Articles| Volume 388, ISSUE 10053, P1725-1774, October 08, 2016
Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

Open AccessPublished:October 08, 2016DOI:https://doi.org/10.1016/S0140-6736(16)31575-6
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    Summary

    Background

    Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time.

    Methods

    Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1–4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980–2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age–sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).

    Findings

    Globally, 5·8 million (95% uncertainty interval [UI] 5·7–6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7–53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3–43·6) to 2·6 million (2·6–2·7) neonatal deaths and 47·0% (35·1–57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6–3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone.

    Interpretation

    Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030.

    Funding

    Bill & Melinda Gates Foundation.

    Introduction

    Substantial reductions in under-5 mortality have occurred worldwide during the past 35 years, with every region recording sizeable improvements in child survival.
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        The Millennium Declaration
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          and the political and technical focus catalysed by Millennium Development Goal 4 (MDG4), arguably incited heightened policy attention and financial commitments to child health by national governments and development partners alike.
          Research in context
          Evidence before this study
          The Global Burden of Disease (GBD) study has a long history of generating comprehensive, comparable estimates of child mortality, and has continually refined current methods or developed new analytical approaches to maximise a full range of data sources and systems that track child survival. For the 2013 iteration of GBD, we evaluated the relative contributions of different factors, including number of births and education levels, to changes in under-5 mortality from 2000 to 2013. In recent years, several studies have sought to assess drivers of changes in child mortality, such as postulating trends caused by a subset of causes and indicators of technical progress. A shortcoming of these past approaches is that estimates of under-5 mortality levels and trends are typically produced within separate analytical frameworks, rather than unified estimation systems. GBD 2015 child mortality analyses feature several advances from previous rounds of the GBD, including an expanded set of territories and subnational geographies, additional causes, and critical examinations on the measurement and impact of changes in sociodemographic status on child survival.
          Added value of this study
          The GBD assessment of child mortality provides timely, robust evidence on documenting child health achievements during the Millennium Development Goal era, identifying causes and regions for which less progress occurred, and characterising the association between improving development and child survival. Estimates of child mortality by age (neonatal, post-neonatal, 1–4 years, and under-5), sex, and cause over time now include 519 geographies, a notable increase from the 264 included in GBD 2013. The under-5 mortality database has increased greatly since GBD 2013, and we implemented several methodological improvements, including data bias adjustments by data source and data type. For the first time, we estimated the number and rates of stillbirths across geographies and over time. Further, this analysis applies measures of Socio-demographic Index (SDI), a composite measure of income per person, educational attainment, and fertility for every geography year, to examine the association between changes in child mortality and improving levels of development.
          Implications
          This study provides the most comprehensive assessment so far of levels and trends of child mortality worldwide, linking recorded rates of change in under-5 mortality with expected rates of decrease based on SDI alone. Through a series of decomposition analyses, we identify which groups of causes contribute most to reductions in under-5 mortality across regions and the development spectrum. Comparisons of recorded levels and cause composition for child mortality with patterns expected based on SDI alone offer an in-depth, nuanced picture of where countries might need to refocus policies and resource allocation for accelerated improvements in child survival in the future.
          Despite such progress, most low-income and middle-income countries (LMICs) did not achieve the MDG4 target of reducing under-5 mortality by two-thirds between 1990 and 2015, which equates to a 4·4% annualised rate of decrease during this time.
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          From 1990 to 2000, the global rate of decrease for under-5 mortality averaged 2·0% (1·7–2·4) per year, and previous forecasts by the UN Inter-agency Group for Child Mortality Estimation (IGME) suggested that 62 of 195 countries would achieve MDG4 by 2015.
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          Further, at the global level, IGME estimated that MDG4 would be missed by 14 percentage points (ie, a 53% decrease in under-5 mortality between 1990 and 2015). The degree to which countries diverged in their pace of progress has prompted extensive debate and reflection on the various drivers of child health, including absolute and relative funding levels,
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          However, few studies, if any, have systematically attributed changes in mortality due to leading causes of child deaths, as well as gains in overall development, across geographies and over time.
          Enhanced estimation methods, as well as increased quantity and quality of data, not only show large disparities in under-5 mortality across and within countries,
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          but also emphasise distinct variations in survival by age group and cause among children younger than 5 years.
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          Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet. 2014; 384: 957-979
            GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544
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            Previous studies report much slower decreases in mortality rates for neonates, or children younger than 28 days, than those recorded for post-neonates and children aged 1 to 4 years.
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            • Coates MM
            • et al.
            Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet. 2014; 384: 957-979
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            • Hogan DR
            • Mathers C
            • Cousens SN
            Neonatal cause-of-death estimates for the early and late neonatal periods for 194 countries: 2000–2013.Bull World Health Organ. 2015; 93: 19-28
            These findings have prompted a heighted focus on newborn health,
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              especially around the types of interventions and health services that might accelerate reductions in neonatal mortality.
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              Systematic disaggregation of levels and trends in neonatal mortality, particularly at subnational levels, can help focus local needs and strategies for improving newborn health. Recent analyses also bring renewed attention to late fetal and intrapartum deaths, known as stillbirths.
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              Especially in low-income areas, higher stillbirth rates have been associated with preventable maternal infections, including malaria and syphilis,
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              Stillbirths: rates, risk factors, and acceleration towards 2030.Lancet. 2016; 387: 587-603
              highlighting the importance of using a comprehensive analytic approach that can account for or link various exposures and socioeconomic factors related to stillbirths. In combination, these findings underscore the vital need to advance understanding of fetal risks and causes of early death associated with pregnancy or delivery across and within populations.
              In 2015, the MDGs were replaced by the more all-encompassing, albeit less health-focused, Sustainable Development Goals (SDGs).
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              SDG3.2 is the main indicator for improving child survival, with targets of reducing under-5 mortality to fewer than 25 deaths per 1000 livebirths, decreasing neonatal mortality to fewer than 12 deaths per 1000 livebirths, and ending preventable deaths of newborns and children younger than 5 years, all by 2030. In view of these ambitious global goals, and the highly heterogeneous trends recorded in absolute and relative child mortality trends in the past, it is crucial to comprehensively assess factors that affected mortality trends in the past and to identify which ones might further improve child survival in the future.
              The 2015 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2015) provides the analytical framework from which reductions in child mortality can be thoroughly examined by age, geography, and cause over time. For GBD 2015, we analyse rates of under-5 mortality disaggregated by age group, as well as stillbirths, for 195 countries and territories from 1980 to 2015; however, much of this paper focuses on results between 1990 and 2015, aligning with the period of time covered by MDG4. Expanding on subnational analyses done for GBD 2013, we provide estimates of levels and trends in under-5 mortality at subnational levels for Brazil, China, India, Japan, Kenya, Mexico, Saudi Arabia, South Africa, Sweden, the UK, and the USA. Through a series of decomposition analyses and assessments of child mortality in relation to measures of sociodemographic status, we quantify differences in observed and expected gains in child survival given changes in development alone.

              Methods

              The methods used to generate estimates of under-5 mortality and age-specific death rates (early neonatal, late neonatal, post-neonatal, ages 1–4 years, infant, and under 5), contribute to broader GBD 2015 analyses and results on all-cause mortality and cause of death. Substantial detail on data inputs, processing, and estimation methods can be found in an accompanying GBD 2015 publication.
                GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544
                Here we provide a brief summary of our under-5 mortality estimation approach and accompanying analyses, including an assessment of mortality trends by Soci-demographic Index (SDI), and attribute changes in under-5 mortality to leading causes of death. We also describe our estimation of stillbirths by geography and over time.
                Our analyses presented here and elsewhere for GBD 2015 follow the recently proposed Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER),
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                • Black RE
                Stevens GA , Alkema L , Black RE , and for the The GATHER Working Group. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement.Lancet. 2016; (published June 28.)
                which include the documentation of data sources and inputs, processing and estimation steps, and overarching methods used throughout the GBD study.

                Geographical units of analysis

                For GBD 2015, we analysed 195 countries and territories in the 21 GBD regions. Since GBD 2013, we added seven territories and expanded subnational analyses from three countries (China, Mexico, and the UK)
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                • et al.
                Cause-specific mortality for 240 causes in China during 1990–2013: a systematic subnational analysis for the Global Burden of Disease Study 2013.Lancet. 2016; 387: 251-272
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                to include eight additional countries: Brazil, India, Japan, Kenya, Saudi Arabia, South Africa, Sweden, and the USA. Here, we present results at the global, regional, national, territory, and, for a subset of countries, subnational levels from 1980–2015. Countries for which subnational estimates are shown include Brazil (26 states and one district), China (33 provinces and municipalities), India (62 urban and rural administrative units), Japan (47 prefectures), Kenya (47 counties), Mexico (32 states), Saudi Arabia (13 regions), South Africa (nine provinces), Sweden (two regions), the UK (four nations and nine subregions for England), and the USA (50 states and the District of Columbia).

                Data

                Data sources and types used for estimating child mortality are described extensively elsewhere,
                  GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544
                  but in sum, vital registration (VR) systems, censuses, and household surveys with complete or summary birth histories served as primary inputs for our analyses. Other sources, including sample registration systems and disease surveillance systems, also contributed as input data. In total we applied formal demographic techniques to 8169 input data sources of under-5 mortality from 1950–2015. Overall data availability and availability by source data type varied by geography.
                  Stillbirth data were extracted from major survey series, including Demographic and Health Surveys, the Centers for Disease Control & Prevention (CDC) Reproductive Health Surveys, UNICEF Multiple Indicator Cluster Surveys, and the WHO Multi-Country Surveys. We also used VR systems, birth registries, and literature sources. Following definitions for stillbirths used by previous studies,
                  • Blencowe H
                  • Cousens S
                  • Jassir FB
                  • et al.
                  National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis.Lancet Glob Health. 2016; 4: e98-108
                  • Lawn JE
                  • Blencowe H
                  • Waiswa P
                  • et al.
                  Stillbirths: rates, risk factors, and acceleration towards 2030.Lancet. 2016; 387: 587-603
                  we classified fetal deaths at 28 weeks or later and intrapartum deaths (ie, deaths that occurred after the onset of labour but prior to birth) as stillbirths. We collated 7579 geography-year datapoints from 1980–2015 on stillbirths, representing 350 countries, territories, and subnational locations in our analysis. The appendix provides additional detail on stillbirth data sources and processing steps (appendix pp 19–22).

