小柯机器人

5岁以下儿童死亡GBD 2019协作组Nicholas J Kassebaum团队研究了全球、区域和国家在实现新生儿和儿童健康可持续发展目标3.2方面的进展。2021年8月17日出版的《柳叶刀》杂志发表了这项成果。

可持续发展目标3.2是到2030年消除可预防的儿童死亡率，将新生儿死亡率降低至每1000活产12人以下，将5岁以下儿童死亡率降低至每1000活产25人以下。为了了解未来十年儿童死亡率的当前比率、近期趋势和潜在轨迹，研究组介绍了全球疾病、伤害和风险因素负担研究（GBD）2019年5岁以下儿童全因死亡率和特定原因死亡率的研究结果，涉及2030年儿童死亡的多种情景，包括考虑COVID-19的潜在影响，以及量化最佳儿童存活率的新框架。

研究组分别完成了204个国家和地区详细年龄组的全因死亡率和特定原因死亡率分析，计算了新生儿死亡率（NMR）和5岁以下儿童死亡率（U5MR）的每1000活产的总死亡率。2030年的情景代表了不同的潜在轨迹，特别是包括COVID-19大流行的潜在影响和优先针对新生儿存活率的改善的潜在影响。根据年龄、性别和所有GBD位置-年的死亡原因制定最佳儿童生存指标。第一个是全局最优指标，基于最低的观察死亡率；第二个是生存潜力前沿指标，基于观察死亡率、医疗服务获取和质量指数的随机前沿分析。

全球U5MR从2000年的每1000活产71.2例死亡下降到2019年的37.1例死亡，全球NMR从2000年的每1000活产28.0例死亡下降到2019年的17.9例死亡。2019年，204个国家中有136个（67%）的U5MR达到或低于SDG 3.2阈值，有133个（65%）的NMR达到或低于SDG 3.2阈值，参考情景表明，到2030年，所有国家中将有154个（75%）能够达到U5MR目标，有139个（68%）能够达到NMR目标。

2000年，5岁以下儿童的死亡总数为965万，2019年为505万，其中新生儿死亡比例从2000年的39%上升到2019年的48%。男性NMR和U5MR普遍高于女性，尽管在全球水平上没有统计学上的显著差异。2019年，新生儿疾病仍然是5岁以下儿童死亡的主要原因，其次是下呼吸道感染、腹泻病、先天性出生缺陷和疟疾。全球最优分析表明，NMR可降至每1000活产0.8人死亡，U5MR可降至每1000活产1.44人死亡，2019年死亡的505万5岁以下儿童中有187万超出潜在生存边缘。

研究结果表明，2000-2019年，全球儿童死亡率下降了近一半，但新生儿死亡率的进展仍然较慢，204个国家中有65个（32%）国家（主要位于撒哈拉以南非洲和南亚）很难在2030年实现SDG 3.2目标。

