Modelling of Noncommunicable Diseases Research Center, Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Lancet Glob Health. 2017 May;5(5):e537-e544. doi: 10.1016/S2214-109X(17)30105-5. Epub 2017 Mar 28.
Child mortality as one of the key Millennium Development Goals (MDG 4-to reduce child mortality by two-thirds from 1990 to 2015), is included in the Sustainable Development Goals (SDG 3, target 2-to reduce child mortality to fewer than 25 deaths per 1000 livebirths for all countries by 2030), and is a key indicator of the health system in every country. In this study, we aimed to estimate the level and trend of child mortality from 1990 to 2015 in Iran, to assess the progress of the country and its provinces toward these goals.
We used three different data sources: three censuses, a Demographic and Health Survey (DHS), and 5-year data from the death registration system. We used the summary birth history data from four data sources (the three censuses and DHS) and used maternal age cohort and maternal age period methods to estimate the trends in child mortality rates, combining the estimates of these two indirect methods using Loess regression. We also used the complete birth history method to estimate child mortality rate directly from DHS data. Finally, to synthesise different trends into a single trend and calculate uncertainty intervals (UI), we used Gaussian process regression.
Under-5 mortality rates (deaths per 1000 livebirths) at the national level in Iran in 1990, 2000, 2010, and 2015 were 63·6 (95% UI 63·1-64·0), 38·8 (38·5-39·2), 24·9 (24·3-25·4), and 19·4 (18·6-20·2), respectively. Between 1990 and 2015, the median annual reduction and total overall reduction in these rates were 4·9% and 70%, respectively. At the provincial level, the difference between the highest and lowest child mortality rates in 1990, 2000, and 2015 were 65·6, 40·4, and 38·1 per 1000 livebirths, respectively. Based on the MDG 4 goal, five provinces had not decreased child mortality by two-thirds by 2015. Furthermore, six provinces had not reached SDG 3 (target 2).
Iran and most of its provinces achieved MDG 4 and SDG 3 (target 2) goals by 2015. However, at the subnational level in some provinces, there is substantial inequity. Local policy makers should use effective strategies to accelerate the reduction of child mortality for these provinces by 2030. Possible recommendations for such strategies include enhancing the level of education and health literacy among women, tackling sex discrimination, and improving incomes for families.
Iran Ministry of Health and Education.
儿童死亡率作为千年发展目标（MDG 4-将 1990 年至 2015 年儿童死亡率降低三分之二）之一，被纳入可持续发展目标（SDG 3，目标 2-到 2030 年，将所有国家的儿童死亡率降低到每千例活产 25 例以下），也是衡量每个国家卫生系统的关键指标。在这项研究中，我们旨在估计 1990 年至 2015 年伊朗儿童死亡率的水平和趋势，评估该国及其各省在实现这些目标方面的进展情况。
我们使用了三种不同的数据源：三次人口普查、一次人口与健康调查（DHS）和死亡登记系统的五年数据。我们使用了来自四个数据源（三次人口普查和 DHS）的综合生育史数据，并使用母亲年龄队列和母亲年龄时期方法来估计儿童死亡率的趋势，将这两种间接方法的估计值结合起来使用 Loess 回归。我们还使用了完整的生育史方法，直接从 DHS 数据中估计儿童死亡率。最后，为了将不同的趋势综合成一个单一的趋势并计算不确定区间（UI），我们使用了高斯过程回归。
1990 年、2000 年、2010 年和 2015 年，伊朗全国范围内 5 岁以下儿童死亡率（每千例活产死亡人数）分别为 63.6（95%UI 63.1-64.0）、38.8（38.5-39.2）、24.9（24.3-25.4）和 19.4（18.6-20.2）。1990 年至 2015 年间，这些比率的年中位数降幅和总体降幅分别为 4.9%和 70%。在省级层面，1990 年、2000 年和 2015 年最高和最低儿童死亡率之间的差异分别为每千例活产 65.6、40.4 和 38.1。根据千年发展目标 4 的目标，到 2015 年，有五个省份的儿童死亡率没有减少三分之二。此外，还有六个省份没有达到可持续发展目标 3（目标 2）。
到 2015 年，伊朗及其大部分省份实现了千年发展目标 4 和可持续发展目标 3（目标 2）。然而，在一些省份的次国家层面，存在着实质性的不平等。地方决策者应采取有效战略，以加速这些省份到 2030 年降低儿童死亡率。为实现这一目标，可能的建议包括提高妇女的教育和健康素养水平，解决性别歧视问题，以及提高家庭收入。
伊朗卫生部和教育部。