                  All-cause under-5 mortality and age-specific mortality

                  The appendix presents the analytical steps involved in estimating all-cause under-5 mortality and death rates by age group: early neonatal (0–6 days), late neonatal (7–28 days), post-neonatal (29–364 days), and ages 1–4 years (appendix p 31). Details on data bias adjustments for under-5 mortality, using spatiotemporal Gaussian Process regression to generate a complete time series of under-5 mortality for all geographies and the age–sex model to produce estimates of mortality for early neonatal, late neonatal, post-neonatal, and ages 1–4 years have been extensively discussed previously
                  • Wang H
                  • Liddell CA
                  • Coates MM
                  • et al.
                  Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet. 2014; 384: 957-979
                  and in the appendix.
                  For subnational analyses, we rescaled estimates from lower administrative units to the national level because data densities were generally much higher at the national level than at the subnational. South Africa was the exception to this approach, where national-level estimates were generated by aggregating subnational estimates up to the national level.
                  To estimate mortality by age group and sex within the under-5 categorisation, we used a two-stage modelling process that has been described in detail elsewhere.
                  • Lozano R
                  • Wang H
                  • Foreman KJ
                  • et al.
                  Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis.Lancet. 2011; 378: 1139-1165
                    GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544
                    For this analysis, we report on early neonatal and late neonatal mortality results in aggregate as neonatal mortality; the appendix provides estimates of early and late neonatal mortality (appendix pp 35, 36).

                    Stillbirth analysis

                    In GBD 2015, for the first time, we generated estimates of stillbirths and stillbirth rates by location from 1980–2015. Drawing from data compiled by Blencowe and colleagues,
                    • Blencowe H
                    • Cousens S
                    • Jassir FB
                    • et al.
                    National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis.Lancet Glob Health. 2016; 4: e98-108
                    we expanded to include additional data from published literature, VR, and surveys. We estimated stillbirth trends by modifying the data synthesis model used for under-5 mortality. We applied a mixed-effects generalised linear model to quantify the ratio of stillbirth rates to neonatal mortality in natural logarithmic space. Our model covariates included educational attainment among women of reproductive age, skilled birth attendance, a random effect on neonatal mortality classified into 20 bins, random intercepts for each location, and data source-specific random effects nested within each location. Neonatal mortality was chosen for its strong coefficient of correlation with stillbirth rates (0·8). Source-specific fixed effects were included to adjust for biases inherent to a subset of data sources; the appendix provides the complete list of data source types (appendix p 21). Finally, we included a variable that accounted for different stillbirth definitions, encompassing the seven definitions found within our database. These definitions included fetal death after 28 weeks of gestation, 26 weeks of gestation, 24 weeks of gestation, 22 weeks of gestation, 20 weeks of gestation, weighing at least 1000 g, and weighing at least 500 g. There were also 1744 location-years where no definition was provided, which we included as an eighth undefined definition category. Stillbirth rates from surveys and complete vital registration systems where the definition of stillbirth was fetal death after 28 weeks of gestation were used as reference sources in the data bias adjustment process. Other non-reference sources were adjusted based on data source fixed effects for surveys or complete VR and data source-specific random effects. The appendix provides additional details on the modelling process (appendix pp 20–22).

                    Under-5 populations and total deaths

                    Accurate estimates of total under-5 deaths hinge upon accurate estimates of under-5 populations, disaggregated by each age group, sex, geography, and year. For each age–sex-specific group, we modelled population as a function of livebirths for every year and corresponding death rates during each interval under analysis. The appendix provides population estimates (appendix pp 93–104).

                    Under-5 causes of death

                    The methods developed and used in GBD 2015, including the systematic approach to collating causes of death from different countries, mapping across different revisions and national variants of the International Classification of Diseases and Injuries (ICD); redistribution of deaths assigned to so-called garbage codes; and the overall and disease-specific cause of death modelling approaches are described in other publications
                      GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544
                        GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet. 2015; 385: 117-171
                        • Naghavi M
                        • Makela S
                        • Foreman K
                        • O'Brien J
                        • Pourmalek F
                        • Lozano R
                        Algorithms for enhancing public health utility of national causes-of-death data.Popul Health Metr. 2010; 8: 9
                        • Lozano R
                        • Naghavi M
                        • Foreman K
                        • et al.
                        Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet. 2012; 380: 2095-2128
                        • Foreman KJ
                        • Lozano R
                        • Lopez AD
                        • Murray CJ
                        Modeling causes of death: an integrated approach using CODEm.Popul Health Metr. 2012; 10: 1
                        and in the appendix (appendix pp 24,25).
                        For GBD 2015, we assessed 249 causes of death across age groups. Because of cause-specific age restrictions (eg, no child deaths due to Alzheimer's disease and other dementias), not all causes of death were applicable for children younger than 5 years. The appendix provides the full GBD 2015 cause list (appendix pp 150–56), and additional information is published elsewhere.
                          GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544
                            Institute for Health Metrics and Evaluation. Protocol for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). (accessed May 1, 2016).

                            Socio-demographic Index

                            Expanding upon analyses from GBD 2013,
                            • Murray CJL
                            • Barber RM
                            • Foreman KJ
                            • et al.
                            Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition.Lancet. 2015; 386: 2145-2191
                            we studied patterns in child mortality as they related to measures of socioeconomic status and development. Drawing on methods used to construct the Human Development Index (HDI),
                              United Nations Development Programme (UNDP). UNDP, Geneva, Switzerland; 2016
                              we created a composite indicator, the Socio-demographic Index (SDI), based on equally weighted estimates of lagged distributed income (LDI) per person, average years of education among individuals older than 15 years, and total fertility rate. SDI was constructed as the geometric mean of these three values. SDI values were scaled to a range of 0–1, with 0 equalling measures of the lowest educational attainment, lowest income, and highest fertility between 1980 and 2015, and 1 equalling measures of the highest educational attainment, highest income, and lowest fertility during this time. SDI was computed for every geography-year under analysis, providing a population-level indicator of overall development at a given time. We tested whether alternative lags of the components of SDI would provide a better predictor of outcomes such as life expectancy and age-specific probabilities of death. We found that using LDI, educational attainment, and the total fertility rate in the current year is the most predictive of these mortality outcomes. The appendix provides additional detail on SDI computation (appendix pp 23, 24) and additional information can be found elsewhere.
                                GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544

                                Decomposing change in under-5 mortality rate by causes of death

                                Based on the age-specific, sex-specific, and cause-specific mortality results from GBD 2015,
                                  GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544
                                  we attributed changes in under-5 mortality rate between 1990 and 2015 to changes in leading causes of death in children younger than 5 years during the same period. To do this, we applied the decomposition method developed by Beltran-Sanchez and colleagues,
                                  • Beltran-Sanchez H
                                  • Preston S
                                  • Canudas-Romo V
                                  An integrated approach to cause-of-death analysis: cause-deleted life tables and decompositions of life expectancy.Demogr Res. 2008; 19: 1323-1350
                                  which has also been used for other GBD analyses.
                                    GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544
                                    • Newton JN
                                    • Briggs ADM
                                    • Murray CJL
                                    • et al.
                                    Changes in health in England, with analysis by English regions and areas of deprivation, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet. 2015; 386: 2257-2274
                                    • Zhou M
                                    • Wang H
                                    • Zhu J
                                    • et al.
                                    Cause-specific mortality for 240 causes in China during 1990–2013: a systematic subnational analysis for the Global Burden of Disease Study 2013.Lancet. 2016; 387: 251-272
                                    • Gómez-Dantés H
                                    • Fullman N
                                    • Lamadrid-Figueroa H
                                    • et al.
                                    Dissonant health transition in the states of Mexico, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet. 2016; (published online Oct 5.)

                                    Uncertainty analysis

                                    We propagated known measures of uncertainty through key steps of the mortality estimation processes, including uncertainty associated with varying sample sizes of data, source-specific adjustments to data used for all-cause mortality, model specifications for spatiotemporal Gaussian Process regression (ST-GPR) and cause-specific model specifications, and estimation procedures. Uncertainty estimates were derived from 1000 draws for under-5 mortality, age-specific mortality, and cause-specific mortality by sex, year, and geography from the posterior distribution of each step of the estimation process. These draws allowed us to quantify, and then propagate, uncertainty for all mortality metrics. Percent changes and annualised rates of change were calculated between mean estimates, while the uncertainty intervals associated with the percent changes were derived from the 1000 draws.

                                    Role of the funding source

                                    The funder had no role in study design, data collection, data analysis, data interpretation, or manuscript writing and submission for publication. The corresponding author had full access to all data in the study and final responsibility to submit the paper.

