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. 2019 Oct;574(7778):353-358.
doi: 10.1038/s41586-019-1545-0. Epub 2019 Oct 16.

Mapping 123 Million Neonatal, Infant and Child Deaths Between 2000 and 2017

Roy Burstein  1 Nathaniel J Henry  1 Michael L Collison  1 Laurie B Marczak  1 Amber Sligar  1 Stefanie Watson  1 Neal Marquez  1 Mahdieh Abbasalizad-Farhangi  2 Masoumeh Abbasi  3 Foad Abd-Allah  4 Amir Abdoli  5 Mohammad Abdollahi  6 Ibrahim Abdollahpour  7   8 Rizwan Suliankatchi Abdulkader  9 Michael R M Abrigo  10 Dilaram Acharya  11   12 Oladimeji M Adebayo  13 Victor Adekanmbi  14 Davoud Adham  15 Mahdi Afshari  16 Mohammad Aghaali  17 Keivan Ahmadi  18 Mehdi Ahmadi  19 Ehsan Ahmadpour  20 Rushdia Ahmed  21   22 Chalachew Genet Akal  23 Joshua O Akinyemi  24 Fares Alahdab  25 Noore Alam  26 Genet Melak Alamene  27 Kefyalew Addis Alene  28   29 Mehran Alijanzadeh  30 Cyrus Alinia  31 Vahid Alipour  32   33 Syed Mohamed Aljunid  34   35 Mohammed J Almalki  36   37 Hesham M Al-Mekhlafi  38   39 Khalid Altirkawi  40 Nelson Alvis-Guzman  41   42 Adeladza Kofi Amegah  43 Saeed Amini  44 Arianna Maever Loreche Amit  45   46 Zohreh Anbari  44 Sofia Androudi  47 Mina Anjomshoa  48 Fereshteh Ansari  49 Carl Abelardo T Antonio  50   51 Jalal Arabloo  33 Zohreh Arefi  52 Olatunde Aremu  53 Bahram Armoon  54   55 Amit Arora  56   57 Al Artaman  58 Anvar Asadi  59 Mehran Asadi-Aliabadi  60 Amir Ashraf-Ganjouei  7   61 Reza Assadi  62 Bahar Ataeinia  63 Sachin R Atre  64   65 Beatriz Paulina Ayala Quintanilla  66   67 Martin Amogre Ayanore  68 Samad Azari  33 Ebrahim Babaee  60 Arefeh Babazadeh  69 Alaa Badawi  70   71 Soghra Bagheri  3 Mojtaba Bagherzadeh  72 Nafiseh Baheiraei  73   74 Abbas Balouchi  75 Aleksandra Barac  76   77 Quique Bassat  78   79 Bernhard T Baune  80 Mohsen Bayati  81 Neeraj Bedi  37   82 Ettore Beghi  83 Masoud Behzadifar  84 Meysam Behzadifar  85 Yared Belete Belay  86 Brent Bell  1 Michelle L Bell  87 Dessalegn Ajema Berbada  88 Robert S Bernstein  89   90 Natalia V Bhattacharjee  1 Suraj Bhattarai  91   92 Zulfiqar A Bhutta  93   94 Ali Bijani  95 Somayeh Bohlouli  96 Nicholas J K Breitborde  97   98 Gabrielle Britton  99   100 Annie J Browne  101 Sharath Burugina Nagaraja  102 Reinhard Busse  103 Zahid A Butt  104   105 Josip Car  106   107 Rosario Cárdenas  108 Carlos A Castañeda-Orjuela  109   110 Ester Cerin  111   112 Wagaye Fentahun Chanie  113 Pranab Chatterjee  114 Dinh-Toi Chu  115 Cyrus Cooper  116   117 Vera M Costa  118 Koustuv Dalal  119   120 Lalit Dandona  1   121 Rakhi Dandona  1   121 Farah Daoud  1 Ahmad Daryani  122 Rajat Das Gupta  21 Ian Davis  1 Nicole Davis Weaver  1 Dragos Virgil Davitoiu  123   124 Jan-Walter De Neve  125 Feleke Mekonnen