Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities
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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 country-years 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.
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Household surveys are often considered better sources of data on neonatal mortality than either civil registration data or routine facility data.
“We used household surveys to determine neonatal mortality, which are often considered better sources of data on neonatal mortality than either the civil registration data or the routine facility data [8, 34].”
From Potential contributions of an on-site nurse mentoring program on neonatal mortality reductions in rural Karnataka state, South India: evidence from repeat community cross-sectional surveys (2020) · cites this paper as [34]
In Methods, ‘Data Identification and Inclusion’ (page unavailable), the paper calls a high-coverage, high-quality civil registration system the gold standard for mortality data collection. It describes household surveys as the most common source globally, not as better than civil registration. The cited passages do not compare surveys with routine facility data. (LLM, conf=0.84)
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- Authors
- Oestergaard, M. Z., Inoue, M., Yoshida, S., Mahanani, W. R., Gore, F. M., Cousens, S., Lawn, J. E., Mathers, C. D., & on behalf of the United Nations Inter-agency Group for Child Mortality Estimation and the Child Health Epidemiology Reference Group
- Affiliations
- World Health Organization (CH)
- London School of Hygiene & Tropical Medicine (GB)
- Save the Children (GB)
- Corresponding author
- Oestergaard, Mikkel Zahle
- Venue
- PLoS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2011-08-30
- Volume
- 8
- Issue
- 8
- Pages
- e1001080
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC3168874
- OpenAlex
- W2167131795
- Cited by
- 481
- References
- 38
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 14 · 2023: 18 · 2022: 14 · 2021: 24 · 2020: 34 · 2019: 30 · 2018: 27 · 2017: 40 · 2016: 38 · 2015: 56 · 2014: 51 · 2013: 62 · 2012: 54
- FWCI
- 50.79
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Bill and Melinda Gates Foundation
- 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 › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Keywords
- neonatal mortality, neonatal death, mortality trends, global mortality estimates, child mortality, under-five mortality, Millennium Development Goal 4, mortality projections, India, Nigeria, Democratic Republic of the Congo, Africa
- MeSH terms
- Cause of Death, Geography, Health Surveys, Humans, Infant Mortality, Infant, Newborn, International Cooperation, Models, Statistical
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