                                    Results

                                    Trends in child mortality and by age group
                                    Between 1990 and 2015, global under-5 deaths decreased by 52·0% (95% UI 50·7–53·3), from 12·1 million (12·0–12·2) in 1990 to 5·8 million (5·7–6·0) in 2015 (table 1). Reductions in total deaths were similar for the post-neonatal and childhood (age 1–4 years) age groups, each decreasing at least 50% between 1990 and 2015; deaths in children aged 1–4 years fell most rapidly during this time (by 59·8%, 95% UI 57·8–61·6). Neonatal deaths fell at a slower pace, decreasing 42·4% (41·3–43·6) from 4·6 million (4·5–4·6) in 1990 to 2·6 million (2·6–2·7) in 2015. In 1990, 37·6% (4·6 million, 4·5–4·6) of total under-5 deaths occurred during the first 28 days of life, 31·2% (3·8 million, 3·7–3·9) were post-neonatal, and 31·2% (3·8 million, 3·6–3·9) took place in children aged 1–4 years. By 2015, the composition of under-5 deaths shifted to 45·0% (2·6 million, 2·6–2·7) for neonatal, 28·8% (1·6 million, 1·6–1·7) for post-neonatal, and 26·1% (1·5 million, 1·4–1·6) for children aged 1–4 years.
                                    Table 1Global deaths (thousands) and mortality rates (per 1000 livebirths) for stillbirths, early neonatal, late neonatal, post-neonatal, child, and under-5 age groups, both sexes combined, 1980–2015
                                    StillbirthsEarly neonatal (0–6 days)Late neonatal (7–27 days)Post-neonatal (28 days to 1 year)Child (1–4 years)Under 5 (0–4 years)
                                    TotalRateTotalRateTotalRateTotalRateTotalRateTotalRate
                                    19804564·42 (3341·20–6298·83)35·32 (26·12–48·13)3467·39 (3393·59–3534·22)27·71 (26·37–28·94)1543·04 (1525·70–1559·96)12·69 (12·29–13·12)4468·32 (4361·17–4572·96)37·47 (35·04–39·85)4643·93 (4470·80–4818·39)40·92 (37·58–44·49)14 122·69 (13 995·96–14 258·76)113·82 (110·88–117·11)
                                    19814517·94 (3310·03–6209·80)34·48 (25·52–46·83)3456·63 (3383·42–3523·71)27·24 (25·92–28·43)1516·58 (1500·77–1533·26)12·29 (11·88–12·70)4405·81 (4300·90–4506·72)36·47 (34·08–38·77)4538·98 (4366·43–4710·35)39·67 (36·41–43·14)13 918·00 (13 796·26–14 056·49)110·97 (108·04–114·26)
                                    19824477·11 (3322·49–6157·15)33·62 (25·19–45·70)3450·41 (3378·35–3516·82)26·74 (25·45–27·90)1490·82 (1474·30–1507·34)11·88 (11·47–12·31)4339·21 (4235·45–4441·98)35·33 (32·94–37·59)4,434·38 (4267·06–4598·46)38·34 (35·13–41·88)13 714·82 (13 589·45–13 857·12)107·85 (104·80–111·36)
                                    19834446·63 (3338·48–6038·33)32·83 (24·87–44·10)3451·08 (3379·46–3517·62)26·27 (25·04–27·41)1468·12 (1453·15–1484·66)11·49 (11·08–11·93)4395·90 (4228·10–4616·23)35·13 (32·49–37·94)4391·16 (4210·33–4575·38)37·42 (34·12–40·92)13 706·26 (13 502·87–13 954·64)106·02 (102·58–109·92)
                                    19844414·01 (3341·28–5878·18)32·04 (24·46–42·24)3451·40 (3380·96–3516·47)25·81 (24·58–26·95)1445·49 (1429·90–1462·11)11·11 (10·70–11·55)4343·05 (4177·90–4563·00)34·05 (31·53–36·86)4309·64 (4142·86–4480·44)36·10 (32·99–39·37)13 549·58 (13 353·43–13 793·75)103·03 (99·70–107·22)
                                    19854372·44 (3329·84–5815·48)31·28 (24·01–41·20)3444·53 (3373·90–3511·49)25·37 (24·18–26·53)1419·42 (1404·16–1435·52)10·73 (10·33–11·20)4198·69 (4086·96–4316·23)32·37 (30·07–34·57)4193·23 (4036·11–4354·84)34·48 (31·56–37·46)13 255·88 (13 120·30–13 398·93)99·21 (96·09–102·89)
                                    19864324·91 (3303·47–5687·58)30·56 (23·53–39·83)3430·87 (3362·62–3494·07)24·94 (23·79–26·07)1392·32 (1375·98–1408·90)10·39 (10·01–10·83)4095·77 (3997·51–4193·69)31·12 (29·00–33·22)4097·73 (3941·17–4255·73)33·09 (30·34–35·95)13 016·69 (12 893·07–13 137·64)96·03 (93·02–99·64)
                                    19874268·38 (3281·74–5574·35)29·90 (23·16–38·72)3413·24 (3345·71–3476·16)24·58 (23·42–25·70)1364·90 (1348·09–1380·90)10·08 (9·70–10·52)4034·29 (3937·80–4131·20)30·28 (28·20–32·40)4026·78 (3876·37–4185·56)31·95 (29·21–34·86)12 839·21 (12 714·31–12 965·82)93·57 (90·57–97·16)
                                    19884191·84 (3222·94–5475·83)29·23 (22·64–37·86)3382·27 (3315·87–3445·31)24·21 (23·08–25·28)1333·94 (1319·08–1349·92)9·79 (9·42–10·21)3960·20 (3864·38–4053·88)29·47 (27·51–31·55)3955·56 (3804·58–4,111·65)30·91 (28·30–33·59)12 631·98 (12 504·07–12 758·92)91·23 (88·36–94·63)
                                    19894103·42 (3155·33–5370·66)28·62 (22·16–37·15)3339·41 (3277·13–3403·54)23·90 (22·83–24·92)1299·73 (1285·45–1315·57)9·53 (9·19–9·95)3871·89 (3781·40–3966·14)28·70 (26·84–30·71)3857·17 (3709·77–4,011·25)29·76 (27·26–32·53)12 368·20 (12 253·57–12 483·93)88·90 (86·13–92·11)
                                    19904007·90 (3083·10–5236·38)28·10 (21·77–36·41)3288·20 (3224·96–3349·07)23·63 (22·59–24·60)1264·72 (1250·49–1279·28)9·31 (8·97–9·68)3784·52 (3693·53–3877·42)28·09 (26·21–29·94)3782·69 (3637·18–3933·80)28·92 (26·55–31·67)12 120·13 (12 010·80–12 239·54)87·08 (84·45–90·05)
                                    19913909·41 (3019·26–5069·41)27·62 (21·48–35·55)3233·63 (3172·82–3293·92)23·41 (22·39–24·31)1230·80 (1216·82–1244·35)9·12 (8·79–9·47)3695·00 (3601·95–3786·01)27·57 (25·77–29·31)3707·73 (3561·58–3857·32)28·21 (25·95–30·87)11 867·16 (11 761·90–11 972·98)85·54 (83·10–88·24)
                                    19923800·25 (2976·27–4886·14)27·12 (21·38–34·62)3168·04 (3106·90–3229·12)23·15 (22·12–24·09)1192·12 (1178·59–1205·93)8·92 (8·61–9·26)3582·20 (3493·61–3673·52)26·94 (25·19–28·74)3593·27 (3453·91–3735·14)27·32 (25·04–29·82)11 535·63 (11 426·11–11 636·72)83·69 (81·18–86·25)
                                    19933687·65 (2907·35–4735·37)26·60 (21·10–33·92)3098·80 (3037·91–3157·56)22·88 (21·88–23·80)1152·81 (1139·48–1166·25)8·71 (8·41–9·02)3467·75 (3381·02–3556·99)26·32 (24·59–28·06)3486·85 (3349·67–3624·72)26·59 (24·47–28·95)11 206·21 (11 110·76–11 310·27)81·96 (79·60–84·56)
                                    19943577·24 (2847·62–4544·93)26·08 (20·88–32·92)3037·42 (2977·47–3096·64)22·65 (21·67–23·56)1118·66 (1105·33–1133·13)8·54 (8·23–8·85)3372·75 (3287·97–3467·51)25·85 (24·26–27·54)3427·31 (3268·93–3578·27)26·27 (24·13–28·58)10 956·15 (10 836·81–11 103·59)80·83 (78·57–83·29)
                                    19953471·39 (2787·86–4366·54)25·58 (20·65–31·97)2970·80 (2910·75–3030·03)22·37 (21·46–23·29)1079·27 (1067·15–1091·46)8·31 (8·04–8·60)3285·45 (3200·44–3372·30)25·42 (23·86–26·93)3291·68 (3160·12–3422·11)25·41 (23·42–27·47)10 627·20 (10 534·17–10 728·52)79·15 (77·10–81·31)
                                    19963389·05 (2755·17–4219·81)25·16 (20·56–31·15)2914·02 (2856·68–2969·53)22·11 (21·21–22·93)1046·09 (1034·26–1057·84)8·12 (7·86–8·39)3190·20 (3106·86–3272·35)24·89 (23·41–26·26)3193·88 (3066·06–3323·32)24·87 (22·91–26·96)10 344·19 (10 255·67–10 441·05)77·71 (75·85–79·66)
                                    19973325·06 (2729·68–4111·07)24·83 (20·48–30·53)2862·34 (2805·44–2916·48)21·84 (20·96–22·64)1014·89 (1003·33–1027·15)7·92 (7·67–8·18)3100·92 (3016·31–3180·72)24·35 (22·95–25·71)3095·57 (2967·45–3227·97)24·30 (22·38–26·32)10 073·72 (9987·08–10 166·45)76·22 (74·45–78·04)