Demeke  126 Gebre Teklemariam Demoz  127   128 Kebede Deribe  129   130 Rupak Desai  131 Aniruddha Deshpande  1 Hanna Demelash Desyibelew  132 Sagnik Dey  133 Samath Dhamminda Dharmaratne  1   134 Meghnath Dhimal  135 Daniel Diaz  136   137 Leila Doshmangir  138 Andre R Duraes  139   140 Laura Dwyer-Lindgren  1   141 Lucas Earl  1 Roya Ebrahimi  142 Soheil Ebrahimpour  69 Andem Effiong  143 Aziz Eftekhari  144   145 Elham Ehsani-Chimeh  146 Iman El Sayed  147 Maysaa El Sayed Zaki  148 Maha El Tantawi  149   150 Ziad El-Khatib  151 Mohammad Hassan Emamian  152 Shymaa Enany  153 Sharareh Eskandarieh  7 Oghenowede Eyawo  154   155 Maha Ezalarab  1 Mahbobeh Faramarzi  156 Mohammad Fareed  157 Roghiyeh Faridnia  158 Andre Faro  159 Ali Akbar Fazaeli  160 Mehdi Fazlzadeh  161   162 Netsanet Fentahun  163 Seyed-Mohammad Fereshtehnejad  164   165 João C Fernandes  166 Irina Filip  167   168 Florian Fischer  169 Nataliya A Foigt  170 Masoud Foroutan  171 Joel Msafiri Francis  172 Takeshi Fukumoto  173   174 Nancy Fullman  1 Silvano Gallus  175 Destallem Gebremedhin Gebre  176   177 Tsegaye Tewelde Gebrehiwot  178 Gebreamlak Gebremedhn Gebremeskel  179   180 Bradford D Gessner  181   182 Birhanu Geta  183 Peter W Gething  101 Reza Ghadimi  184 Keyghobad Ghadiri  3 Mahsa Ghajarzadeh  185 Ahmad Ghashghaee  186 Paramjit Singh Gill  187 Tiffany K Gill  188 Nick Golding  189 Nelson G M Gomes  190   191 Philimon N Gona  192 Sameer Vali Gopalani  193   194 Giuseppe Gorini  195 Bárbara Niegia Garcia Goulart  196 Nicholas Graetz  1 Felix Greaves  197   198 Manfred S Green  199 Yuming Guo  200   201 Arvin Haj-Mirzaian  202   203 Arya Haj-Mirzaian  202   204 Brian James Hall  205 Samer Hamidi  206 Hamidreza Haririan  207 Josep Maria Haro  208   209 Milad Hasankhani  210 Edris Hasanpoor  211 Amir Hasanzadeh  212   213 Hadi Hassankhani  214   215 Hamid Yimam Hassen  216   217 Mohamed I Hegazy  4 Delia Hendrie  218 Fatemeh Heydarpour  219 Thomas R Hird  200   220 Chi Linh Hoang  221 Gillian Hollerich  1 Enayatollah Homaie Rad  222   223 Mojtaba Hoseini-Ghahfarokhi  224 Naznin Hossain  22   225 Mostafa Hosseini  226 Mehdi Hosseinzadeh  33   227 Mihaela Hostiuc  123   228 Sorin Hostiuc  229   230 Mowafa Househ  231   232 Mohamed Hsairi  233 Olayinka Stephen Ilesanmi  234 Mohammad Hasan Imani-Nasab  235 Usman Iqbal  236 Seyed Sina Naghibi Irvani  237 Nazrul Islam  238   239 Sheikh Mohammed Shariful Islam  240   241 Mikk Jürisson  242 Nader Jafari Balalami  243 Amir Jalali  244 Javad Javidnia  245 Achala Upendra Jayatilleke  246   247 Ensiyeh Jenabi  248 John S Ji  249 Yash B Jobanputra  250 Kimberly Johnson  1 Jost B Jonas  251   252 Zahra Jorjoran Shushtari  253 Jacek Jerzy Jozwiak  254   255 Ali Kabir  256 