., Abdoli, A., Abdollahi, M., Abdollahpour, I., Abdulkader, R. S., Abrigo, M. R. M., Acharya, D., Adebayo, O. M., Adekanmbi, V., Adham, D., Afshari, M., Aghaali, M., Ahmadi, K., Ahmadi, M., Ahmadpour, E., Ahmed, R., Akal, C. G., Akinyemi, J. O., Alahdab, F., Alam, N., Alamene, G. M., Alene, K. A., Alijanzadeh, M., Alinia, C., Alipour, V., Aljunid, S. M., Almalki, M. J., Al-Mekhlafi, H. M., Altirkawi, K., Alvis-Guzman, N., Amegah, A. K., Amini, S., Amit, A. M. L., Anbari, Z., Androudi, S., Anjomshoa, M., Ansari, F., Antonio, C. A. T., Arabloo, J., Arefi, Z., Aremu, O., Armoon, B., Arora, A., Artaman, A., Asadi, A., Asadi-Aliabadi, M., Ashraf-Ganjouei, A., Assadi, R., Ataeinia, B., Atre, S. R., Quintanilla, B. P. A., Ayanore, M. A., Azari, S., Babaee, E., Babazadeh, A., Badawi, A., Bagheri, S., Bagherzadeh, M., Baheiraei, N., Balouchi, A., Barac, A., Bassat, Q., Baune, B. T., Bayati, M., Bedi, N., Beghi, E., Behzadifar, M., Behzadifar, M., Belay, Y. B., Bell, B., Bell, M. L., Berbada, D. A., Bernstein, R. S., Bhattacharjee, N. V., Bhattarai, S., Bhutta, Z. A., Bijani, A., Bohlouli, S., Breitborde, N. J. K., Britton, G., Browne, A. J., Nagaraja, S. B., Busse, R., Butt, Z. A., Car, J., Cárdenas, R., Castañeda-Orjuela, C. A., Cerin, E., Chanie, W. F., Chatterjee, P., Chu, D.-T., Cooper, C., Costa, V. M., Dalal, K., Dandona, L., Dandona, R., Daoud, F., Daryani, A., Das Gupta, R., Davis, I., Davis Weaver, N., Davitoiu, D. V., De Neve, J.-W., Demeke, F. M., Demoz, G. T., Deribe, K., Desai, R., Deshpande, A., Desyibelew, H. D., Dey, S., Dharmaratne, S. D., Dhimal, M., Diaz, D., Doshmangir, L., Duraes, A. R., Dwyer-Lindgren, L., Earl, L., Ebrahimi, R., Ebrahimpour, S., Effiong, A., Eftekhari, A., Ehsani-Chimeh, E., El Sayed, I., El Sayed Zaki, M., El Tantawi, M., El-Khatib, Z., Emamian, M. H., Enany, S., Eskandarieh, S., Eyawo, O., Ezalarab, M., Faramarzi, M., Fareed, M., Faridnia, R., Faro, A., Fazaeli, A. A., Fazlzadeh, M., Fentahun, N., Fereshtehnejad, S.-M., Fernandes, J. C., Filip, I., Fischer, F., Foigt, N. A., Foroutan, M., Francis, J. M., Fukumoto, T., Fullman, N., Gallus, S., Gebre, D. G., Gebrehiwot, T. T., Gebremeskel, G. G., Gessner, B. D., Geta, B., Gething, P. W., Ghadimi, R., Ghadiri, K., Ghajarzadeh, M., Ghashghaee, A., Gill, P. S., Gill, T. K., Golding, N., Gomes, N. G. M., Gona, P. N., Gopalani, S. V., Gorini, G., Goulart, B. N. G., Graetz, N., Greaves, F., Green, M. S., Guo, Y., Haj-Mirzaian, A., Haj-Mirzaian, A., Hall, B. J., Hamidi, S., Haririan, H., Haro, J. M., Hasankhani, M., Hasanpoor, E., Hasanzadeh, A., Hassankhani, H., Hassen, H. Y., Hegazy, M. I., Hendrie, D., Heydarpour, F., Hird, T. R., Hoang, C. L., Hollerich, G., Rad, E. H., Hoseini-Ghahfarokhi, M., Hossain, N., Hosseini, M., Hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Househ, M., Hsairi, M., Ilesanmi, O. S., Imani-Nasab, M. H., Iqbal, U., Irvani, S. S. N., Islam, N., Islam, S. M. S., Jürisson, M., Balalami, N. J., Jalali, A., Javidnia, J., Jayatilleke, A. U., Jenabi, E., Ji, J. S., Jobanputra, Y. B., Johnson, K., Jonas, J. B., Shushtari, Z. J., Jozwiak, J. J., Kabir, A., Kahsay, A., Kalani, H., Kalhor, R., Karami, M., Karki, S., Kasaeian, A., Kassebaum, N. J., Keiyoro, P. N., Kemp, G. R., Khabiri, R., Khader, Y. S., Khafaie, M. A., Khan, E. A., Khan, J., Khan, M. S., Khang, Y.-H., Khatab, K., Khater, A., Khater, M. M., Khatony, A., Khazaei, M., Khazaei, S., Khazaei-Pool, M., Khubchandani, J., Kianipour, N., Kim, Y. J., Kimokoti, R. W., Kinyoki, D. K., Kisa, A., Kisa, S., Kolola, T., Kosen, S., Koul, P. A., Koyanagi, A., Kraemer, M. U. G., Krishan, K., Krohn, K. J., Kugbey, N., Kumar, G. A., Kumar, M., Kumar, P., Kuupiel, D., Lacey, B., Lad, S. D., Lami, F. H., Larsson, A. O., Lee, P. H., Leili, M., Levine, A. J., Li, S., Lim, L.-L., Listl, S., Longbottom, J., Lopez, J. C. F., Lorkowski, S., Magdeldin, S., Abd El Razek, H. M., Abd El Razek, M. M., Majeed, A., Maleki, A., Malekzadeh, R., Malta, D. C., Mamun, A. A., Manafi, N., Manda, A.-L., Mansourian, M., Martins-Melo, F. R., Masaka, A., Massenburg, B. B., Maulik, P. K., Mayala, B. K., Mazidi, M., McKee, M., Mehrotra, R., Mehta, K. M., Meles, G. G., Mendoza, W., Menezes, R. G., Meretoja, A., Meretoja, T. J., Mestrovic, T., Miller, T. R., Miller-Petrie, M. K., Mills, E. J., Milne, G. J., Mini, G. K., Mir, S. M., Mirjalali, H., Mirrakhimov, E. M., Mohamadi, E., Mohammad, D. K., Darwesh, A. M., Mezerji, N. M. G., Mohammed, A. S., Mohammed, S., Mokdad, A. H., Molokhia, M., Monasta, L., Moodley, Y., Moosazadeh, M., Moradi, G., Moradi, M., Moradi, Y., Moradi-Lakeh, M., Moradinazar, M., Moraga, P., Morawska, L., Mosapour, A., Mousavi, S. M., Mueller, U. O., Muluneh, A. G., Mustafa, G., Nabavizadeh, B., Naderi, M., Nagarajan, A. J., Nahvijou, A., Najafi, F., Nangia, V., Ndwandwe, D. E., Neamati, N., Negoi, I., Negoi, R. I., Ngunjiri, J. W., Thi Nguyen, H. L., Nguyen, L. H., Nguyen, S. H., Nielsen, K. R., Ningrum, D. N. A., Nirayo, Y. L., Nixon, M. R., Nnaji, C. A., Nojomi, M., Noroozi, M., Nosratnejad, S., Noubiap, J. J., Motlagh, S. N., Ofori-Asenso, R., Ogbo, F. A., Oladimeji, K. E., Olagunju, A. T., Olfatifar, M., Olum, S., Olusanya, B. O., Oluwasanu, M. M., Onwujekwe, O. E., Oren, E., Ortega-Altamirano, D. D. V., Ortiz, A., Osarenotor, O., Osei, F. B., Osgood-Zimmerman, A. E., Otstavnov, S. S., Owolabi, M. O., P. A., M., Pagheh, A. S., Pakhale, S., Panda-Jonas, S., Pandey, A., Park, E.