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Review
. 2017 Nov 11;390(10108):2171-2182.
doi: 10.1016/S0140-6736(17)31758-0. Epub 2017 Sep 25.

Mapping under-5 and Neonatal Mortality in Africa, 2000-15: A Baseline Analysis for the Sustainable Development Goals

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Free PMC article
Review

Mapping under-5 and Neonatal Mortality in Africa, 2000-15: A Baseline Analysis for the Sustainable Development Goals

Nick Golding et al. Lancet. .
Free PMC article

Abstract

Background: 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.

Methods: 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.

Findings: 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.

Interpretation: 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.

Funding: Bill & Melinda Gates Foundation.

Figures

Figure 1
Figure 1
Data availability by type and country, 2000–15 All data are mapped (A), and shown by country and year of survey (B). Surveys can contribute mortality data up to 17 years before the time of the survey. (A) Complete birth history data are displayed in preference to summary birth histories when both have been used in that location. Cluster locations are mapped as points, and polygon data as shapes where available. (B) Data on summary birth histories are green and complete birth histories data are blue.
Figure 2
Figure 2
Under-5 mortality rates at the 5 × 5 km resolution in 2000, 2005, 2010, and 2015 Data are at 5 × 5 km resolution. All pixels with an under-5 mortality rate equal to or fewer than 25 deaths per 1000 livebirths (the Sustainable Development Goal 3.2 target for under-5 mortality) are coloured purple. Pixels with fewer than ten people and classified as barren or sparsely vegetated are coloured in grey. Grey areas with diagonal lines are not included in this analysis. km=kilometre.
Figure 3
Figure 3
Under-5 mortality rates at the national, first and second administrative, and 5 × 5 km levels in 2015 All locations with a mortality rate equal to or fewer than 25 deaths per 1000 livebirths (the Sustainable Development Goal 3.2 target for under-5 mortality) are coloured purple. Pixels with fewer than ten people and classified as barren or sparsely vegetated are coloured in grey. Grey areas with diagonal lines are not included in this analysis. km=kilometre.
Figure 4
Figure 4
Overlapping population-weighted quartiles of under-5 mortality and relative uncertainty in 2015 Under-5 mortality rate quartile cutoff points were 56, 80, and 102 deaths per 1000 livebirths. Relative uncertainty was computed as the ratio of the 95% uncertainty intervals and under-5 mortality rate for each pixel. Cutoff points for uncertainty were 29%, 35%, and 41%. The lowest quartile of mortality is white, and the highest is dark pink. The lowest quartile for uncertainty is white and the highest is blue. These colours overlap such that areas coloured purple have both high under-5 mortality rates and high relative uncertainty. Pixels with fewer than ten people and classified as barren or sparsely vegetated are coloured in grey. Grey areas with diagonal lines are not included in this analysis.
Figure 5
Figure 5
Annualised rates of decline in under-5 mortality during the MDG era, with projections to 2030, and needed rates of decline to reach the SDG target 4·4% is the annualised rate of decline that was equivalent to the pace of progress required to meet Millennium Development Goal 4. (A) Annualised rates of decline for under-5 mortality from 2000 to 2015. Pixels coloured blue exceeded the annualised rate of decline between 2000 and 2015, whereas pixels coloured green to yellow had a slower rate of annualised decline during this time. (B) Predicted under-5 mortality rates in 2030, based on annualised rates of decline achieved between 2000 and 2015. Pixel-level under-5 mortality rates were predicted for 2030 on the basis of annualised rates of decline achieved from 2000 to 2015. Based on this prediction, pixels for which under-5 mortality rates equalled or were less than 25 deaths per 1000 livebirths in 2030 are coloured purple. (C) Rates of decline required to reach the SDG 3.2 target for under-5 mortality by 2030 (25 deaths per 1000 livebirths). Pixels coloured blue will need to achieve a 4·4% or greater decline per year from 2015 to 2030 to achieve the SDG 3.2 target for under-5 mortality. Pixels coloured green to yellow can meet the SDG 3.2 target by 2030 at a pace slower than a 4·4% reduction per year from 2015 to 2030. Pixels with fewer than ten people and classified as barren or sparsely vegetated are coloured in grey. Grey areas with diagonal lines are not included in this analysis. SDG=Sustainable Development Goal.

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