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National and subnational burden of under-5, infant, and neonatal mortality in Ethiopia, 1990–2019: Findings from the Global Burden of Disease Study 2019

The under-5 mortality rate is a commonly used indicator of population health and socioeconomic status worldwide. However, as in most low- and middle-income countries settings, deaths among children under-5 and in any age group in Ethiopia remain underreported and fragmented. We aimed to systematical...

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Autores principales: Tessema, Gizachew A., Berheto, Tezera Moshago, Pereira, Gavin, Misganaw, Awoke, Kinfu, Yohannes
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10284418/
https://www.ncbi.nlm.nih.gov/pubmed/37343009
http://dx.doi.org/10.1371/journal.pgph.0001471
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author Tessema, Gizachew A.
Berheto, Tezera Moshago
Pereira, Gavin
Misganaw, Awoke
Kinfu, Yohannes
author_facet Tessema, Gizachew A.
Berheto, Tezera Moshago
Pereira, Gavin
Misganaw, Awoke
Kinfu, Yohannes
author_sort Tessema, Gizachew A.
collection PubMed
description The under-5 mortality rate is a commonly used indicator of population health and socioeconomic status worldwide. However, as in most low- and middle-income countries settings, deaths among children under-5 and in any age group in Ethiopia remain underreported and fragmented. We aimed to systematically estimate neonatal, infant, and under-5 mortality trends, identify underlying causes, and make subnational (regional and chartered cities) comparisons between 1990 and 2019. We used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2019) to estimate three key under-5 mortality indicators—the probability of death between the date of birth and 28 days (neonatal mortality rate, NMR), the date of birth and 1 year (infant mortality rate, IMR), and the date of birth and 5 years (under-5 mortality rate, U5MR). The causes of death by age groups, sex, and year were estimated using Cause of Death Ensemble modelling (CODEm). Specifically, this involved a multi-stage process that includes a non-linear mixed-effects model, source bias correction, spatiotemporal smoothing, and a Gaussian process regression to synthesise mortality estimates by age, sex, location, and year. In 2019, an estimated 190,173 (95% uncertainty interval 149,789–242,575) under-5 deaths occurred in Ethiopia. Nearly three-quarters (74%) of under-5 deaths in 2019 were within the first year of life, and over half (52%) in the first 28 days. The overall U5MR, IMR, and NMR in the country were estimated to be 52.4 (44.7–62.4), 41.5 (35.2–50.0), and 26.6 (22.6–31.5) deaths per 1000 livebirths, respectively, with substantial variations between administrative regions. Over three-quarters of under-5 deaths in 2019 were due to five leading causes, namely neonatal disorders (40.7%), diarrhoeal diseases (13.2%), lower respiratory infections (10.3%), congenital birth defects (7.0%), and malaria (6.0%). During the same period, neonatal disorders alone accounted for about 76.4% (70.2–79.6) of neonatal and 54.7% (51.9–57.2) of infant deaths in Ethiopia. While all regional states in Ethiopia have experienced a decline in under-5, infant, and neonatal mortality rates in the past three decades, the rate of change was not large enough to meet the targets of the Sustainable Development Goals (SDGs). Inter-regional disparities in under 5 mortality also remain significant, with the biggest differences being in the neonatal period. A concerted effort is required to improve neonatal survival and lessen regional disparity, which may require strengthening essential obstetric and neonatal care services, among others. Our study also highlights the urgent need for primary studies to improve the accuracy of regional estimates in Ethiopia, particularly in pastoralist regions.