-K., Parsian, H., Pashaei, T., Patel, S. K., Pepito, V. C. F., Pereira, A., Perkins, S., Pickering, B. V., Pilgrim, T., Pirestani, M., Piroozi, B., Pirsaheb, M., Plana-Ripoll, O., Pourjafar, H., Puri, P., Qorbani, M., Quintana, H., Rabiee, M., Rabiee, N., Radfar, A., Rafiei, A., Rahim, F., Rahimi, Z., Rahimi-Movaghar, V., Rahimzadeh, S., Rajati, F., Raju, S. B., Ramezankhani, A., Ranabhat, C. L., Rasella, D., Rashedi, V., Rawal, L., Reiner Jr, R. C., Renzaho, A. M. N., Rezaei, S., Rezapour, A., Riahi, S. M., Ribeiro, A. I., Roever, L., Roro, E. M., Roser, M., Roshandel, G., Roshani, D., Rostami, A., Rubagotti, E., Rubino, S., Sabour, S., Sadat, N., Sadeghi, E., Saeedi, R., Safari, Y., Safari-Faramani, R., Safdarian, M., Sahebkar, A., Salahshoor, M. R., Salam, N., Salamati, P., Salehi, F., Zahabi, S. S., Salimi, Y., Salimzadeh, H., Salomon, J. A., Sambala, E. Z., Samy, A. M., Santric Milicevic, M. M., Jose, B. P. S., Saraswathy, S. Y. I., Sarmiento-Suárez, R., Sartorius, B., Sathian, B., Saxena, S., Sbarra, A. N., Schaeffer, L. E., Schwebel, D. C., Sepanlou, S. G., Seyedmousavi, S., Shaahmadi, F., Shaikh, M. A., Shams-Beyranvand, M., Shamshirian, A., Shamsizadeh, M., Sharafi, K., Sharif, M., Sharif-Alhoseini, M., Sharifi, H., Sharma, J., Sharma, R., Sheikh, A., Shields, C., Shigematsu, M., Shiri, R., Shiue, I., Shuval, K., Siddiqi, T. J., Silva, J. P., Singh, J. A., Sinha, D. N., Sisay, M. M., Sisay, S., Sliwa, K., Smith, D. L., Somayaji, R., Soofi, M., Soriano, J. B., Sreeramareddy, C. T., Sudaryanto, A., Sufiyan, M. B., Sykes, B. L., Sylaja, P. N., Tabarés-Seisdedos, R., Tabb, K. M., Tabuchi, T., Taveira, N., Temsah, M.-H., Terkawi, A. S., Tessema, Z. T., Thankappan, K. R., Thirunavukkarasu, S., To, Q. G., Tovani-Palone, M. R., Tran, B. X., Tran, K. B., Ullah, I., Usman, M. S., Uthman, O. A., Vahedian-Azimi, A., Valdez, P. R., van Boven, J. F. M., Vasankari, T. J., Vasseghian, Y., Veisani, Y., Venketasubramanian, N., Violante, F. S., Vladimirov, S. K., Vlassov, V., Vos, T., Vu, G. T., Vujcic, I. S., Waheed, Y., Wakefield, J., Wang, H., Wang, Y., Wang, Y.-P., Ward, J. L., Weintraub, R. G., Weldegwergs, K. G., Weldesamuel, G. T., Westerman, R., Wiysonge, C. S., Wondafrash, D. Z., Woyczynski, L., Wu, A.-M., Xu, G., Yadegar, A., Yamada, T., Yazdi-Feyzabadi, V., Yilgwan, C. S., Yip, P., Yonemoto, N., Lebni, J. Y., Younis, M. Z., Yousefifard, M., Yousof, H.-A. S. A., Yu, C., Yusefzadeh, H., Zabeh, E., Moghadam, T. Z., Bin Zaman, S., Zamani, M., Zandian, H., Zangeneh, A., Zerfu, T. A., Zhang, Y., Ziapour, A., Zodpey, S., Murray, C. J. L., & Hay, S. I.