Amaha Kahsay  257 Hamed Kalani  258   259 Rohollah Kalhor  260 Manoochehr Karami  261 Surendra Karki  262   263 Amir Kasaeian  264   265 Nicholas J Kassebaum  1   266 Peter Njenga Keiyoro  267 Grant Rodgers Kemp  1   268 Roghayeh Khabiri  269   270 Yousef Saleh Khader  271 Morteza Abdullatif Khafaie  272 Ejaz Ahmad Khan  273 Junaid Khan  274 Muhammad Shahzeb Khan  275   276 Young-Ho Khang  277   278 Khaled Khatab  279   280 Amir Khater  281 Mona M Khater  282 Alireza Khatony  3 Mohammad Khazaei  283 Salman Khazaei  261 Maryam Khazaei-Pool  284 Jagdish Khubchandani  285 Neda Kianipour  3   286 Yun Jin Kim  287 Ruth W Kimokoti  288 Damaris K Kinyoki  1   141 Adnan Kisa  289   290 Sezer Kisa  291 Tufa Kolola  292 Soewarta Kosen  293 Parvaiz A Koul  294 Ai Koyanagi  79   295 Moritz U G Kraemer  296   297 Kewal Krishan  298 Kris J Krohn  1 Nuworza Kugbey  299   300 G Anil Kumar  121 Manasi Kumar  301   302 Pushpendra Kumar  303 Desmond Kuupiel  304   305 Ben Lacey  306   307 Sheetal D Lad  308 Faris Hasan Lami  309 Anders O Larsson  310   311 Paul H Lee  312 Mostafa Leili  283 Aubrey J Levine  1 Shanshan Li  200 Lee-Ling Lim  313   314 Stefan Listl  315   316 Joshua Longbottom  317 Jaifred Christian F Lopez  45   318 Stefan Lorkowski  319   320 Sameh Magdeldin  321   322 Hassan Magdy Abd El Razek  323 Muhammed Magdy Abd El Razek  324 Azeem Majeed  197 Afshin Maleki  142 Reza Malekzadeh  325   326 Deborah Carvalho Malta  327 Abdullah A Mamun  328 Navid Manafi  329   330 Ana-Laura Manda  331 Morteza Mansourian  332 Francisco Rogerlândio Martins-Melo  333 Anthony Masaka  334 Benjamin Ballard Massenburg  335 Pallab K Maulik  336   337 Benjamin K Mayala  1 Mohsen Mazidi  338 Martin McKee  339 Ravi Mehrotra  340 Kala M Mehta  341 Gebrekiros Gebremichael Meles  88 Walter Mendoza  342 Ritesh G Menezes  343 Atte Meretoja  344   345 Tuomo J Meretoja  346   347 Tomislav Mestrovic  348   349 Ted R Miller  218   350 Molly K Miller-Petrie  1 Edward J Mills  351 George J Milne  352 G K Mini  353 Seyed Mostafa Mir  354   355 Hamed Mirjalali  356 Erkin M Mirrakhimov  357   358 Efat Mohamadi  359 Dara K Mohammad  360   361 Aso Mohammad Darwesh  362 Naser Mohammad Gholi Mezerji  363 Ammas Siraj Mohammed  364 Shafiu Mohammed  365   366 Ali H Mokdad  1   141 Mariam Molokhia  367 Lorenzo Monasta  368 Yoshan Moodley  304 Mahmood Moosazadeh  369 Ghobad Moradi  370   371 Masoud Moradi  3   59 Yousef Moradi  372 Maziar Moradi-Lakeh  60 Mehdi Moradinazar  59 Paula Moraga  373 Lidia Morawska  374 Abbas Mosapour  354   375 Seyyed Meysam Mousavi  376 Ulrich Otto Mueller  377   378 Atalay Goshu Muluneh  379 Ghulam Mustafa  380   381 Behnam Nabavizadeh  382 Mehdi Naderi  383 Ahamarshan Jayaraman Nagarajan  384   385 Azin