Annual rates of decline in child, maternal, HIV, and tuberculosis mortality across 109 countries of low and middle income from 1990 to 2013: an assessment of the feasibility of post-2015 goals
Background: Measuring a country's health performance has focused mostly on estimating levels of mortality. An alternative is to measure rates of decline in mortality, which are more sensitive to changes in health policy than are mortality levels. Historical rates of decline in mortality can als...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2014-12-01
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| Series: | The Lancet Global Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X1470316X |
| _version_ | 1828434926271201280 |
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| author | Dr. Stéphane Verguet, PhD Prof. Ole Frithjof Norheim, PhD Zachary D Olson, MA Gavin Yamey, MD Prof. Dean T Jamison, PhD |
| author_facet | Dr. Stéphane Verguet, PhD Prof. Ole Frithjof Norheim, PhD Zachary D Olson, MA Gavin Yamey, MD Prof. Dean T Jamison, PhD |
| author_sort | Dr. Stéphane Verguet, PhD |
| collection | DOAJ |
| description | Background: Measuring a country's health performance has focused mostly on estimating levels of mortality. An alternative is to measure rates of decline in mortality, which are more sensitive to changes in health policy than are mortality levels. Historical rates of decline in mortality can also help test the feasibility of future health goals (eg, post-2015). We aimed to assess the annual rates of decline in under-5, maternal, tuberculosis, and HIV mortality over the past two decades for 109 low-income and middle-income countries.
Methods: For the period 1990–2013, we estimated annual rates of decline in under-5 mortality (deaths per 1000 livebirths), the maternal mortality ratio (deaths per 100 000 livebirths), and tuberculosis and HIV mortality (deaths per 100 000 population per year) using published data from UNICEF and WHO. For every 5-year interval (eg, 1990–95), we defined performance as the size of the annual rate of decline for every mortality indicator. Subsequently, we tested the feasibility of post-2015 goals by estimating the year by which countries would achieve 2030 targets proposed by The Lancet's Commission on Investing in Health (ie, 20 deaths per 1000 for under-5 mortality, 94 deaths per 100 000 for maternal mortality, four deaths per 100 000 for tuberculosis mortality, and eight deaths per 100 000 for HIV mortality) at observed country and aspirational best-performer (90th percentile) rates.
Findings: From 2005 to 2013, the mean annual rate of decline in under-5 mortality was 4·3% (95% uncertainty interval [UI] 3·9–4·6), for maternal mortality it was 3·3% (2·5–4·1), for tuberculosis mortality 4·1% (2·8–5·4), and for HIV mortality 2·2% (0·1–4·3); aspirational best-performer rates per year were 7·1% (6·8–7·5), 6·3% (5·5–7·1), 12·8% (11·5–14·1), and 15·3% (13·2–17·4), respectively. The top two country performers were Macedonia and South Africa for under-5 mortality, Belarus and Bulgaria for maternal mortality, Uzbekistan and Macedonia for tuberculosis mortality, and Namibia and Rwanda for HIV mortality. At aspirational rates of decline, The Lancet's Commission on Investing in Health target for under-5 mortality would be achieved by 50–64% of countries, 35–41% of countries would achieve the 2030 target for maternal mortality, 74–90% of countries would meet the goal for tuberculosis mortality, and 66–82% of countries would achieve the target for HIV mortality.
Interpretation: Historical rates of decline can help define realistic targets for Sustainable Development Goals. The gap between targets and projected achievement based on recent trends suggests that countries and the international community must seek further acceleration of progress in mortality.