Affiliations
  • University of Washington (US)
  • Kermanshah University of Medical Sciences (IR)
  • Cairo University (EG)
  • Jahrom University of Medical Sciences (IR)
  • Tehran University of Medical Sciences (IR)
  • Arak University of Medical Sciences (IR)
  • Ministry of Health (SA)
  • Dongguk University (KR)
  • University College Hospital, Ibadan (NG)
  • Cardiff University (GB)
  • Ardabil University of Medical Sciences (IR)
  • Zabol University of Medical Sciences (IR)
  • Qom University of Medical Science and Health Services (IR)
  • University of Lincoln (GB)
  • Ahvaz Jundishapur University of Medical Sciences (IR)
  • Tabriz University of Medical Sciences (IR)
  • University of Ibadan (NG)
  • Mayo Clinic (US)
  • Queensland Health (AU)
  • Madda Walabu University (ET)
  • Australian National University (AU)
  • Qazvin University of Medical Sciences (IR)
  • Urmia University (IR)
  • Iran University of Medical Sciences (IR)
  • Kuwait University (KW)
  • Jazan University (SA)
  • King Saud University (SA)
  • University of Cape Coast (GH)
  • Johns Hopkins University (US)
  • University of Thessaly (GR)
  • Rafsanjan University of Medical Sciences (IR)
  • Hong Kong Polytechnic University (HK)
  • Birmingham City University (GB)
  • Saveh University of Medical Sciences (IR)
  • Sydney Local Health District (AU)
  • University of Manitoba (CA)
  • Mashhad University of Medical Sciences (IR)
  • Non-Communicable Diseases Research Center (IR)
  • La Trobe University (AU)
  • University of Health and Allied Sciences (GH)
  • Babol University of Medical Sciences (IR)
  • Public Health Agency of Canada (CA)
  • Sharif University of Technology (IR)
  • Tarbiat Modares University (IR)
  • University of Belgrade (RS)
  • Institució Catalana de Recerca i Estudis Avançats (ES)
  • The University of Melbourne (AU)
  • Shiraz University of Medical Sciences (IR)
  • Gandhi Medical College (IN)
  • Mario Negri Institute for Pharmacological Research (IT)
  • Lorestan University of Medical Sciences (IR)
  • Mekelle University (ET)
  • Yale University (US)
  • Arba Minch University (ET)
  • Emory University (US)
  • London School of Hygiene & Tropical Medicine (GB)
  • Aga Khan University (PK)
  • Islamic Azad University, Karaj (IR)
  • The Ohio State University (US)
  • Instituto Conmemorativo Gorgas de Estudios de la Salud (PA)
  • University of Oxford (GB)
  • Employees' State Insurance Model Hospital (IN)
  • Technische Universität Berlin (DE)
  • University of British Columbia (CA)
  • Nanyang Technological University (SG)
  • Universidad Autónoma Metropolitana (MX)
  • Universidad Nacional de Colombia (CO)
  • Australian Catholic University (AU)
  • University of Gondar (ET)
  • National Institute of Cholera and Enteric Diseases (IN)
  • Hanoi National University of Education (VN)
  • Universidade do Porto (PT)
  • Örebro University (SE)
  • Mazandaran University of Medical Sciences (IR)
  • Bahir Dar University (ET)
  • Addis Ababa University (ET)
  • Brighton and Sussex Medical School (GB)
  • Atlanta VA Medical Center (US)
  • Indian Institute of Technology Delhi (IN)
  • University of Peradeniya (LK)
  • Nepal Health Research Council (NP)
  • Kurdistan University of Medical Sciences (IR)
  • University of Newcastle Australia (AU)
  • Shahroud University of Medical Sciences (IR)
  • Suez Canal University (EG)
  • Simon Fraser University (CA)
  • Imam Mohammad ibn Saud Islamic University (SA)
  • Hamedan University of Medical Sciences (IR)