Nahvijou  386 Farid Najafi  387 Vinay Nangia  388 Duduzile Edith Ndwandwe  389 Nahid Neamati  354 Ionut Negoi  390   391 Ruxandra Irina Negoi  392   393 Josephine W Ngunjiri  394 Huong Lan Thi Nguyen  395 Long Hoang Nguyen  396 Son Hoang Nguyen  396 Katie R Nielsen  397   398 Dina Nur Anggraini Ningrum  399   400 Yirga Legesse Nirayo  401 Molly R Nixon  1 Chukwudi A Nnaji  389   402 Marzieh Nojomi  60   403 Mehdi Noroozi  404 Shirin Nosratnejad  405 Jean Jacques Noubiap  406 Soraya Nouraei Motlagh  235 Richard Ofori-Asenso  407   408 Felix Akpojene Ogbo  409 Kelechi E Oladimeji  304   410 Andrew T Olagunju  411   412 Meysam Olfatifar  413 Solomon Olum  414   415 Bolajoko Olubukunola Olusanya  416 Mojisola Morenike Oluwasanu  417 Obinna E Onwujekwe  418 Eyal Oren  419   420 Doris D V Ortega-Altamirano  421 Alberto Ortiz  422   423 Osayomwanbo Osarenotor  424 Frank B Osei  425   426 Aaron E Osgood-Zimmerman  1 Stanislav S Otstavnov  427   428 Mayowa Ojo Owolabi  429 Mahesh P A  430 Abdol Sattar Pagheh  122 Smita Pakhale  431 Songhomitra Panda-Jonas  432 Animika Pandey  121 Eun-Kee Park  433 Hadi Parsian  354 Tahereh Pashaei  142 Sangram Kishor Patel  434   435 Veincent Christian Filipino Pepito  436 Alexandre Pereira  437   438 Samantha Perkins  1 Brandon V Pickering  1 Thomas Pilgrim  439 Majid Pirestani  440 Bakhtiar Piroozi  371 Meghdad Pirsaheb  3 Oleguer Plana-Ripoll  441 Hadi Pourjafar  442   443 Parul Puri  303 Mostafa Qorbani  444 Hedley Quintana  100 Mohammad Rabiee  445 Navid Rabiee  72 Amir Radfar  446   447 Alireza Rafiei  448   449 Fakher Rahim  450   451 Zohreh Rahimi  452 Vafa Rahimi-Movaghar  453 Shadi Rahimzadeh  63 Fatemeh Rajati  454 Sree Bhushan Raju  455 Azra Ramezankhani  456   457 Chhabi Lal Ranabhat  458   459 Davide Rasella  460   461 Vahid Rashedi  462 Lal Rawal  56   463 Robert C Reiner Jr  1   141 Andre M N Renzaho  464 Satar Rezaei  465 Aziz Rezapour  33 Seyed Mohammad Riahi  466   467 Ana Isabel Ribeiro  468 Leonardo Roever  469 Elias Merdassa Roro  470   471 Max Roser  472 Gholamreza Roshandel  325   473 Daem Roshani  474 Ali Rostami  475 Enrico Rubagotti  476   477 Salvatore Rubino  478 Siamak Sabour  466 Nafis Sadat  1 Ehsan Sadeghi  59 Reza Saeedi  479 Yahya Safari  3 Roya Safari-Faramani  480 Mahdi Safdarian  453   481 Amirhossein Sahebkar  482   483 Mohammad Reza Salahshoor  484 Nasir Salam  485 Payman Salamati  453   486 Farkhonde Salehi  487 Saleh Salehi Zahabi  488   489 Yahya Salimi  387 Hamideh Salimzadeh  325 Joshua A Salomon  490 Evanson Zondani Sambala  389 Abdallah M Samy  491 Milena M Santric Milicevic  492 Bruno Piassi Sao Jose  493 Sivan Yegnanarayana Iyer Saraswathy  494   495 Rodrigo Sarmiento-Suárez  496 Benn Sartorius  141   497 Brijesh