School of BioSciences, University of Melbourne, Parkville, VIC, Australia.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Lancet. 2017 Nov 11;390(10108):2171-2182. doi: 10.1016/S0140-6736(17)31758-0. Epub 2017 Sep 25.
During the Millennium Development Goal (MDG) era, many countries in Africa achieved marked reductions in under-5 and neonatal mortality. Yet the pace of progress toward these goals substantially varied at the national level, demonstrating an essential need for tracking even more local trends in child mortality. With the adoption of the Sustainable Development Goals (SDGs) in 2015, which established ambitious targets for improving child survival by 2030, optimal intervention planning and targeting will require understanding of trends and rates of progress at a higher spatial resolution. In this study, we aimed to generate high-resolution estimates of under-5 and neonatal all-cause mortality across 46 countries in Africa.
We assembled 235 geographically resolved household survey and census data sources on child deaths to produce estimates of under-5 and neonatal mortality at a resolution of 5 × 5 km grid cells across 46 African countries for 2000, 2005, 2010, and 2015. We used a Bayesian geostatistical analytical framework to generate these estimates, and implemented predictive validity tests. In addition to reporting 5 × 5 km estimates, we also aggregated results obtained from these estimates into three different levels-national, and subnational administrative levels 1 and 2-to provide the full range of geospatial resolution that local, national, and global decision makers might require.
Amid improving child survival in Africa, there was substantial heterogeneity in absolute levels of under-5 and neonatal mortality in 2015, as well as the annualised rates of decline achieved from 2000 to 2015. Subnational areas in countries such as Botswana, Rwanda, and Ethiopia recorded some of the largest decreases in child mortality rates since 2000, positioning them well to achieve SDG targets by 2030 or earlier. Yet these places were the exception for Africa, since many areas, particularly in central and western Africa, must reduce under-5 mortality rates by at least 8·8% per year, between 2015 and 2030, to achieve the SDG 3.2 target for under-5 mortality by 2030.
In the absence of unprecedented political commitment, financial support, and medical advances, the viability of SDG 3.2 achievement in Africa is precarious at best. By producing under-5 and neonatal mortality rates at multiple levels of geospatial resolution over time, this study provides key information for decision makers to target interventions at populations in the greatest need. In an era when precision public health increasingly has the potential to transform the design, implementation, and impact of health programmes, our 5 × 5 km estimates of child mortality in Africa provide a baseline against which local, national, and global stakeholders can map the pathways for ending preventable child deaths by 2030.
Bill & Melinda Gates Foundation.
在千年发展目标（MDG）时代，非洲许多国家在降低 5 岁以下和新生儿死亡率方面取得了显著成效。然而，各国在实现这些目标的速度上存在显著差异，这表明需要更精确地跟踪儿童死亡率的地方趋势。2015 年通过的可持续发展目标（SDG）为改善儿童生存状况设立了雄心勃勃的目标，到 2030 年要实现这一目标，需要更好地了解进展趋势和速度，这就需要更高的空间分辨率。在这项研究中，我们旨在生成 46 个非洲国家的 5 岁以下儿童和新生儿全因死亡率的高分辨率估计值。
我们收集了 235 个地理分辨率的家庭调查和人口普查儿童死亡数据来源，以生成分辨率为 5×5 公里网格单元的 46 个非洲国家的 2000 年、2005 年、2010 年和 2015 年 5 岁以下儿童和新生儿死亡率的估计值。我们使用贝叶斯地统计学分析框架生成这些估计值，并进行了预测有效性测试。除了报告 5×5 公里的估计值外，我们还将从这些估计值中得出的结果汇总到三个不同的级别——国家、国家以下一级和国家以下二级，以提供当地、国家和全球决策者可能需要的全范围地理空间分辨率。
在非洲儿童生存率不断提高的背景下，2015 年 5 岁以下儿童和新生儿死亡率的绝对水平以及 2000 年至 2015 年的年化下降率存在很大差异。博茨瓦纳、卢旺达和埃塞俄比亚等国的国家以下地区自 2000 年以来记录到儿童死亡率的最大降幅，这使它们有望在 2030 年或更早实现可持续发展目标 3.2 提出的儿童死亡率目标。然而，这些地方只是非洲的例外，因为许多地区，特别是中非和西非，必须在 2015 年至 2030 年期间将 5 岁以下儿童死亡率每年降低至少 8.8%，才能实现 2030 年 5 岁以下儿童死亡率可持续发展目标 3.2 提出的目标。
如果没有前所未有的政治承诺、财政支持和医学进步，非洲实现可持续发展目标 3.2 的前景不容乐观。本研究通过在不同的时空地理分辨率上生成 5 岁以下儿童和新生儿死亡率数据，为决策者提供了将干预措施针对最需要的人群的关键信息。在精准公共卫生日益有潜力改变卫生规划的设计、实施和影响的时代，我们对非洲儿童死亡率的 5×5 公里估计值为地方、国家和全球利益相关者提供了一个基线，他们可以根据这个基线来规划实现到 2030 年消除可预防儿童死亡的途径。
比尔及梅琳达·盖茨基金会。