  • University of Ottawa (CA)
  • Universidade Católica Portuguesa (PT)
  • Kaiser Permanente (US)
  • Bielefeld University (DE)
  • D. F. Chebotarev State Institute of Gerontology of the National Academy of Medical Sciences of Ukraine (UA)
  • Abadan University of Medical Sciences (IR)
  • University of the Witwatersrand (ZA)
  • Kobe University (JP)
  • Jimma University (ET)
  • Pfizer (United States) (US)
  • Wollo University (ET)
  • University of Warwick (GB)
  • The University of Adelaide (AU)
  • University of Massachusetts Boston (US)
  • Department of Health and Social Affairs (FM)
  • Public Health England (GB)
  • University of Haifa (IL)
  • Zhengzhou University (CN)
  • University of Macau (MO)
  • Hamdan Bin Mohammed Smart University (AE)
  • Centro de Investigación Biomédica en Red de Salud Mental (ES)
  • Maragheh University of Medical Sciences (IR)
  • Mizan Tepi University (ET)
  • Curtin University (AU)
  • Baker Heart and Diabetes Institute (AU)
  • Trường ĐH Nguyễn Tất Thành (VN)
  • Guilan University of Medical Sciences (IR)
  • University of Dhaka (BD)
  • Carol Davila University of Medicine and Pharmacy (RO)
  • Hamad bin Khalifa University (QA)
  • Taipei Medical University (TW)
  • Research Institute for Endocrine Sciences (IR)
  • Harvard University (US)
  • The University of Sydney (AU)
  • University of Tartu (EE)
  • Babol Noshirvani University of Technology (IR)
  • University of Colombo (LK)
  • A.T. Still University (US)
  • Duke Kunshan University (CN)
  • University of Miami (US)
  • Beijing Tongren Hospital (CN)
  • University of Social Welfare and Rehabilitation Sciences (IR)
  • University of Opole (PL)
  • Isfahan University of Medical Sciences (IR)
  • Australian Red Cross Lifeblood (AU)
  • University of Nairobi (KE)
  • Jordan University of Science and Technology (JO)
  • Health Services Academy (PK)
  • International Institute for Population Sciences (IN)
  • John H. Stroger, Jr. Hospital of Cook County (US)
  • Seoul National University (KR)
  • Ohio University Zanesville (US)
  • Ball State University (US)
  • Xiamen University Malaysia (MY)
  • Simmons University (US)
  • Debre Berhan University (ET)
  • Sher-i-Kashmir Institute of Medical Sciences (IN)
  • Panjab University (IN)
  • Public Health Foundation of India (IN)
  • Ghana Health Service (GH)
  • National Institute for Health and Care Research (GB)
  • Post Graduate Institute of Medical Education and Research (IN)
  • Uppsala University (SE)
  • Monash University (AU)
  • Chinese University of Hong Kong (HK)
  • Radboud University Nijmegen (NL)
  • Liverpool School of Tropical Medicine (GB)
  • Imperial College London (GB)
  • The University of Queensland (AU)
  • Bucharest Emergency University Hospital (RO)
  • Botho University (BW)
  • UNSW Sydney (AU)
  • Chalmers University of Technology (SE)
  • National Institute of Cancer Prevention and Research (IN)
  • University of California, San Francisco (US)
  • United Nations Population Fund (US)
  • Imam Abdulrahman Bin Faisal University (SA)
  • University of Helsinki (FI)
  • McMaster University (CA)
  • The University of Western Australia (AU)
  • Amrita Institute of Medical Sciences and Research Centre (IN)
  • Golestan University of Medical Sciences (IR)
  • Shahid Beheshti University (IR)
  • Kyrgyz State Medical Academy (KG)
  • Health Equity Research Center (IR)
  • Karolinska Institutet (SE)
  • University of Human Development (IQ)
  • Haramaya University (ET)
  • Ahmadu Bello University (NG)
