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Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities
Mikkel Zahle Oestergaard1*, Mie Inoue1, Sachiyo Yoshida2, Wahyu Retno Mahanani1, Fiona M. Gore1, Simon Cousens3, Joy E. Lawn4, Colin Douglas Mathers1, on behalf of the United Nations Inter-agency Group for Child Mortality Estimation and the Child HealthEpidemiology Reference Group
1 World Health Organization, Department of Health Statistics and Informatics, Geneva, Switzerland, 2 World Health Organization, Department of Child and Adolescent Health and Development, Geneva, Switzerland, 3 London School of Hygiene & Tropical Medicine, London, United Kingdom, 4 Saving Newborn Lives/Save the Children, Cape Town, South Africa

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 period1990–2009 with forecasts into the future. Methods and Findings: We compiled a database of mortality in neonates and children (,5 years) comprising 3,551 countryyears 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. Countryconsultation 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.
Please see later in the article for the Editors’ Summary.
Citation: Oestergaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, etal. (2011) Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities. PLoS Med 8(8): e1001080. doi:10.1371/journal.pmed.1001080 ˚ Academic Editor: Peter Byass, Umea Centre for Global Health Research, Sweden Received January 10, 2011; Accepted July 15, 2011; Published August 30, 2011 Copyright: ß 2011 World HealthOrganization; licensee Public Library of Science (PLoS). This is an Open Access article in the spirit of the Public Library of Science (PLoS) principles for Open Access, without any waiver of WHO’s privileges and immunities under international law, convention, or agreement. This article should not be reproduced for use in association with the promotion of commercial products,services, or any legal entity. There should be no suggestion that WHO endorses any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL. Funding: The study was supported by funding from WHO and grants from the Bill & Melinda Gates Foundation to Saving Newborn Lives/Save the Children (JEL), SC, and to...
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