Funding: Bill & Melinda Gates Foundation, NORAD. |
| first_indexed | 2024-12-10T18:57:45Z |
| format | Article |
| id | doaj.art-d41d15f7abae4f08afee98c65d051cbe |
| institution | Directory Open Access Journal |
| issn | 2214-109X |
| language | English |
| last_indexed | 2024-12-10T18:57:45Z |
| publishDate | 2014-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Global Health |
| spelling | doaj.art-d41d15f7abae4f08afee98c65d051cbe2022-12-22T01:37:07ZengElsevierThe Lancet Global Health2214-109X2014-12-01212e698e70910.1016/S2214-109X(14)70316-XAnnual rates of decline in child, maternal, HIV, and tuberculosis mortality across 109 countries of low and middle income from 1990 to 2013: an assessment of the feasibility of post-2015 goalsDr. Stéphane Verguet, PhD0Prof. Ole Frithjof Norheim, PhD1Zachary D Olson, MA2Gavin Yamey, MD3Prof. Dean T Jamison, PhD4Department of Global Health, University of Washington, Seattle, WA, USADepartment of Global Public Health and Primary Health Care, University of Bergen, Bergen, NorwayDepartment of Global Health, University of Washington, Seattle, WA, USAGlobal Health Sciences, University of California at San Francisco, San Francisco, CA, USAGlobal Health Sciences, University of California at San Francisco, San Francisco, CA, USABackground: Measuring a country's health performance has focused mostly on estimating levels of mortality. An alternative is to measure rates of decline in mortality, which are more sensitive to changes in health policy than are mortality levels. Historical rates of decline in mortality can also help test the feasibility of future health goals (eg, post-2015). We aimed to assess the annual rates of decline in under-5, maternal, tuberculosis, and HIV mortality over the past two decades for 109 low-income and middle-income countries. Methods: For the period 1990–2013, we estimated annual rates of decline in under-5 mortality (deaths per 1000 livebirths), the maternal mortality ratio (deaths per 100 000 livebirths), and tuberculosis and HIV mortality (deaths per 100 000 population per year) using published data from UNICEF and WHO. For every 5-year interval (eg, 1990–95), we defined performance as the size of the annual rate of decline for every mortality indicator. Subsequently, we tested the feasibility of post-2015 goals by estimating the year by which countries would achieve 2030 targets proposed by The Lancet's Commission on Investing in Health (ie, 20 deaths per 1000 for under-5 mortality, 94 deaths per 100 000 for maternal mortality, four deaths per 100 000 for tuberculosis mortality, and eight deaths per 100 000 for HIV mortality) at observed country and aspirational best-performer (90th percentile) rates. Findings: From 2005 to 2013, the mean annual rate of decline in under-5 mortality was 4·3% (95% uncertainty interval [UI] 3·9–4·6), for maternal mortality it was 3·3% (2·5–4·1), for tuberculosis mortality 4·1% (2·8–5·4), and for HIV mortality 2·2% (0·1–4·3); aspirational best-performer rates per year were 7·1% (6·8–7·5), 6·3% (5·5–7·1), 12·8% (11·5–14·1), and 15·3% (13·2–17·4), respectively. The top two country performers were Macedonia and South Africa for under-5 mortality, Belarus and Bulgaria for maternal mortality, Uzbekistan and Macedonia for tuberculosis mortality, and Namibia and Rwanda for HIV mortality. At aspirational rates of decline, The Lancet's Commission on Investing in Health target for under-5 mortality would be achieved by 50–64% of countries, 35–41% of countries would achieve the 2030 target for maternal mortality, 74–90% of countries would meet the goal for tuberculosis mortality, and 66–82% of countries would achieve the target for HIV mortality. Interpretation: Historical rates of decline can help define realistic targets for Sustainable Development Goals. The gap between targets and projected achievement based on recent trends suggests that countries and the international community must seek further acceleration of progress in mortality. Funding: Bill & Melinda Gates Foundation, NORAD.http://www.sciencedirect.com/science/article/pii/S2214109X1470316X |
| spellingShingle | Dr. Stéphane Verguet, PhD Prof. Ole Frithjof Norheim, PhD Zachary D Olson, MA Gavin Yamey, MD Prof. Dean T Jamison, PhD Annual rates of decline in child, maternal, HIV, and tuberculosis mortality across 109 countries of low and middle income from 1990 to 2013: an assessment of the feasibility of post-2015 goals The Lancet Global Health |
| title | Annual rates of decline in child, maternal, HIV, and tuberculosis mortality across 109 countries of low and middle income from 1990 to 2013: an assessment of the feasibility of post-2015 goals |
| title_full | Annual rates of decline in child, maternal, HIV, and tuberculosis mortality across 109 countries of low and middle income from 1990 to 2013: an assessment of the feasibility of post-2015 goals |
| title_fullStr | Annual rates of decline in child, maternal, HIV, and tuberculosis mortality across 109 countries of low and middle income from 1990 to 2013: an assessment of the feasibility of post-2015 goals |
| title_full_unstemmed | Annual rates of decline in child, maternal, HIV, and tuberculosis mortality across 109 countries of low and middle income from 1990 to 2013: an assessment of the feasibility of post-2015 goals |
| title_short | Annual rates of decline in child, maternal, HIV, and tuberculosis mortality across 109 countries of low and middle income from 1990 to 2013: an assessment of the feasibility of post-2015 goals |
| title_sort | annual rates of decline in child maternal hiv and tuberculosis mortality across 109 countries of low and middle income from 1990 to 2013 an assessment of the feasibility of post 2015 goals |
| url | http://www.sciencedirect.com/science/article/pii/S2214109X1470316X |
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