                                    19983252·85 (2679·00–4,002·19)24·39 (20·18–29·85)2813·68 (2759·54–2868·11)21·55 (20·69–22·34)985·58 (973·89–996·93)7·72 (7·46–7·98)3016·13 (2934·45–3095·42)23·78 (22·39–25·17)3003·76 (2876·08–3131·97)23·75 (21·96–25·66)9819·14 (9735·05–9907·36)74·70 (72·90–76·52)
                                    19993171·09 (2619·78–3878·74)23·81 (19·76–28·98)2767·68 (2713·91–2821·33)21·22 (20·36–21·97)956·75 (945·22–968·45)7·50 (7·23–7·76)2930·95 (2852·37–3009·62)23·16 (21·79–24·52)2910·24 (2782·65–3038·66)23·14 (21·39–25·07)9565·62 (9481·09–9652·39)73·03 (71·20–74·90)
                                    20003090·13 (2563·52–3751·10)23·19 (19·32–28·02)2721·60 (2666·35–2773·39)20·86 (19·98–21·62)927·49 (915·82–938·98)7·26 (7·00–7·53)2843·08 (2763·31–2918·67)22·46 (21·15–23·77)2810·32 (2688·05–2935·63)22·44 (20·72–24·32)9302·50 (9218·10–9386·18)71·12 (69·33–73·03)
                                    20013014·27 (2521·45–3629·82)22·57 (18·95–27·06)2676·78 (2621·56–2727·91)20·46 (19·62–21·22)899·27 (887·84–911·07)7·02 (6·76–7·28)2755·20 (2676·23–2831·45)21·72 (20·44–22·98)2710·94 (2589·72–2832·43)21·68 (20·00–23·49)9042·19 (8956·84–9127·83)69·09 (67·17–71·02)
                                    20022945·64 (2486·44–3536·51)21·96 (18·61–26·26)2632·58 (2579·35–2684·35)20·03 (19·21–20·82)872·56 (861·77–884·33)6·78 (6·52–7·04)2669·20 (2593·57–2744·00)20·95 (19·67–22·21)2614·51 (2497·63–2732·49)20·90 (19·31–22·64)8788·85 (8703·87–8873·68)66·98 (65·07–68·94)
                                    20032883·13 (2450·30–3432·10)21·38 (18·24–25·36)2587·51 (2536·18–2639·32)19·57 (18·77–20·34)846·66 (835·85–858·26)6·54 (6·29–6·80)2556·92 (2488·41–2631·87)19·96 (18·75–21·15)2505·81 (2387·30–2621·50)19·98 (18·43–21·65)8496·90 (8424·32–8578·98)64·49 (62·74–66·38)
                                    20042822·77 (2398·46–3342·95)20·81 (17·74–24·56)2541·18 (2490·19–2592·63)19·10 (18·31–19·88)821·44 (810·90–833·33)6·30 (6·05–6·56)2475·08 (2407·74–2548·10)19·19 (18·00–20·33)2419·48 (2302·48–2532·72)19·21 (17·73–20·86)8257·17 (8181·77–8342·34)62·34 (60·55–64·29)
                                    20052752·80 (2351·02–3241·05)20·19 (17·29–23·68)2492·25 (2439·11–2543·30)18·61 (17·80–19·36)795·67 (785·04–807·58)6·06 (5·81–6·33)2389·57 (2321·08–2460·22)18·39 (17·28–19·53)2319·16 (2211·24–2427·96)18·30 (16·89–19·90)7996·65 (7921·62–8081·51)60·03 (58·15–61·99)
                                    20062677·89 (2300·31–3132·63)19·51 (16·81–22·75)2444·92 (2393·69–2495·80)18·14 (17·34–18·89)771·64 (760·76–783·26)5·83 (5·56–6·10)2307·74 (2239·59–2375·84)17·64 (16·57–18·76)2224·50 (2117·95–2330·96)17·43 (16·05–18·96)7748·81 (7671·16–7829·99)57·81 (55·82–59·82)
                                    20072608·90 (2238·50–3052·02)18·88 (16·25–22·02)2399·66 (2348·31–2449·79)17·67 (16·90–18·41)749·16 (737·98–761·74)5·62 (5·35–5·89)2231·91 (2165·03–2298·04)16·93 (15·88–18·07)2135·85 (2032·78–2238·85)16·62 (15·28–18·12)7516·57 (7440·60–7604·72)55·69 (53·60–57·78)
                                    20082546·84 (2194·02–2972·40)18·32 (15·82–21·31)2357·29 (2306·72–2407·17)17·24 (16·46–17·99)728·66 (717·15–741·87)5·43 (5·15–5·72)2163·00 (2098·82–2224·69)16·28 (15·22–17·42)2061·12 (1959·62–2160·84)15·91 (14·61–17·34)7310·06 (7225·74–7408·43)53·79 (51·58–56·10)
                                    20092485·07 (2142·42–2891·93)17·76 (15·35–20·61)2313·06 (2263·54–2361·49)16·81 (16·02–17·56)707·89 (695·78–721·70)5·24 (4·94–5·55)2089·18 (2026·36–2150·70)15·61 (14·52–16·71)1968·96 (1868·41–2062·99)15·08 (13·78–16·55)7079·10 (6988·35–7178·71)51·74 (49·33–54·14)
                                    20102419·94 (2087·79–2824·25)17·22 (14·89–20·04)2264·25 (2214·86–2314·31)16·37 (15·55–17·19)686·86 (674·78–700·15)5·05 (4·75–5·40)2022·54 (1958·02–2083·52)15·01 (13·87–16·14)1902·19 (1803·78–1996·75)14·46 (13·12–15·89)6875·83 (6777·71–6980·62)49·97 (47·34–52·70)
                                    20112350·47 (2025·78–2732·56)16·64 (14·38–19·29)2214·81 (2165·09–2262·24)15·93 (15·06–16·77)665·33 (652·82–679·02)4·87 (4·53–5·25)1944·92 (1883·12–2005·91)14·35 (13·22–15·52)1806·20 (1712·64–1898·00)13·62 (12·27–15·10)6631·25 (6530·28–6737·69)47·91 (45·12–50·92)
                                    20122282·19 (1973·84–2669·70)16·09 (13·95–18·77)2168·30 (2118·47–2215·24)15·52 (14·57–16·41)645·09 (631·47–659·03)4·69 (4·34–5·10)1871·79 (1810·03–1932·00)13·73 (12·57–14·95)1728·34 (1634·29–1820·64)12·94 (11·58–14·44)6413·53 (6297·89–6,522·55)46·11 (43·17–49·32)
                                    20132225·15 (1916·54–2604·35)15·64 (13·50–18·26)2124·20 (2074·05–2173·09)15·15 (14·16–16·10)625·70 (611·59–640·35)4·53 (4·16–4·96)1807·71 (1748·13–1866·80)13·20 (12·01–14·49)1656·45 (1563·93–1752·38)12·32 (10·93–13·86)6,214·06 (6090·86–6332·79)44·47 (41·29–48·02)
                                    20142175·23 (1868·96–2564·58)15·25 (13·14–17·94)2080·13 (2031·06–2129·80)14·79 (13·78–15·86)606·19 (590·75–621·97)4·38 (3·99–4·83)1744·31 (1684·25–1804·67)12·68 (11·46–14·13)1588·47 (1494·61–1685·85)11·75 (10·33–13·31)6019·08 (5878·69–6153·38)42·93 (39·54–46·89)
                                    20152124·96 (1827·78–2521·12)14·89 (12·83–17·62)2034·23 (1982·93–2082·87)14·45 (13·39–15·56)587·23 (570·64–604·00)4·23 (3·84–4·71)1677·99 (1617·86–1741·50)12·16 (10·93–13·63)1521·40 (1425·62–1620·55)11·20 (9·80–12·81)5820·85 (5673·34–5965·06)41·41 (37·93–45·45)
                                    95% UIs are provided in parentheses. UI=uncertainty intervals.
                                    Worldwide, under-5 mortality rates fell 52·4% (95% UI 47·7–56·4) between 1990 and 2015, from 87·1 deaths per 1000 livebirths (84·5–90·1) in 1990 to 41·4 deaths per 1000 livebirths (37·9–45·5) in 2015. Global under-5 mortality decreased at a faster pace from 2000–15 (an annualised rate of decrease of 3·6%, 3·0–4·2) than from 1990–2000 (an annualised rate of decrease of 2·0%, 1·7–2·4). Similar to trends in total deaths by age group, mortality rates in post-neonates and children aged 1–4 years decreased faster than those recorded for neonates. In 2015, neonatal mortality (18·6 deaths per 1000 livebirths, 17·3–20·1) exceeded mortality rates estimated for all other age groups (post-neonatal and childhood).