附：英文原文

Title: Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

Author: Katherine R Paulson, Aruna M Kamath, Tahiya Alam, Kelly Bienhoff, Gdiom Gebreheat Abady, Jaffar Abbas, Mohsen Abbasi-Kangevari, Hedayat Abbastabar, Foad Abd-Allah, Sherief M Abd-Elsalam, Amir Abdoli, Aidin Abedi, Hassan Abolhassani, Lucas Guimares Abreu, Eman Abu-Gharbieh, Niveen ME Abu-Rmeileh, Abdelrahman I Abushouk, Aishatu L Adamu, Oladimeji M Adebayo, Adeyinka Emmanuel Adegbosin, Victor Adekanmbi, Olatunji O Adetokunboh, Daniel Adedayo Adeyinka, Jose C Adsuar, Khashayar Afshari, Mohammad Aghaali, Marcela Agudelo-Botero, Bright Opoku Ahinkorah, Tauseef Ahmad, Keivan Ahmadi, Muktar Beshir Ahmed, Budi Aji, Yonas Akalu, Oluwaseun Oladapo Akinyemi, Addis Aklilu, Ziyad Al-Aly, Khurshid Alam, Fahad Mashhour Alanezi, Turki M Alanzi, Jacqueline Elizabeth Alcalde-Rabanal, Ayman Al-Eyadhy, Tilahun Ali, Gianfranco Alicandro, Sheikh Mohammad Alif, Vahid Alipour, Hesam Alizade, Syed Mohamed Aljunid, Amir Almasi-Hashiani, Nihad A Almasri, Hesham M Al-Mekhlafi, Jordi Alonso, Rajaa M Al-Raddadi, Khalid A Altirkawi, Arwa Khalid Alumran, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Edward Kwabena Ameyaw, Saeed Amini, Mostafa Amini-Rarani, Arianna Maever L Amit, Dickson A Amugsi, Robert Ancuceanu, Deanna Anderlini, Catalina Liliana Andrei, Fereshteh Ansari, Alireza Ansari-Moghaddam, Carl Abelardo T Antonio, Ernoiz Antriyandarti, Davood Anvari, Razique Anwer, Muhammad Aqeel, Jalal Arabloo, Morteza Arab-Zozani, Timur Aripov, Johan rnlv, Kurnia Dwi Artanti, Afsaneh Arzani, Malke Asaad, Mehran Asadi-Aliabadi, Ali A Asadi-Pooya, Mohammad Asghari Jafarabadi, Seyyed Shamsadin Athari, Seyyede Masoume Athari, Desta Debalkie Atnafu, Alok Atreya, Madhu Sudhan Atteraya, Marcel Ausloos, Asma Tahir Awan, Beatriz Paulina Ayala Quintanilla, Getinet Ayano, Martin Amogre Ayanore, Yared Asmare Aynalem, Samad Azari, Ghasem Azarian, Zelalem Nigussie Azene, Darshan B B, Ebrahim Babaee, Ashish D Badiye, Atif Amin Baig, Maciej Banach, Palash Chandra Banik, Suzanne Lyn Barker-Collo, Hiba Jawdat Barqawi, Quique Bassat, Sanjay Basu, Bernhard T Baune, Mohsen Bayati, Neeraj Bedi, Ettore Beghi, Massimiliano Beghi, Michelle L Bell, Salaheddine Bendak, Derrick A Bennett, Isabela M Bensenor, Kidanemaryam Berhe, Adam E Berman, Yihienew Mequanint Bezabih, Akshaya Srikanth Bhagavathula, Dinesh Bhandari, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Suraj Bhattarai, Zulfiqar A Bhutta, Boris Bikbov, Antonio Biondi, Binyam Minuye Birihane, Raaj Kishore Biswas, Somayeh Bohlouli, Nicola Luigi Bragazzi, Alexey V Breusov, Andre R Brunoni, Katrin Burkart, Sharath Burugina Nagaraja, Reinhard Busse, Zahid A Butt, Florentino Luciano Caetano dos Santos, Lucero Cahuana-Hurtado, Paulo Camargos, Luis Alberto Cámera, Rosario Cárdenas, Giulia Carreras, Juan J Carrero, Felix Carvalho, Joao Mauricio Castaldelli-Maia, Carlos A Castaeda-Orjuela, Giulio Castelpietra, Ester Cerin, Jung-Chen Chang, Wagaye Fentahun Chanie

Issue&Volume: 2021-08-17

Abstract:

Background

Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival.

Methods

We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index.

Findings

Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3–74·0) in 2000 to 37·1 (33·2–41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8–29·5) in 2000 to 17·9 (16·3–19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05–10·30) in 2000 and 5·05 million (4·27–6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53–4·02]) in 2000 to 48% (2·42 million; 2·06–2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71–0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27–1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35–2·58; 37% [95% UI 32–43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier.

Interpretation

Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress.

DOI: 10.1016/S0140-6736(21)01207-1

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01207-1/fulltext

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