Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
Int J Equity Health. 2021 Apr 26;20(1):109. doi: 10.1186/s12939-021-01449-8.
As under-5 mortality rates declined all over the world, the relative distribution of under-5 deaths during different periods of life changed. To provide information for policymakers to plan for multi-layer health strategies targeting child health, it is essential to quantify the distribution of under-5 deaths by age groups.
Using 245 Demographic and Health Surveys from 64 low- and middle-income countries conducted between 1986 and 2018, we compiled a database of 2,437,718 children under-5 years old with 173,493 deaths. We examined the share of deaths that occurred in the neonatal (< 1 month), postneonatal (1 month to 1 year old), and childhood (1 to 5 years old) periods to the total number of under-5 deaths at both aggregate- and country-level. We estimated the annual change in share of deaths to track the changes over time. We also assessed the association between share of deaths and Gross Domestic Product (GDP) per capita.
Neonatal deaths accounted for 53.1% (95% confidence interval [CI]: 52.7, 53.4) of the total under-5 deaths. The neonatal share of deaths was lower in low-income countries at 44.0% (43.5, 44.5), and higher in lower-middle-income and upper-middle income countries at 57.2% (56.8, 57.6) and 54.7% (53.8, 55.5) respectively. There was substantial heterogeneity in share of deaths across countries; for example, the share of neonatal to total under-5 deaths ranged from 20.9% (14.1, 27.6) in Eswatini to 82.8% (73.0, 92.6) in Dominican Republic. The shares of deaths in all three periods were significantly associated with GDP per capita, but in different directions-as GDP per capita increased by 10%, the neonatal share of deaths would significantly increase by 0.78 percentage points [PPs] (0.43, 1.13), and the postneonatal and childhood shares of deaths would significantly decrease by 0.29 PPs (0.04, 0.54) and 0.49 PPs (0.24, 0.74) respectively.
Along with the countries' economic development, an increasing proportion of under-5 deaths occurs in the neonatal period, suggesting a need for multi-layer health strategies with potentially heavier investment in newborn health.
随着全球五岁以下儿童死亡率的下降，不同生命阶段的五岁以下儿童死亡的相对分布发生了变化。为了为决策者提供制定针对儿童健康的多层次卫生战略的信息，量化按年龄组划分的五岁以下儿童死亡分布至关重要。
我们使用了 1986 年至 2018 年间在 64 个低收入和中等收入国家进行的 245 项人口与健康调查，编制了一个包含 2437718 名 5 岁以下儿童和 173493 例死亡的数据库。我们检查了新生儿期（<1 个月）、后期新生儿期（1 个月至 1 岁）和儿童期（1 至 5 岁）死亡人数占五岁以下儿童总死亡人数的比例，分别在国家和国家层面上。我们估计了死亡份额的年变化，以跟踪随时间的变化。我们还评估了死亡份额与人均国内生产总值（GDP）之间的关联。
新生儿死亡占五岁以下儿童总死亡人数的 53.1%（95%置信区间[CI]：52.7，53.4）。在低收入国家，新生儿死亡所占比例较低，为 44.0%（43.5，44.5），而在中低收入和中高收入国家，新生儿死亡所占比例较高，分别为 57.2%（56.8，57.6）和 54.7%（53.8，55.5）。各国之间的死亡份额存在很大差异；例如，新生儿死亡占五岁以下儿童总死亡人数的比例从斯威士兰的 20.9%（14.1，27.6）到多米尼加共和国的 82.8%（73.0，92.6）不等。所有三个时期的死亡份额均与人均 GDP 显著相关，但方向不同——人均 GDP 每增加 10%，新生儿死亡比例将显著增加 0.78 个百分点[PP]（0.43，1.13），后期新生儿和儿童死亡比例将分别显著下降 0.29 个百分点[PP]（0.04，0.54）和 0.49 个百分点[PP]（0.24，0.74）。
随着各国经济的发展，五岁以下儿童死亡中有越来越大的比例发生在新生儿期，这表明需要采取多层次的卫生战略，可能需要在新生儿健康方面投入更多资金。
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