                                    In 2015, age-specific mortality rates and total under-5 deaths varied by region and country (table 2). Neonatal mortality rates generally exceeded levels recorded for other child age groups in many regions; for instance, in south Asia, neonatal mortality rates (29·8 per 1000 livebirths [95% UI 27·2–32·7]) exceeded mortality rates for other child age groups (eg, post-neonatal, at 12·1 per 1000 livebirths [10·3–14·1]) by double in 2015. For other regions, particularly western and central sub-Saharan Africa, mortality rates were higher in children aged 1–4 years. Across countries, children in this age group had the largest difference in mortality rates, ranging from 0·3 deaths per 1000 livebirths (95% UI 0·2–0·4) in Andorra to 61·1 per 1000 livebirths (49·6–74·2) in Niger. At the regional level, 30·1% (1·7 million [95% UI 1·7–1·8 million]) of under-5 deaths occurred in South Asia, 25·3% (1·5 million [1·4–1·6 million]) in western sub-Saharan Africa, and 15·6% (909 000 [871 000–948 000]) in eastern sub-Saharan Africa. India recorded the largest number of under-5 deaths in 2015, at 1·3 million (1·2–1·3 million), followed by Nigeria (726 600 [647 200–814 600]) and Pakistan (341 700 [311 300–376 000]). Mali had the highest neonatal mortality rate in 2015 with 40·6 per 1000 livebirths (34·6–47·1); Central African Republic and Pakistan, with neonatal mortality rates of 40·2 per 1000 livebirths (32·2–49·9) and 37·9 per 1000 livebirths (34·8–41·3), respectively, recorded the second-highest and third-highest toll for neonatal mortality in 2015.
                                    Table 2Stillbirth rates, neonatal, post-neonatal, child, and under-5 mortality rates (per 1000 livebirths), total under-5 deaths, and total stillbirths in 2015, annualised rates of change for under-5 mortality for 1990–2000, 2000–15, and 1990–2015, by countries and territories and subnational units in the United Kingdom, both sexes combined
                                    Deaths per 1000 livebirthsTotal stillbirths (thousands)Total under-5 deaths (thousands)Annualised rate of change for under-5 mortality
                                    StillbirthsNeonatal(0–27 days)Post-neonatal (28 days to 1 year)Child(1–4 years)Under 51990–20002000–151990–2015
                                    Global14·89 (12·83 to 17·62)18·62 (17·26 to 20·14)12·16 (10·93 to 13·63)11·20 (9·80 to 12·81)41·41 (37·93 to 45·45)2124·96 (1827·78 to 2521·12)5820·85 (5673·34 to 5965·06)−2·02 (−2·39 to −1·70)−3·61 (−4·17 to −2·98)−2·97 (−3·32 to −2·59)
                                    High SDI3·00 (2·71 to 3·36)2·78 (2·61 to 2·98)1·59 (1·50 to 1·69)0·95 (0·86 to 1·06)5·31 (5·04 to 5·63)42·18 (38·15 to 47·25)74·54 (72·97 to 76·25)−3·90 (−4·12 to −3·69)−3·26 (−3·61 to −2·88)−3·52 (−3·74 to −3·28)
                                    High-middle SDI6·73 (5·90 to 7·70)8·52 (7·52 to 9·63)4·39 (3·86 to 5·00)2·81 (2·48 to 3·18)15·64 (13·92 to 17·66)165·69 (145·07 to 189·86)372·15 (355·30 to 388·69)−3·65 (−4·42 to −2·91)−4·61 (−5·41 to −3·73)−4·22 (−4·75 to −3·69)
                                    Middle SDI10·15 (8·84 to 11·64)12·90 (11·55 to 14·30)6·26 (5·46 to 7·17)4·40 (3·83 to 5·05)23·40 (20·89 to 26·09)372·28 (323·69 to 427·48)868·83 (828·55 to 909·42)−3·54 (−4·47 to −2·60)−4·97 (−5·79 to −4·14)−4·40 (−4·94 to −3·86)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Low-middle SDI24·01 (20·78 to 28·01)29·14 (27·14 to 31·34)17·59 (15·81 to 19·52)16·63 (14·34 to 19·23)62·07 (57·46 to 67·10)1115·34 (962·28 to 1306·27)2814·33 (2706·19 to 2924·44)−2·56 (−2·87 to −2·27)−3·63 (−4·17 to −3·08)−3·20 (−3·53 to −2·86)
                                    Low SDI20·56 (15·95 to 27·02)27·65 (25·65 to 29·87)28·19 (25·05 to 31·74)30·64 (26·17 to 35·37)84·02 (75·99 to 93·24)428·45 (330·77 to 566·64)1688·71 (1615·60 to 1769·42)−2·16 (−2·37 to −1·97)−3·89 (−4·50 to −3·23)−3·20 (−3·61 to −2·78)
                                    High income2·94 (2·71 to 3·22)2·69 (2·50 to 2·91)1·54 (1·44 to 1·65)0·84 (0·73 to 0·96)5·06 (4·75 to 5·40)34·73 (31·99 to 37·99)59·66 (58·68 to 60·76)−3·91 (−4·11 to −3·75)−2·68 (−3·11 to −2·25)−3·17 (−3·43 to −2·91)
                                    High-income North America2·81 (2·71 to 2·92)3·27 (3·08 to 3·45)1·69 (1·55 to 1·82)0·97 (0·75 to 1·21)5·92 (5·71 to 6·14)12·45 (12·00 to 12·93)26·10 (25·83 to 26·36)−3·24 (−3·35 to −3·13)−2·03 (−2·27 to −1·77)−2·51 (−2·65 to −2·36)
                                    Canada2·57 (2·15 to 3·12)2·77 (2·54 to 3·02)1·45 (1·31 to 1·58)0·82 (0·62 to 1·06)5·03 (4·72 to 5·38)1·00 (0·84 to 1·21)1·94 (1·82 to 2·08)−3·15 (−3·47 to −2·84)−1·34 (−1·78 to −0·88)−2·06 (−2·32 to −1·79)
                                    Greenland5·87 (4·14 to 8·11)8·62 (7·50 to 9·86)4·43 (3·93 to 4·96)1·97 (1·42 to 2·60)14·95 (13·40 to 16·71)<0·01 (<0·01 to 0·01)0·01 (0·01 to 0·01)−5·51 (−6·33 to −4·66)−2·22 (−2·96 to −1·45)−3·54 (−4·03 to −3·03)
                                    USA2·84 (2·73 to 2·95)3·32 (3·14 to 3·50)1·71 (1·57 to 1·85)0·98 (0·74 to 1·25)6·00 (5·80 to 6·21)11·45 (11·02 to 11·91)24·13 (23·90 to 24·36)−3·27 (−3·38 to −3·16)−2·06 (−2·29 to −1·82)−2·54 (−2·68 to −2·40)
                                    Australasia3·65 (2·96 to 4·59)2·09 (1·92 to 2·25)1·32 (1·19 to 1·43)0·76 (0·58 to 0·97)4·16 (3·93 to 4·41)1·38 (1·12 to 1·74)1·56 (1·49 to 1·64)−4·21 (−4·51 to −3·89)−2·96 (−3·36 to −2·53)−3·46 (−3·71 to −3·21)
                                    Australia3·71 (2·98 to 4·71)2·04 (1·88 to 2·20)1·19 (1·06 to 1·31)0·72 (0·52 to 0·97)3·94 (3·73 to 4·17)1·18 (0·95 to 1·50)1·25 (1·18 to 1·32)−4·28 (−4·66 to −3·88)−3·08 (−3·49 to −2·66)−3·56 (−3·81 to −3·31)
                                    New Zealand3·34 (2·85 to 3·97)2·32 (2·11 to 2·53)1·99 (1·74 to 2·22)0·97 (0·71 to 1·32)5·27 (4·95 to 5·63)0·20 (0·17 to 0·24)0·32 (0·30 to 0·34)−3·97 (−4·42 to −3·51)−2·30 (−2·75 to −1·81)−2·96 (−3·25 to −2·67)
                                    High-income Asia Pacific1·81 (1·64 to 2·01)1·19 (1·07 to 1·32)0·97 (0·87 to 1·08)0·73 (0·60 to 0·88)2·89 (2·68 to 3·15)2·78 (2·51 to 3·09)4·46 (4·19 to 4·73)−4·14 (−5·62 to −2·89)−4·18 (−4·71 to −3·58)−4·16 (−4·81 to −3·48)
                                    Brunei4·06 (3·16 to 5·14)3·86 (3·32 to 4·43)2·50 (2·00 to 3·05)2·57 (1·93 to 3·29)8·90 (7·81 to 10·17)0·03 (0·02 to 0·03)0·06 (0·05 to 0·07)−1·38 (−2·28 to −0·58)0·03 (−0·91 to 1·06)−0·53 (−1·15 to 0·10)
                                    Japan1·78 (1·58 to 2·02)1·11 (0·99 to 1·24)0·92 (0·80 to 1·06)0·70 (0·53 to 0·88)2·73 (2·50 to 2·98)1·84 (1·64 to 2·09)2·84 (2·76 to 2·91)−2·88 (−3·14 to −2·59)−3·48 (−4·06 to −2·90)−3·24 (−3·58 to −2·88)
                                    Singapore2·20 (1·75 to 2·81)1·05 (0·94 to 1·17)0·67 (0·58 to 0·77)0·45 (0·33 to 0·59)2·17 (1·95 to 2·42)0·08 (0·07 to 0·11)0·08 (0·07 to 0·09)−7·34 (−8·11 to −6·56)−3·53 (−4·34 to −2·73)−5·05 (−5·54 to −4·59)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    South Korea1·82 (1·51 to 2·18)1·34 (1·09 to 1·65)1·09 (0·89 to 1·30)0·80 (0·59 to 1·06)3·22 (2·69 to 3·82)0·83 (0·69 to 1·00)1·47 (1·23 to 1·74)−5·34 (−8·21 to −2·61)−5·30 (−6·47 to −4·15)−5·32 (−6·57 to −3·98)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Western Europe2·65 (2·39 to 2·95)1·88 (1·64 to 2·17)1·12 (1·00 to 1·24)0·58 (0·49 to 0·68)3·58 (3·18 to 4·05)11·72 (10·53 to 13·05)15·82 (15·01 to 16·71)−4·92 (−5·08 to −4·77)−3·16 (−3·95 to −2·36)−3·87 (−4·34 to −3·37)
                                    Andorra1·38 (1·12 to 1·75)0·98 (0·81 to 1·23)0·64 (0·50 to 0·82)0·29 (0·19 to 0·43)1·91 (1·55 to 2·39)<0·01 (<0·01 to <0·01)<0·01 (<0·01 to <0·01)−7·37 (−8·97 to −5·75)−2·83 (−4·10 to −1·49)−4·65 (−5·53 to −3·64)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Austria2·23 (1·91 to 2·66)1·85 (1·60 to 2·16)1·10 (0·97 to 1·25)0·57 (0·43 to 0·77)3·53 (3·12 to 3·99)0·18 (0·16 to 0·22)0·29 (0·25 to 0·33)−5·34 (−6·09 to −4·67)−3·16 (−4·10 to −2·22)−4·03 (−4·57 to −3·52)
