title: Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities.
abstract: BACKGROUND
  Historically, the main focus of studies of childhood mortality has been the infant and under-five mortality rates. Neonatal mortality (deaths <28 days of age) has received limited attention, although such deaths account for about 41% of all child deaths. To better assess progress, we developed annual estimates for neonatal mortality rates (NMRs) and neonatal deaths for 193 countries for the period 1990-2009 with forecasts into the future.
  
  
  RESULTS
  We compiled a database of mortality in neonates and children (<5 years) comprising 3,551 country-years of information. Reliable civil registration data from 1990 to 2009 were available for 38 countries. A statistical model was developed to estimate NMRs for the remaining 155 countries, 17 of which had no national data. Country consultation was undertaken to identify data inputs and review estimates. In 2009, an estimated 3.3 million babies died in the first month of life-compared with 4.6 million neonatal deaths in 1990-and more than half of all neonatal deaths occurred in five countries of the world (44% of global livebirths): India 27.8% (19.6% of global livebirths), Nigeria 7.2% (4.5%), Pakistan 6.9% (4.0%), China 6.4% (13.4%), and Democratic Republic of the Congo 4.6% (2.1%). Between 1990 and 2009, the global NMR declined by 28% from 33.2 deaths per 1,000 livebirths to 23.9. The proportion of child deaths that are in the neonatal period increased in all regions of the world, and globally is now 41%. While NMRs were halved in some regions of the world, Africa's NMR only dropped 17.6% (43.6 to 35.9).
  
  
  CONCLUSIONS
  Neonatal mortality has declined in all world regions. Progress has been slowest in the regions with high NMRs. Global health programs need to address neonatal deaths more effectively if Millennium Development Goal 4 (two-thirds reduction in child mortality) is to be achieved.
authors.affiliation: World Health Organization, Department of Health Statistics and Informatics, Geneva, Switzerland. oestergaardm@who.int
authors.forename: Mikkel Zahle
authors.initials: MZ
authors.lastname: Oestergaard
authors.forename: Mie
authors.initials: M
authors.lastname: Inoue
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Yoshida
authors.forename: Wahyu Retno
authors.initials: WR
authors.lastname: Mahanani
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Gore
authors.forename: Simon
authors.initials: S
authors.lastname: Cousens
authors.forename: Joy E
authors.initials: JE
authors.lastname: Lawn
authors.forename: Colin Douglas
authors.initials: CD
authors.lastname: Mathers
mesh_terms: D002423:Cause of Death; D005843:Geography; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D007226:Infant Mortality / Q000208:ethnology / Q000639:trends*; D007231:Infant, Newborn; D007391:International Cooperation; D015233:Models, Statistical