Sathian  498   499 Sonia Saxena  500 Alyssa N Sbarra  1 Lauren E Schaeffer  1 David C Schwebel  501 Sadaf G Sepanlou  325   326 Seyedmojtaba Seyedmousavi  502   503 Faramarz Shaahmadi  504 Masood Ali Shaikh  505 Mehran Shams-Beyranvand  63   506 Amir Shamshirian  507 Morteza Shamsizadeh  508 Kiomars Sharafi  3 Mehdi Sharif  509   510 Mahdi Sharif-Alhoseini  453 Hamid Sharifi  511 Jayendra Sharma  512 Rajesh Sharma  513 Aziz Sheikh  514   515 Chloe Shields  1 Mika Shigematsu  516 Rahman Shiri  517 Ivy Shiue  518 Kerem Shuval  199 Tariq J Siddiqi  276 João Pedro Silva  118 Jasvinder A Singh  519   520 Dhirendra Narain Sinha  521   522 Malede Mequanent Sisay  379   523 Solomon Sisay  524 Karen Sliwa  406 David L Smith  1   141 Ranjani Somayaji  525   526 Moslem Soofi  527 Joan B Soriano  528   529 Chandrashekhar T Sreeramareddy  530 Agus Sudaryanto  531 Mu'awiyyah Babale Sufiyan  532 Bryan L Sykes  533 P N Sylaja  534 Rafael Tabarés-Seisdedos  535   536 Karen M Tabb  537 Takahiro Tabuchi  538 Nuno Taveira  539   540 Mohamad-Hani Temsah  541   542 Abdullah Sulieman Terkawi  543   544 Zemenu Tadesse Tessema  379 Kavumpurathu Raman Thankappan  545 Sathish Thirunavukkarasu  546 Quyen G To  547 Marcos Roberto Tovani-Palone  548 Bach Xuan Tran  549 Khanh Bao Tran  550   551 Irfan Ullah  552   553 Muhammad Shariq Usman  276 Olalekan A Uthman  554 Amir Vahedian-Azimi  555   556 Pascual R Valdez  557   558 Job F M van Boven  559   560 Tommi Juhani Vasankari  561 Yasser Vasseghian  465 Yousef Veisani  562 Narayanaswamy Venketasubramanian  563   564 Francesco S Violante  565   566 Sergey Konstantinovitch Vladimirov  567   568 Vasily Vlassov  569 Theo Vos  1   141 Giang Thu Vu  221 Isidora S Vujcic  77 Yasir Waheed  570 Jon Wakefield  571 Haidong Wang  1   141 Yafeng Wang  572 Yuan-Pang Wang  573 Joseph L Ward  574 Robert G Weintraub  575   576 Kidu Gidey Weldegwergs  401 Girmay Teklay Weldesamuel  577 Ronny Westerman  578 Charles Shey Wiysonge  579   580 Dawit Zewdu Wondafrash  581   582 Lauren Woyczynski  1 Ai-Min Wu  583 Gelin Xu  584 Abbas Yadegar  356 Tomohide Yamada  585 Vahid Yazdi-Feyzabadi  586   587 Christopher Sabo Yilgwan  588   589 Paul Yip  590   591 Naohiro Yonemoto  592 Javad Yoosefi Lebni  332 Mustafa Z Younis  593   594 Mahmoud Yousefifard  595 Hebat-Allah Salah A Yousof  596 Chuanhua Yu  572   597 Hasan Yusefzadeh  598 Erfan Zabeh  599   600 Telma Zahirian Moghadam  33   601 Sojib Bin Zaman  602   603 Mohammad Zamani  604 Hamed Zandian  601   605 Alireza Zangeneh  527 Taddese Alemu Zerfu  606   607 Yunquan Zhang  608   609 Arash Ziapour  332 Sanjay Zodpey  610 Christopher J L Murray  1   141 Simon I Hay  611   612
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Free PMC article

