title: Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals.
abstract: Despite remarkable progress in the improvement of child survival between 1990 and 2015, the Millennium Development Goal (MDG) 4 target of a two-thirds reduction of under-5 mortality rate (U5MR) was not achieved globally. In this paper, we updated our annual estimates of child mortality by cause to 2000-15 to reflect on progress toward the MDG 4 and consider implications for the Sustainable Development Goals (SDG) target for child survival.
  
  
  
  We increased the estimation input data for causes of deaths by 43% among neonates and 23% among 1-59-month-olds, respectively. We used adequate vital registration (VR) data where available, and modelled cause-specific mortality fractions applying multinomial logistic regressions using adequate VR for low U5MR countries and verbal autopsy data for high U5MR countries. We updated the estimation to use Plasmodium falciparum parasite rate in place of malaria index in the modelling of malaria deaths; to use adjusted empirical estimates instead of modelled estimates for China; and to consider the effects of pneumococcal conjugate vaccine and rotavirus vaccine in the estimation.
  
  
  
  In 2015, among the 5·9 million under-5 deaths, 2·7 million occurred in the neonatal period. The leading under-5 causes were preterm birth complications (1·055 million [95% uncertainty range (UR) 0·935-1·179]), pneumonia (0·921 million [0·812 -1·117]), and intrapartum-related events (0·691 million [0·598 -0·778]). In the two MDG regions with the most under-5 deaths, the leading cause was pneumonia in sub-Saharan Africa and preterm birth complications in southern Asia. Reductions in mortality rates for pneumonia, diarrhoea, neonatal intrapartum-related events, malaria, and measles were responsible for 61% of the total reduction of 35 per 1000 livebirths in U5MR in 2000-15. Stratified by U5MR, pneumonia was the leading cause in countries with very high U5MR. Preterm birth complications and pneumonia were both important in high, medium high, and medium child mortality countries; whereas congenital abnormalities was the most important cause in countries with low and very low U5MR.
  
  
  
  In the SDG era, countries are advised to prioritise child survival policy and programmes based on their child cause-of-death composition. Continued and enhanced efforts to scale up proven life-saving interventions are needed to achieve the SDG child survival target.
  
  
  
  Bill & Melinda Gates Foundation, WHO.
authors.affiliation: Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; The Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: lliu26@jhu.edu.
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Shefali
authors.initials: S
authors.lastname: Oza
authors.affiliation: Department of Health Statistics and Informatics, World Health Organization, Geneva, Switzerland.
authors.forename: Dan
authors.initials: D
authors.lastname: Hogan
authors.affiliation: The Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Yue
authors.initials: Y
authors.lastname: Chu
authors.affiliation: The Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Perin
authors.affiliation: National Office of Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhu
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Joy E
authors.initials: JE
authors.lastname: Lawn
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Cousens
authors.affiliation: Department of Health Statistics and Informatics, World Health Organization, Geneva, Switzerland.
authors.forename: Colin
authors.initials: C
authors.lastname: Mathers
authors.affiliation: The Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
mesh_terms: D000349:Africa; D001208:Asia; D002423:Cause of Death / Q000639:trends*; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D003141:Communicable Diseases / Q000401:mortality; D003967:Diarrhea / Q000401:mortality; D014943:Global Health; D006040:Goals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000401:mortality; D010963:Plasmodium falciparum / Q000302:isolation & purification; D011014:Pneumonia / Q000401:mortality