  • King's College London (GB)
  • IRCCS Materno Infantile Burlo Garofolo (IT)
  • University of KwaZulu-Natal (ZA)
  • University of Bath (GB)
  • Federal Institute for Population Research (DE)
  • Nishtar Medical College and Hospital (PK)
  • Suraj Eye Institute (IN)
  • South African Medical Research Council (ZA)
  • University of Embu (KE)
  • State University of Semarang (ID)
  • University of Cape Town (ZA)
  • Western Sydney University (AU)
  • Centre for the AIDS Programme of Research in South Africa (ZA)
  • University of Lagos (NG)
  • Gulu University (UG)
  • Centre for Healthy Start Initiative (NG)
  • University of Nigeria (NG)
  • University of Benin (NG)
  • University of Energy and Natural Resources (GH)
  • Moscow Institute of Physics and Technology (RU)
  • Ottawa Hospital Research Institute (CA)
  • Kosin University (KR)
  • Population Council (IN)
  • Ateneo de Manila University (PH)
  • University of Bern (CH)
  • University of Maragheh (IR)
  • Alborz University of Medical Sciences (IR)
  • Amirkabir University of Technology (IR)
  • Medichem (Spain) (ES)
  • Nizam's Institute of Medical Sciences (IN)
  • Yonsei University (KR)
  • Universidade Federal da Bahia (BR)
  • Shahid Beheshti University of Medical Sciences (IR)
  • Universidade Federal de Uberlândia (BR)
  • Wollega University (ET)
  • Southern University of Science and Technology (CN)
  • University of Sassari (IT)
  • York University (CA)
  • Digestive Disease Research Institute (IR)
  • Stanford University (US)
  • Ain Shams University (EG)
  • Foundation for Advancement of International Medical Education and Research (US)
  • Universidad de Ciencias Aplicadas y Ambientales (CO)
  • Hamad Medical Corporation (QA)
  • University of Alabama at Birmingham (US)
  • Dezful University of Medical Sciences (IR)
  • Kerman University of Medical Sciences (IR)
  • Delhi Technological University (IN)
  • National Institute of Infectious Diseases (JP)
  • Finnish Institute of Occupational Health (FI)
  • Martin Luther University Halle-Wittenberg (DE)
  • Dow University of Health Sciences (PK)
  • Patna University (IN)
  • Slagelse Hospital (DK)
  • University of Calgary (CA)
  • Instituto de Salud Carlos III (ES)
  • IMU University (MY)
  • Muhammadiyah University of Surakarta (ID)
  • University of California, Irvine (US)
  • Sree Chitra Thirunal Institute for Medical Sciences and Technology (IN)
  • University of Illinois Urbana-Champaign (US)
  • Osaka International Cancer Institute (JP)
  • University of Lisbon (PT)
  • Alfaisal University (SA)
  • University of Virginia (US)
  • Central University of Kerala (IN)
  • Queensland University of Technology (AU)
  • Hanoi Medical University (VN)
  • University of Auckland (NZ)
  • Gomal University (PK)
  • University Medical Center Groningen (NL)
  • Urho Kaleva Kekkonen Institute (FI)
  • Medical University of Ilam (IR)
  • National University of Singapore (SG)
  • IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
  • National Research University Higher School of Economics (RU)
  • Foundation University Medical College (PK)
  • Universidade de São Paulo (BR)
  • University College London (GB)
  • Royal Children's Hospital (AU)
  • Nanjing University (CN)
  • The University of Tokyo (JP)
  • University of Jos (NG)
  • University of Hong Kong (HK)
  • National Center of Neurology and Psychiatry (JP)
  • Jackson State University (US)
  • Wuhan University (CN)
  • African Population and Health Research Center (KE)
Corresponding author
Hay, Simon I.