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spelling pubmed-102844182023-06-22 National and subnational burden of under-5, infant, and neonatal mortality in Ethiopia, 1990–2019: Findings from the Global Burden of Disease Study 2019 Tessema, Gizachew A. Berheto, Tezera Moshago Pereira, Gavin Misganaw, Awoke Kinfu, Yohannes PLOS Glob Public Health Research Article The under-5 mortality rate is a commonly used indicator of population health and socioeconomic status worldwide. However, as in most low- and middle-income countries settings, deaths among children under-5 and in any age group in Ethiopia remain underreported and fragmented. We aimed to systematically estimate neonatal, infant, and under-5 mortality trends, identify underlying causes, and make subnational (regional and chartered cities) comparisons between 1990 and 2019. We used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2019) to estimate three key under-5 mortality indicators—the probability of death between the date of birth and 28 days (neonatal mortality rate, NMR), the date of birth and 1 year (infant mortality rate, IMR), and the date of birth and 5 years (under-5 mortality rate, U5MR). The causes of death by age groups, sex, and year were estimated using Cause of Death Ensemble modelling (CODEm). Specifically, this involved a multi-stage process that includes a non-linear mixed-effects model, source bias correction, spatiotemporal smoothing, and a Gaussian process regression to synthesise mortality estimates by age, sex, location, and year. In 2019, an estimated 190,173 (95% uncertainty interval 149,789–242,575) under-5 deaths occurred in Ethiopia. Nearly three-quarters (74%) of under-5 deaths in 2019 were within the first year of life, and over half (52%) in the first 28 days. The overall U5MR, IMR, and NMR in the country were estimated to be 52.4 (44.7–62.4), 41.5 (35.2–50.0), and 26.6 (22.6–31.5) deaths per 1000 livebirths, respectively, with substantial variations between administrative regions. Over three-quarters of under-5 deaths in 2019 were due to five leading causes, namely neonatal disorders (40.7%), diarrhoeal diseases (13.2%), lower respiratory infections (10.3%), congenital birth defects (7.0%), and malaria (6.0%). During the same period, neonatal disorders alone accounted for about 76.4% (70.2–79.6) of neonatal and 54.7% (51.9–57.2) of infant deaths in Ethiopia. While all regional states in Ethiopia have experienced a decline in under-5, infant, and neonatal mortality rates in the past three decades, the rate of change was not large enough to meet the targets of the Sustainable Development Goals (SDGs). Inter-regional disparities in under 5 mortality also remain significant, with the biggest differences being in the neonatal period. A concerted effort is required to improve neonatal survival and lessen regional disparity, which may require strengthening essential obstetric and neonatal care services, among others. Our study also highlights the urgent need for primary studies to improve the accuracy of regional estimates in Ethiopia, particularly in pastoralist regions. Public Library of Science 2023-06-21 /pmc/articles/PMC10284418/ /pubmed/37343009 http://dx.doi.org/10.1371/journal.pgph.0001471 Text en © 2023 Tessema et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Tessema, Gizachew A.
Berheto, Tezera Moshago
Pereira, Gavin
Misganaw, Awoke
Kinfu, Yohannes
National and subnational burden of under-5, infant, and neonatal mortality in Ethiopia, 1990–2019: Findings from the Global Burden of Disease Study 2019
title National and subnational burden of under-5, infant, and neonatal mortality in Ethiopia, 1990–2019: Findings from the Global Burden of Disease Study 2019
title_full National and subnational burden of under-5, infant, and neonatal mortality in Ethiopia, 1990–2019: Findings from the Global Burden of Disease Study 2019
title_fullStr National and subnational burden of under-5, infant, and neonatal mortality in Ethiopia, 1990–2019: Findings from the Global Burden of Disease Study 2019
title_full_unstemmed National and subnational burden of under-5, infant, and neonatal mortality in Ethiopia, 1990–2019: Findings from the Global Burden of Disease Study 2019
title_short National and subnational burden of under-5, infant, and neonatal mortality in Ethiopia, 1990–2019: Findings from the Global Burden of Disease Study 2019
title_sort national and subnational burden of under-5, infant, and neonatal mortality in ethiopia, 1990–2019: findings from the global burden of disease study 2019
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10284418/
https://www.ncbi.nlm.nih.gov/pubmed/37343009
http://dx.doi.org/10.1371/journal.pgph.0001471
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