                                    Belgium2·43 (1·95 to 3·09)1·93 (1·70 to 2·19)1·27 (1·13 to 1·42)0·61 (0·46 to 0·79)3·81 (3·45 to 4·22)0·32 (0·25 to 0·40)0·50 (0·45 to 0·55)−5·05 (−5·45 to −4·68)−3·08 (−3·78 to −2·39)−3·87 (−4·28 to −3·46)
                                    Cyprus2·92 (2·38 to 3·65)2·80 (2·37 to 3·32)1·44 (1·26 to 1·69)0·54 (0·38 to 0·72)4·78 (4·16 to 5·58)0·02 (0·02 to 0·02)0·03 (0·03 to 0·04)−5·88 (−6·60 to −5·17)−2·86 (−3·79 to −1·80)−4·07 (−4·67 to −3·46)
                                    Denmark1·35 (1·12 to 1·62)1·97 (1·63 to 2·39)0·99 (0·85 to 1·14)0·58 (0·42 to 0·79)3·55 (3·02 to 4·18)0·08 (0·07 to 0·10)0·21 (0·18 to 0·25)−5·04 (−5·81 to −4·30)−2·97 (−4·09 to −1·85)−3·80 (−4·47 to −3·13)
                                    Finland1·52 (1·27 to 1·86)1·32 (1·05 to 1·69)0·66 (0·53 to 0·83)0·41 (0·28 to 0·59)2·40 (1·89 to 3·03)0·09 (0·07 to 0·11)0·14 (0·11 to 0·18)−5·10 (−6·13 to −4·05)−3·71 (−5·42 to −2·04)−4·27 (−5·24 to −3·31)
                                    France3·30 (2·67 to 4·07)1·53 (1·16 to 2·02)1·18 (0·94 to 1·44)0·58 (0·41 to 0·82)3·28 (2·59 to 4·15)2·59 (2·10 to 3·20)2·58 (2·04 to 3·25)−4·85 (−5·25 to −4·51)−3·40 (−4·99 to −1·86)−3·98 (−4·93 to −3·05)
                                    Germany2·10 (1·79 to 2·50)1·77 (1·46 to 2·20)1·19 (1·02 to 1·38)0·58 (0·42 to 0·78)3·53 (3·01 to 4·22)1·44 (1·23 to 1·72)2·41 (2·05 to 2·88)−5·53 (−5·87 to −5·17)−2·71 (−3·82 to −1·52)−3·84 (−4·49 to −3·15)
                                    Greece2·49 (2·09 to 2·97)1·92 (1·74 to 2·13)0·91 (0·81 to 1·01)0·47 (0·34 to 0·63)3·30 (3·03 to 3·61)0·23 (0·19 to 0·27)0·31 (0·28 to 0·34)−5·25 (−5·75 to −4·78)−4·21 (−4·81 to −3·58)−4·62 (−4·99 to −4·26)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Iceland1·23 (1·01 to 1·53)0·95 (0·81 to 1·13)0·68 (0·56 to 0·80)0·39 (0·27 to 0·54)2·03 (1·72 to 2·38)0·01 (<0·01 to 0·01)0·01 (0·01 to 0·01)−5·03 (−6·17 to −3·76)−4·49 (−5·64 to −3·24)−4·71 (−5·39 to −4·01)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Ireland2·87 (2·23 to 3·77)1·83 (1·59 to 2·09)1·13 (0·99 to 1·26)0·56 (0·41 to 0·74)3·51 (3·15 to 3·92)0·20 (0·15 to 0·26)0·24 (0·22 to 0·27)−3·23 (−3·92 to −2·50)−4·50 (−5·28 to −3·69)−3·99 (−4·49 to −3·53)
                                    Israel2·55 (2·06 to 3·15)1·85 (1·63 to 2·09)1·24 (1·09 to 1·38)0·75 (0·56 to 0·96)3·84 (3·50 to 4·22)0·43 (0·34 to 0·53)0·64 (0·58 to 0·70)−5·08 (−5·64 to −4·52)−4·32 (−4·96 to −3·66)−4·62 (−5·04 to −4·23)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Italy1·75 (1·44 to 2·16)1·91 (1·54 to 2·39)0·77 (0·64 to 0·92)0·45 (0·31 to 0·60)3·13 (2·55 to 3·83)0·88 (0·72 to 1·08)1·58 (1·29 to 1·93)−5·52 (−5·94 to −5·13)−3·74 (−5·09 to −2·40)−4·45 (−5·25 to −3·64)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Luxembourg3·12 (2·59 to 3·84)1·13 (0·97 to 1·33)1·03 (0·88 to 1·21)0·42 (0·30 to 0·57)2·58 (2·23 to 2·99)0·02 (0·02 to 0·02)0·02 (0·01 to 0·02)−6·57 (−7·64 to −5·36)−4·04 (−5·03 to −2·98)−5·05 (−5·71 to −4·41)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Malta3·05 (2·46 to 3·73)4·16 (3·56 to 4·84)1·46 (1·27 to 1·65)0·65 (0·46 to 0·87)6·25 (5·47 to 7·16)0·01 (0·01 to 0·01)0·02 (0·02 to 0·03)−3·04 (−4·09 to −1·92)−0·87 (−1·92 to 0·19)−1·74 (−2·31 to −1·12)
                                    Netherlands2·24 (1·81 to 2·75)2·18 (1·88 to 2·53)1·00 (0·87 to 1·12)0·73 (0·55 to 0·97)3·91 (3·48 to 4·41)0·40 (0·32 to 0·49)0·69 (0·62 to 0·78)−2·99 (−3·47 to −2·48)−3·36 (−4·19 to −2·54)−3·21 (−3·70 to −2·72)
                                    Norway2·09 (1·58 to 2·76)1·34 (1·17 to 1·53)0·86 (0·74 to 0·98)0·51 (0·38 to 0·67)2·71 (2·40 to 3·06)0·13 (0·10 to 0·17)0·17 (0·15 to 0·19)−5·94 (−6·69 to −5·14)−4·01 (−4·90 to −3·14)−4·78 (−5·30 to −4·25)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Portugal2·09 (1·96 to 2·24)1·39 (1·28 to 1·52)0·97 (0·86 to 1·09)0·60 (0·45 to 0·77)2·97 (2·78 to 3·17)0·17 (0·16 to 0·19)0·25 (0·24 to 0·27)−6·84 (−7·12 to −6·56)−5·88 (−6·33 to −5·42)−6·27 (−6·54 to −6·00)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Spain1·81 (1·50 to 2·21)1·56 (1·35 to 1·80)0·94 (0·82 to 1·07)0·50 (0·37 to 0·66)3·00 (2·65 to 3·40)0·75 (0·62 to 0·91)1·26 (1·11 to 1·42)−5·46 (−5·89 to −5·01)−3·99 (−4·86 to −3·14)−4·58 (−5·07 to −4·06)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Sweden2·32 (1·75 to 3·06)1·41 (1·23 to 1·65)0·76 (0·66 to 0·88)0·42 (0·30 to 0·57)2·60 (2·26 to 2·99)0·28 (0·21 to 0·36)0·31 (0·28 to 0·34)−6·15 (−6·97 to −5·37)−2·65 (−3·66 to −1·60)−4·05 (−4·64 to −3·47)
                                    Switzerland1·89 (1·64 to 2·18)2·25 (1·86 to 2·74)1·09 (0·96 to 1·25)0·71 (0·51 to 0·92)4·05 (3·45 to 4·75)0·16 (0·14 to 0·19)0·35 (0·29 to 0·41)−3·96 (−4·61 to −3·29)−2·47 (−3·56 to −1·38)−3·07 (−3·72 to −2·42)
                                    UK4·08 (3·51 to 4·73)2·56 (2·31 to 2·83)1·46 (1·33 to 1·61)0·68 (0·50 to 0·88)4·69 (4·34 to 5·10)3·33 (2·86 to 3·86)3·81 (3·70 to 3·93)−3·85 (−4·18 to −3·51)−2·15 (−2·68 to −1·59)−2·83 (−3·17 to −2·49)
                                    England4·09 (3·49 to 4·76)2·57 (2·34 to 2·84)1·46 (1·36 to 1·57)0·69 (0·60 to 0·78)4·71 (4·34 to 5·13)2·87 (2·45 to 3·34)3·28 (3·18 to 3·39)−3·87 (−4·19 to −3·54)−2·14 (−2·68 to −1·53)−2·83 (−3·16 to −2·48)
                                    Northern Ireland4·10 (3·43 to 4·94)3·21 (2·38 to 4·18)1·37 (1·10 to 1·67)0·76 (0·55 to 1·03)5·33 (4·15 to 6·72)0·10 (0·09 to 0·12)0·13 (0·10 to 0·17)−3·64 (−5·05 to −2·33)−1·23 (−3·05 to 0·51)−2·20 (−3·26 to −1·20)
                                    Scotland4·09 (3·51 to 4·68)2·35 (1·86 to 2·88)1·39 (1·17 to 1·62)0·67 (0·47 to 0·91)4·40 (3·67 to 5·21)0·23 (0·19 to 0·26)0·24 (0·21 to 0·29)−3·83 (−4·60 to −3·00)−2·64 (−3·94 to −1·38)−3·11 (−3·86 to −2·40)
                                    Wales4·03 (3·46 to 4·72)2·31 (2·07 to 2·60)1·38 (1·24 to 1·53)0·69 (0·51 to 0·91)4·38 (4·02 to 4·80)0·14 (0·12 to 0·16)0·15 (0·14 to 0·16)−3·75 (−4·64 to −2·80)−2·21 (−2·97 to −1·43)−2·82 (−3·25 to −2·43)
                                    Southern Latin America6·12 (5·10 to 7·48)6·06 (5·69 to 6·47)3·65 (3·33 to 3·97)1·63 (1·23 to 2·10)11·31 (10·75 to 11·93)6·38 (5·31 to 7·81)11·72 (11·31 to 12·15)−3·83 (−3·91 to −3·74)−2·85 (−3·20 to −2·49)−3·24 (−3·44 to −3·03)
                                    Argentina5·38 (4·37 to 6·56)6·80 (6·40 to 7·20)3·97 (3·60 to 4·36)1·85 (1·31 to 2·47)12·57 (12·08 to 13·10)4·07 (3·31 to 4·98)9·47 (9·10 to 9·87)−3·56 (−3·66 to −3·44)−3·03 (−3·31 to −2·76)−3·24 (−3·40 to −3·08)
                                    Chile8·81 (6·00 to 13·14)3·94 (3·67 to 4·21)2·63 (2·33 to 2·91)1·06 (0·75 to 1·44)7·61 (7·17 to 8·08)2·08 (1·41 to 3·12)1·78 (1·68 to 1·90)−5·64 (−5·85 to −5·44)−2·29 (−2·69 to −1·88)−3·63 (−3·88 to −3·39)
                                    Uruguay4·64 (3·79 to 5·63)4·89 (3·79 to 6·35)3·59 (2·63 to 4·69)1·13 (0·74 to 1·65)9·58 (7·35 to 12·43)0·23 (0·18 to 0·28)0·47 (0·36 to 0·61)−3·68 (−4·28 to −3·05)−3·39 (−5·19 to −1·63)−3·50 (−4·55 to −2·49)