ORCID
Venue
Nature
Publisher
Springer Science and Business Media LLC
Published
2019-10-16
Volume
574
Issue
7778
Pages
353-358
ISSN
  • 0028-0836 (ISSN-L)
  • 1476-4687
DOI
10.1038/s41586-019-1545-0
PMC
PMC6800389
OpenAlex
W2980608708
Cited by
276
References
62
Citations by year
2026: 12 · 2025: 34 · 2024: 38 · 2023: 37 · 2022: 55 · 2021: 47 · 2020: 47 · 2019: 4
FWCI
40.03
Type
journal article
Language
en
Open access
Licence
Locations
  • Nature (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
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  • University of Twente Research Information (publishedVersion, cc-by)
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  • Lincoln Repository (University of Lincoln) (acceptedVersion)
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  • ePrints Soton (University of Southampton) (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • QUT ePrints (Queensland University of Technology) (submittedVersion, cc-by)
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  • Repositório Comum (Repositório Científico de Acesso Aberto de Portugal) (submittedVersion, cc-by)
  • Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by)
  • BRAC University Institutional Repository (BRAC University) (submittedVersion, cc-by)
  • Research Repository Portal (Ilam University of Medical Sciences) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
  • Figshare (submittedVersion, cc-by)
  • Työväentutkimus Vuosikirja (submittedVersion)
  • University of Thessaly Institutional Repository (University of Thessaly) (submittedVersion)
  • UnissResearch (Università degli Studi di Sassari) (submittedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
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  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, cc-by)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Griffith Research Online (submittedVersion, cc-by)
  • Chalmers Research (Chalmers University of Technology) (submittedVersion)
  • ResearchSpace (University of Auckland) (submittedVersion, cc-by)
  • Seoul National University Open Repository (Seoul National University) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion, cc-by)
  • UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
  • Radboud Repository (Radboud University) (submittedVersion, other-oa)
  • University of Twente Research Information (submittedVersion, cc-by)
  • Apollo (cc-by)
  • Greater South Information System
Funders
  • U.S. Department of Veterans Affairs
  • Bill and Melinda Gates Foundation (#OPP1132415)
  • Kaiser Permanente
  • University of Washington
  • University of Ottawa
  • Wellcome Trust (201-900/Z/16/Z, 109949/Z/15/Z)
  • A.T. Still University
  • Aksum University
  • Istituto di Ricerche Farmacologiche Mario Negri - IRCCS
  • Maragheh University of Medical Sciences
  • National Institute for Health and Care Research (NF-SI-0508-10082, NF-SI-0513-10085)
  • University of Southampton
  • University of Oxford
  • Australian Catholic University
  • Public Health Foundation of India
  • Karolinska Institutet
  • Mazandaran University of Medical Sciences
  • Shahroud University of Medical Sciences
  • Simon Fraser University
  • Tabriz University of Medical Sciences
  • Tehran University of Medical Sciences and Health Services
  • Hamadan University of Medical Sciences
  • Babol University of Medical Sciences
  • Universität Bielefeld
  • Universidad Nacional Autónoma de México
  • Bahir Dar University
  • Universidade do Porto
  • Indian Institute of Technology Delhi
  • Universitatea de Medicină şi Farmacie "Carol Davila" Bucureşti
  • University of Tabriz
  • University of Gondar
  • Addis Ababa University
  • University of Peradeniya
  • Mansoura University
  • Mekelle University
  • Alexandria University
  • Kurdistan University Of Medical Sciences
  • Imam Abdulrahman Bin Faisal University
  • Applied Molecular Biosciences Unit
  • Universidade Federal de Sergipe
  • Universidad Autónoma de Sinaloa
  • Đại học Quốc gia Hà Nội
  • Medical Research Council (MR/R00160X/1, MC_UU_12011/1)
  • Fogarty International Center (K43TW010716)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32HD007242)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Keywords
child mortality, neonatal mortality, infant mortality, under-five mortality, mortality trends, mortality averted, Sustainable Development Goal 3.2, low- and middle-income countries
MeSH terms
Child, Geography, Humans, Infant, Infant Mortality, Infant, Newborn, Organizational Objectives, Public Health, Socioeconomic Factors, United Nations, Global Health, 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.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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