Mapping 123 Million Neonatal, Infant and Child Deaths Between 2000 and 2017

Roy Burstein et al. Nature. .
Free PMC article

Abstract

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

Conflict of interest statement

This study was funded by the Bill & Melinda Gates Foundation. Co-authors employed by the Bill & Melinda Gates Foundation provided feedback on initial maps and drafts of this manuscript. Otherwise, the funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the final report, or decision to publish. The corresponding author had full access to all of the data in the study and had final responsibility for the decision to submit for publication.

Figures

Fig. 1
Fig. 1. U5MR estimates in 99 LMICs.
a, U5MR at the second administrative level in 2000. b, U5MR at the second administrative level in 2017. c, Modelled posterior exceedance probability that a given second administrative unit had achieved the SDG 3.2 target of 25 deaths per 1,000 live births for children under 5 in 2017. d, Proportion of mortality of children under 5 occurring in the neonatal (0–28 days) group at the second administrative level in 2017.
Fig. 2
Fig. 2. Geographical inequality in U5MR across 99 countries for 2000 and 2017.
a, Absolute inequalities. Range of U5MR estimates in second administrative-level units across 99 LMICs. b, Relative inequalities. Range of ratios of U5MR estimates in second administrative-level units relative to country means. Each dot represents a second administrative-level unit. The lower bound of each bar represents the second administrative-level unit with the lowest U5MR in each country. The upper end of each bar represents the second administrative-level unit with the highest U5MR in each country. Thus, each bar represents the extent of geographical inequality in U5MRs estimated for each country. Bars indicating the range in 2017 are coloured according to their Global Burden of Disease super-region. Grey bars indicate the range in U5MR in 2000. The diamond in each bar represents the median U5MR estimated across second administrative-level units in each country and year. A coloured bar that is shorter than its grey counterpart indicates that geographical inequality has narrowed.
Fig. 3
Fig. 3. Estimated number of children under 5 who died within 99 countries in 2017.
a, Number of deaths of children under 5 in each country. b, Number of deaths in each first administrative-level unit. c, Number of deaths in each second administrative-level unit. d, Number of deaths of children under 5 in each 5 × 5-km grid cell. Note that scales vary for each aggregation unit.
Fig. 4
Fig. 4. Number of deaths of children under 5, distributed across level of U5MR, in 2000 and in 2017, across 99 countries.
Bar heights represent the total number of deaths of children under 5 within all second administrative-level units with corresponding U5MR. Bins are a width of 5 deaths per 1,000 live births. The colour of each bar represents the global region as defined by the subset legend map. As such, the sum of heights of all bars represents the total number of deaths across the 99 countries. a, Deaths of children under 5 in 2000. b, Deaths of children under 5 in 2017. The dotted line in the 2000 plot is the shape of the distribution in 2017, and the dotted line in the 2017 plot represents the distribution in 2000.
Extended Data Fig. 1
Extended Data Fig. 1. Neonatal and infant mortality rates in 2017.
a, b, Maps showing the mortality rates of neonates (a; birth to 28 days of age) and infants (b; under 1 year of age) across second administrative-level units in 2017. Note that the ranges in the keys are different for the two maps.
Extended Data Fig. 2
Extended Data Fig. 2. Impact of inequality on U5MR.
a, Potential reduction in the number of deaths that would have occurred if all second administrative-level units in the 20 countries with the greatest number of deaths of children under 5 in 2017 realized a homogenous U5MR that was equal to that of the lowest observed mortality rate in that country. In total, 66% of under-5 deaths could have been averted if all countries maintained mortality rates equal to the second administrative-level unit with lowest mortality. If this reference rate is set to the lowest observed rate across all of the 99 countries that were included in this study, 95% of under-5 deaths could have been averted. The size of each bar represents the total number of under-5 deaths in each country. The red portion of each bar indicates the number of deaths ‘attributed’ to geographical inequality in mortality rates, whereas the blue portion represents the number of deaths that would remain in the scenario in which all second administrative-level units within countries had the same mortality rate as the best-performing unit. b, Locations of under-5 deaths ‘attributable’ to geographical inequality, across all second administrative-level units in each country. Each country has one unit highlighted with a green diamond, which is the reference unit, or the location with the lowest mortality rate in the country in 2017.
Extended Data Fig. 3
Extended Data Fig. 3. Relative uncertainty in U5MR estimates for 2017.
Relative uncertainty in second administrative-level estimates compared with mean estimated U5MRs in each second administrative-level unit for 2017. Mean rates and relative uncertainty are split into population-weighted quartiles. These cut-off points indicate the relative uncertainty minimum, 25th, 50th and 75th percentiles, and maximum, which are 0.29, 0.51, 0.63 and 0.86, and 3.12, respectively. The under-5 mortality minimum, 25th, 50th and 75th percentiles, and maximum are 1.4, 13.0, 22.9 and 44.8, and 190.6 deaths per 1,000 live births. Areas in which our estimates are more uncertain are coloured with a scale of increasing blue hue, whereas areas in which the mean estimates of U5MR are high are coloured with a scale of increasing red hue. Purple areas have high, but uncertain, estimates of U5MRs. White areas have low relative mortality, with fairly certain estimates. Relative uncertainty is defined as the ratio of the width of the 95% uncertainty interval to the mean estimate.
Extended Data Fig. 4
Extended Data Fig. 4. Lower and upper uncertainty interval boundaries for U5MR mortality estimates in 2017.
a, b, Lower (a) and upper (b) 95% uncertainty intervals for U5MR estimates across the second administrative-level units in 99 countries.
Extended Data Fig. 5
Extended Data Fig. 5. The counteracting forces of population change and mortality rate decline on total number of under-5 deaths.
Arrow plots show the mortality rate strata (bins of 10 per 1,000 livebirths) in 2000.
Extended Data Fig. 6
Extended Data Fig. 6. Flowchart summarizing analytical process.
Standard demographic notation were used. n, length of age bin; x, starting age of age bin; d, number of deaths; q, probability of death; a, average time lived in age bin by those who died in the age bin.

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