                                    Central Europe, eastern Europe, and central Asia4·91 (4·03 to 6·13)7·19 (6·27 to 8·16)4·13 (3·51 to 4·90)2·65 (2·24 to 3·14)13·91 (12·15 to 15·95)27·60 (22·63 to 34·49)77·90 (72·86 to 83·58)−1·48 (−1·96 to −0·96)−4·65 (−5·56 to −3·72)−3·38 (−3·94 to −2·84)
                                    Eastern Europe3·98 (3·13 to 5·17)4·41 (4·02 to 4·96)2·56 (2·25 to 2·90)1·76 (1·39 to 2·18)8·70 (8·00 to 9·60)10·09 (7·94 to 13·12)21·95 (20·24 to 24·16)−0·62 (−1·28 to 0·09)−5·51 (−6·13 to −4·81)−3·56 (−3·92 to −3·15)
                                    Belarus2·12 (1·78 to 2·57)2·91 (2·11 to 4·00)1·72 (1·32 to 2·28)1·08 (0·72 to 1·54)5·70 (4·34 to 7·65)0·24 (0·20 to 0·29)0·64 (0·48 to 0·85)−2·91 (−4·74 to −1·10)−6·65 (−8·52 to −4·59)−5·15 (−6·41 to −3·90)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Estonia1·97 (1·91 to 2·03)1·46 (1·07 to 2·01)1·10 (0·86 to 1·40)0·74 (0·51 to 1·02)3·30 (2·53 to 4·26)0·03 (0·03 to 0·03)0·05 (0·04 to 0·06)−4·02 (−5·11 to −2·90)−8·42 (−10·34 to −6·58)−6·66 (−7·74 to −5·63)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Latvia3·20 (2·87 to 3·62)2·57 (1·64 to 3·80)1·50 (1·09 to 2·08)1·14 (0·76 to 1·65)5·20 (3·60 to 7·29)0·06 (0·06 to 0·07)0·10 (0·07 to 0·15)−3·04 (−4·05 to −1·99)−6·24 (−8·75 to −3·90)−4·96 (−6·47 to −3·52)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Lithuania2·59 (2·24 to 3·04)1·80 (1·44 to 2·26)1·40 (1·17 to 1·66)0·87 (0·64 to 1·17)4·07 (3·44 to 4·89)0·08 (0·07 to 0·09)0·12 (0·10 to 0·15)−2·33 (−3·01 to −1·64)−6·71 (−7·90 to −5·45)−4·95 (−5·66 to −4·21)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Moldova4·15 (3·56 to 4·90)5·43 (3·66 to 8·21)3·24 (2·08 to 4·57)2·05 (1·25 to 3·26)10·68 (7·16 to 15·38)0·18 (0·15 to 0·21)0·46 (0·31 to 0·67)0·54 (−1·72 to 3·11)−7·27 (−10·14 to −4·55)−4·15 (−5·85 to −2·49)
                                    Russia4·09 (3·00 to 5·68)4·43 (4·18 to 4·64)2·56 (2·24 to 2·85)1·78 (1·33 to 2·32)8·75 (8·57 to 8·94)7·48 (5·48 to 10·42)15·92 (15·59 to 16·26)−0·67 (−0·82 to −0·51)−5·40 (−5·58 to −5·23)−3·51 (−3·59 to −3·42)
                                    Ukraine4·16 (3·34 to 5·17)4·89 (3·06 to 7·60)2·83 (1·76 to 4·18)1·91 (1·16 to 2·96)9·60 (6·09 to 14·43)2·02 (1·63 to 2·52)4·66 (3·01 to 6·94)−0·01 (−2·76 to 2·84)−5·37 (−8·50 to −2·41)−3·22 (−5·14 to −1·50)
                                    Central Europe3·05 (2·71 to 3·49)3·03 (2·35 to 3·92)1·94 (1·55 to 2·44)0·92 (0·71 to 1·17)5·88 (4·64 to 7·46)3·50 (3·12 to 4·01)6·78 (6·05 to 7·63)−4·79 (−5·08 to −4·47)−5·49 (−7·10 to −3·86)−5·21 (−6·15 to −4·25)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Albania2·93 (2·41 to 3·56)3·31 (2·28 to 5·02)5·38 (3·60 to 7·48)3·51 (2·34 to 5·13)12·15 (8·48 to 17·15)0·12 (0·10 to 0·14)0·47 (0·33 to 0·66)−4·35 (−6·10 to −2·40)−5·26 (−7·85 to −2·74)−4·89 (−6·42 to −3·48)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Bosnia and Herzegovina3·55 (3·03 to 4·24)2·89 (2·42 to 3·42)1·80 (1·52 to 2·10)0·71 (0·52 to 0·96)5·39 (4·64 to 6·24)0·12 (0·10 to 0·14)0·18 (0·16 to 0·21)−5·21 (−5·86 to −4·56)−4·67 (−5·76 to −3·60)−4·89 (−5·51 to −4·28)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Bulgaria4·32 (3·65 to 5·09)4·21 (2·95 to 5·78)3·06 (2·09 to 4·36)1·48 (0·99 to 2·16)8·72 (6·22 to 12·09)0·29 (0·25 to 0·35)0·59 (0·42 to 0·82)−0·29 (−0·92 to 0·35)−4·71 (−7·07 to −2·60)−2·94 (−4·32 to −1·64)
                                    Croatia1·68 (1·38 to 2·08)2·70 (2·31 to 3·14)1·07 (0·94 to 1·21)0·64 (0·46 to 0·86)4·40 (3·87 to 5·00)0·07 (0·06 to 0·08)0·18 (0·16 to 0·20)−3·36 (−4·01 to −2·66)−4·48 (−5·42 to −3·56)−4·03 (−4·55 to −3·50)
                                    Czech Republic2·20 (2·18 to 2·21)1·23 (1·04 to 1·45)0·86 (0·72 to 1·01)0·40 (0·29 to 0·54)2·49 (2·12 to 2·93)0·24 (0·23 to 0·24)0·27 (0·23 to 0·31)−8·04 (−8·77 to −7·27)−5·10 (−6·30 to −3·92)−6·27 (−6·93 to −5·60)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Hungary2·90 (2·30 to 3·61)3·05 (2·05 to 4·39)1·29 (1·00 to 1·70)0·61 (0·38 to 0·88)4·94 (3·51 to 6·87)0·27 (0·21 to 0·33)0·46 (0·32 to 0·63)−4·87 (−5·50 to −4·24)−4·97 (−7·28 to −2·70)−4·93 (−6·31 to −3·63)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Macedonia7·88 (6·70 to 9·22)5·82 (3·86 to 8·74)2·69 (1·74 to 3·83)1·09 (0·68 to 1·64)9·57 (6·38 to 13·95)0·19 (0·16 to 0·22)0·22 (0·15 to 0·33)−8·13 (−8·97 to −7·31)−3·17 (−5·87 to −0·67)−5·15 (−6·81 to −3·61)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Montenegro3·54 (2·84 to 4·50)2·91 (1·99 to 4·10)1·76 (1·35 to 2·27)0·53 (0·34 to 0·77)5·18 (3·78 to 7·01)0·03 (0·02 to 0·03)0·04 (0·03 to 0·05)0·49 (−2·62 to 3·89)−9·02 (−11·20 to −6·90)−5·22 (−6·96 to −3·34)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Poland2·35 (2·02 to 2·78)2·69 (1·80 to 3·91)1·23 (0·95 to 1·61)0·59 (0·38 to 0·85)4·50 (3·18 to 6·29)0·91 (0·78 to 1·08)1·75 (1·24 to 2·45)−6·40 (−6·73 to −6·06)−4·89 (−7·21 to −2·67)−5·49 (−6·86 to −4·17)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Romania3·46 (2·81 to 4·34)3·62 (2·71 to 4·65)3·27 (2·40 to 4·53)1·47 (0·99 to 2·07)8·34 (6·31 to 10·95)0·62 (0·50 to 0·78)1·51 (1·15 to 1·99)−3·58 (−3·90 to −3·26)−6·79 (−8·61 to −5·01)−5·50 (−6·62 to −4·43)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Serbia4·88 (4·02 to 6·01)4·30 (3·87 to 4·77)2·43 (2·09 to 2·80)1·01 (0·73 to 1·38)7·72 (6·98 to 8·54)0·44 (0·36 to 0·55)0·70 (0·63 to 0·77)−6·23 (−8·14 to −4·37)−3·40 (−4·35 to −2·46)−4·54 (−5·33 to −3·78)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Slovakia2·85 (2·79 to 2·91)3·09 (2·51 to 3·76)2·02 (1·68 to 2·44)0·88 (0·64 to 1·18)5·99 (5·01 to 7·16)0·16 (0·16 to 0·17)0·34 (0·29 to 0·41)−3·80 (−4·57 to −2·96)−3·21 (−4·41 to −1·96)−3·45 (−4·19 to −2·69)
                                    Slovenia2·57 (2·20 to 3·06)1·40 (1·20 to 1·64)0·79 (0·67 to 0·92)0·46 (0·33 to 0·61)2·64 (2·29 to 3·04)0·06 (0·05 to 0·07)0·06 (0·05 to 0·07)−6·23 (−7·19 to −5·20)−4·75 (−5·86 to −3·71)−5·35 (−5·96 to −4·74)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Central Asia7·23 (5·95 to 8·98)13·31 (11·00 to 15·87)7·55 (5·89 to 9·63)4·93 (3·92 to 6·13)25·59 (21·16 to 31·10)14·00 (11·50 to 17·42)49·17 (44·30 to 54·66)−1·74 (−2·51 to −0·95)−4·49 (−5·80 to −3·22)−3·39 (−4·18 to −2·61)
                                    Armenia6·35 (5·17 to 7·74)7·82 (5·61 to 10·45)4·07 (3·15 to 5·19)3·13 (2·12 to 4·36)14·95 (11·62 to 18·98)0·25 (0·20 to 0·31)0·59 (0·46 to 0·75)−4·17 (−5·67 to −2·62)−4·89 (−6·81 to −3·12)−4·60 (−5·68 to −3·58)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Azerbaijan8·06 (6·47 to 10·22)15·85 (12·79 to 19·17)9·99 (6·96 to 13·98)4·14 (2·78 to 6·00)29·71 (23·10 to 37·70)1·57 (1·26 to 2·00)5·79 (4·50 to 7·35)−2·25 (−3·77 to −0·68)−5·18 (−6·99 to −3·42)−4·01 (−5·16 to −3·01)
                                    Georgia4·99 (3·51 to 6·91)9·57 (7·31 to 12·16)4·60 (3·67 to 5·95)3·31 (2·27 to 4·73)17·39 (13·91 to 21·52)0·27 (0·19 to 0·38)0·95 (0·76 to 1·17)−1·33 (−2·67 to 0·10)−4·89 (−6·45 to −3·37)−3·47 (−4·49 to −2·48)
                                    Kazakhstan6·38 (4·46 to 9·30)9·18 (6·60 to 12·08)4·50 (3·48 to 5·92)3·74 (2·63 to 5·05)17·33 (13·42 to 22·06)2·42 (1·69 to 3·53)6·54 (5·07 to 8·33)−0·89 (−2·52 to 0·73)−4·84 (−6·85 to −2·90)−3·26 (−4·30 to −2·21)
                                    Kyrgyzstan8·12 (6·52 to 10·31)17·00 (15·17 to 18·89)7·71 (6·27 to 9·39)4·50 (3·26 to 6·11)28·96 (25·73 to 32·53)1·26 (1·01 to 1·60)4·45 (3·95 to 5·00)−2·71 (−3·34 to −2·05)−3·59 (−4·47 to −2·70)−3·24 (−3·76 to −2·71)
                                    Mongolia5·74 (4·72 to 6·93)14·34 (11·73 to 17·33)8·25 (5·84 to 11·63)5·75 (4·07 to 8·00)28·09 (22·56 to 35·61)0·40 (0·33 to 0·48)1·94 (1·56 to 2·46)−4·06 (−5·23 to −2·81)−5·01 (−6·53 to −3·44)−4·63 (−5·56 to −3·71)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Tajikistan8·37 (6·79 to 10·25)15·39 (12·88 to 18·09)11·45 (8·34 to 15·50)6·34 (4·17 to 8·96)32·84 (26·33 to 40·53)2·16 (1·75 to 2·65)8·34 (6·69 to 10·29)−2·59 (−3·90 to −1·25)−5·06 (−6·64 to −3·45)−4·07 (−5·03 to −3·12)
                                    Turkmenistan8·88 (7·14 to 11·25)19·18 (15·15 to 23·62)13·00 (8·36 to 18·69)7·94 (4·89 to 12·19)39·61 (29·39 to 52·32)1·00 (0·81 to 1·27)4·43 (3·28 to 5·84)−1·96 (−4·61 to 0·56)−4·44 (−6·87 to −2·29)−3·45 (−4·78 to −2·21)
                                    Uzbekistan6·94 (5·57 to 8·80)12·78 (9·94 to 15·86)6·51 (4·59 to 9·07)5·10 (3·60 to 7·00)24·20 (18·78 to 30·77)4·66 (3·74 to 5·93)16·15 (12·52 to 20·55)−1·45 (−3·20 to 0·34)−3·82 (−5·79 to −1·95)−2·87 (−3·92 to −1·81)
                                    Latin America and Caribbean6·87 (5·97 to 8·08)9·28 (7·29 to 11·60)5·87 (4·77 to 7·42)3·27 (2·59 to 4·02)18·31 (14·72 to 22·83)67·81 (58·94 to 79·93)179·94 (172·04 to 188·67)−4·73 (−5·39 to −4·04)−3·76 (−5·28 to −2·31)−4·15 (−5·04 to −3·30)
                                    Central Latin America5·56 (4·81 to 6·51)8·26 (6·37 to 10·56)5·17 (4·24 to 6·60)3·38 (2·70 to 4·17)16·72 (13·36 to 20·93)26·10 (22·56 to 30·60)78·22 (73·59 to 83·46)−4·18 (−4·92 to −3·42)−3·47 (−5·00 to −1·98)−3·75 (−4·66 to −2·84)
                                    Colombia9·52 (8·08 to 11·43)7·11 (4·90 to 9·75)5·22 (3·97 to 6·96)3·55 (2·46 to 4·91)15·81 (11·79 to 21·03)7·18 (6·08 to 8·63)11·88 (8·86 to 15·80)−2·96 (−4·06 to −1·89)−2·75 (−4·86 to −0·79)−2·83 (−4·05 to −1·67)
                                    Costa Rica5·83 (5·03 to 6·77)5·16 (3·79 to 7·12)2·95 (2·05 to 3·97)1·67 (1·09 to 2·40)9·75 (7·13 to 13·22)0·41 (0·35 to 0·48)0·68 (0·50 to 0·93)−2·58 (−4·51 to −0·51)−3·15 (−5·55 to −0·70)−2·92 (−4·28 to −1·63)
                                    El Salvador2·90 (2·40 to 3·55)5·14 (3·60 to 7·67)3·84 (2·54 to 5·24)2·33 (1·54 to 3·36)11·27 (7·99 to 15·71)0·31 (0·25 to 0·38)1·19 (0·85 to 1·66)−5·96 (−7·85 to −4·31)−6·33 (−8·71 to −4·01)−6·18 (−7·60 to −4·79)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Guatemala6·08 (4·52 to 8·04)8·96 (7·48 to 10·64)9·62 (7·23 to 12·89)7·62 (5·57 to 10·06)25·97 (21·21 to 31·77)2·68 (1·99 to 3·55)11·28 (9·22 to 13·79)−4·55 (−5·24 to −3·81)−4·54 (−5·88 to −3·30)−4·55 (−5·39 to −3·73)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Honduras8·40 (6·84 to 10·48)11·56 (9·61 to 13·58)6·02 (4·73 to 7·66)4·77 (3·54 to 6·21)22·20 (18·87 to 26·53)1·43 (1·16 to 1·79)3·76 (3·19 to 4·49)−4·08 (−4·73 to −3·39)−3·27 (−4·39 to −2·08)−3·60 (−4·28 to −2·90)
                                    Mexico4·35 (3·76 to 5·09)8·32 (5·93 to 11·22)4·51 (3·49 to 6·00)2·61 (1·81 to 3·55)15·37 (11·72 to 20·04)10·24 (8·86 to 11·99)36·12 (33·37 to 39·10)−4·69 (−6·16 to −3·24)−3·73 (−5·60 to −1·82)−4·11 (−5·24 to −3·02)
                                    Nicaragua5·34 (4·40 to 6·61)7·71 (5·92 to 9·68)5·09 (4·22 to 6·17)2·63 (1·87 to 3·62)15·36 (12·58 to 18·74)0·65 (0·54 to 0·81)1·87 (1·53 to 2·29)−5·67 (−6·44 to −5·00)−5·60 (−6·96 to −4·28)−5·63 (−6·44 to −4·82)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Panama5·12 (4·27 to 6·09)8·15 (5·63 to 11·06)4·78 (3·49 to 6·67)4·73 (3·39 to 6·32)17·55 (13·19 to 23·18)0·39 (0·32 to 0·46)1·32 (0·99 to 1·74)−1·76 (−3·32 to −0·08)−1·78 (−3·80 to 0·29)−1·77 (−3·05 to −0·54)
                                    Venezuela4·68 (3·85 to 5·79)9·06 (8·25 to 9·88)4·75 (4·17 to 5·30)3·15 (2·35 to 4·07)16·87 (15·77 to 18·09)2·82 (2·32 to 3·49)10·12 (9·46 to 10·85)−2·88 (−3·00 to −2·76)−1·49 (−1·95 to −1·03)−2·04 (−2·32 to −1·77)
                                    Andean Latin America6·64 (5·77 to 7·73)9·04 (7·85 to 10·31)5·98 (5·05 to 7·03)4·28 (3·54 to 5·19)19·19 (16·94 to 21·57)8·01 (6·96 to 9·34)23·00 (20·71 to 25·26)−6·11 (−6·45 to −5·76)−5·17 (−5·99 to −4·36)−5·55 (−6·05 to −5·07)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Bolivia10·61 (8·05 to 14·25)15·36 (12·80 to 17·99)8·81 (6·46 to 11·68)5·46 (3·81 to 7·60)29·37 (24·19 to 35·66)2·72 (2·06 to 3·66)7·42 (6·11 to 9·02)−4·88 (−5·43 to −4·37)−5·62 (−6·94 to −4·37)−5·32 (−6·11 to −4·56)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Ecuador6·06 (5·36 to 6·83)6·95 (5·68 to 8·28)6·44 (5·16 to 7·95)4·46 (3·30 to 5·84)17·75 (15·24 to 20·70)2·02 (1·78 to 2·27)5·86 (5·03 to 6·84)−3·62 (−4·41 to −2·90)−4·25 (−5·24 to −3·26)−4·00 (−4·68 to −3·35)
                                    Peru5·30 (4·39 to 6·36)7·57 (6·09 to 9·24)4·58 (3·79 to 5·51)3·71 (2·72 to 4·90)15·79 (13·50 to 18·77)3·28 (2·71 to 3·93)9·72 (8·30 to 11·55)−7·99 (−8·55 to −7·43)−5·29 (−6·38 to −4·17)−6·37 (−7·00 to −5·70)
                                    Geographies that achieved MDG4 based on a greater than 4·4% annualised rate of decline in under-5 mortality between 1990 and 2015. 95% UIs are provided in parentheses. MDG4=Millennium Development Goal 4. UIs=uncertainty intervals.
                                    Caribbean16·16 (11·60 to 23·36)15·21 (12·17 to 18·89)10·62 (7·35 to 14·83)6·36 (4·28 to 9·41)31·87 (23·96 to 42·23)12·84 (9·17 to 18·69)24·98 (20·34 to 30·68)−3·75 (−4·51 to −3·00)−2·65 (−4·58 to −0·76)−3·09 (−4·23 to −1·98)
                                    Antigua and Barbuda8·96 (6·41 to 12·78)7·34 (4·86 to 11·09)3·15 (2·15 to 4·32)2·43 (1·57 to 3·47)12·87 (8·84 to 18·41)0·01 (0·01 to 0·02)0·02 (0·01 to 0·03)−0·01 (−2·13 to 2·50)−2·54 (−4·97 to −0·27)−1·53 (−3·13 to 0·17)
                                    The Bahamas12·81 (9·72 to 17·15)11·67 (6·33 to 20·60)2·58 (1·57 to 4·87)2·02 (1·08 to 3·32)16·21 (9·06 to 28·81)0·08 (0·06 to 0·10)0·09 (0·05 to 0·17)−5·73 (−10·16 to −1·30)−0·83 (−5·30 to 3·18)−2·79 (−5·41 to −0·15)
                                    Barbados11·28 (7·45 to 17·35)11·04 (5·94 to 18·79)3·66 (2·17 to 6·52)1·58 (0·91 to 2·46)16·22 (9·12 to 27·31)0·04 (0·03 to 0·06)0·06 (0·03 to 0·09)−2·30 (−6·85 to 2·54)−1·71 (−6·40 to 2·77)−1·95 (−4·63 to 0·78)
                                    Belize11·33 (8·11 to 16·16)9·40 (5·50 to 15·24)4·08 (2·73 to 7·02)3·27 (2·06 to 4·91)16·67 (10·54 to 26·60)0·09 (0·07 to 0·13)0·14 (0·09 to 0·22)−4·10 (−6·87 to −1·39)−2·93 (−6·26 to 0·40)−3·40 (−5·38 to −1·51)
                                    Bermuda5·93 (4·49 to 7·77)2·61 (1·61 to 4·04)1·18 (0·83 to 1·63)0·54 (0·34 to 0·82)4·32 (2·84 to 6·43)<0·01 (<0·01 to 0·01)<0·01 (<0·01 to 0·01)−9·00 (−13·58 to −4·68)−0·33 (−3·78 to 3·67)−3·80 (−5·83 to −1·99)
                                    Cuba10·70 (8·23 to 14·18)3·22 (3·00 to 3·48)1·80 (1·60 to 1·99)1·08 (0·82 to 1·40)6·08 (5·77 to 6·46)1·24 (0·95 to 1·65)0·70 (0·67 to 0·75)−4·88 (−5·11 to −4·63)−2