Measuring Iran's success in achieving Millennium Development Goal 4: a systematic analysis of under-5 mortality at national and subnational levels from 1990 to 2015
Summary: Background: Child mortality as one of the key Millennium Development Goals (MDG 4—to reduce child mortality by two-thirds from 1990 to 2015), is included in the Sustainable Development Goals (SDG 3, target 2—to reduce child mortality to fewer than 25 deaths per 1000 livebirths for all coun...
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2017-05-01
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Series: | The Lancet Global Health |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X17301055 |
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English |
format |
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author |
Younes Mohammadi, PhD Mahboubeh Parsaeian, PhD Parinaz Mehdipour, MSc Ardeshir Khosravi Bagher Larijani, ProfMD Ali Sheidaei Anita Mansouri, MSc Amir Kasaeian, PhD Kamran Yazdani, MD Maziar Moradi-Lakeh, MD Elaheh Kazemi Saeide Aghamohamadi Nazila Rezaei, MD Maryam Chegini, MPH Rosa Haghshenas, BSc Hamidreza Jamshidi, PhD Farnaz Delavari Mohsen Asadi-Lari, ProfMD Farshad Farzadfar, DrMD |
spellingShingle |
Younes Mohammadi, PhD Mahboubeh Parsaeian, PhD Parinaz Mehdipour, MSc Ardeshir Khosravi Bagher Larijani, ProfMD Ali Sheidaei Anita Mansouri, MSc Amir Kasaeian, PhD Kamran Yazdani, MD Maziar Moradi-Lakeh, MD Elaheh Kazemi Saeide Aghamohamadi Nazila Rezaei, MD Maryam Chegini, MPH Rosa Haghshenas, BSc Hamidreza Jamshidi, PhD Farnaz Delavari Mohsen Asadi-Lari, ProfMD Farshad Farzadfar, DrMD Measuring Iran's success in achieving Millennium Development Goal 4: a systematic analysis of under-5 mortality at national and subnational levels from 1990 to 2015 The Lancet Global Health |
author_facet |
Younes Mohammadi, PhD Mahboubeh Parsaeian, PhD Parinaz Mehdipour, MSc Ardeshir Khosravi Bagher Larijani, ProfMD Ali Sheidaei Anita Mansouri, MSc Amir Kasaeian, PhD Kamran Yazdani, MD Maziar Moradi-Lakeh, MD Elaheh Kazemi Saeide Aghamohamadi Nazila Rezaei, MD Maryam Chegini, MPH Rosa Haghshenas, BSc Hamidreza Jamshidi, PhD Farnaz Delavari Mohsen Asadi-Lari, ProfMD Farshad Farzadfar, DrMD |
author_sort |
Younes Mohammadi, PhD |
title |
Measuring Iran's success in achieving Millennium Development Goal 4: a systematic analysis of under-5 mortality at national and subnational levels from 1990 to 2015 |
title_short |
Measuring Iran's success in achieving Millennium Development Goal 4: a systematic analysis of under-5 mortality at national and subnational levels from 1990 to 2015 |
title_full |
Measuring Iran's success in achieving Millennium Development Goal 4: a systematic analysis of under-5 mortality at national and subnational levels from 1990 to 2015 |
title_fullStr |
Measuring Iran's success in achieving Millennium Development Goal 4: a systematic analysis of under-5 mortality at national and subnational levels from 1990 to 2015 |
title_full_unstemmed |
Measuring Iran's success in achieving Millennium Development Goal 4: a systematic analysis of under-5 mortality at national and subnational levels from 1990 to 2015 |
title_sort |
measuring iran's success in achieving millennium development goal 4: a systematic analysis of under-5 mortality at national and subnational levels from 1990 to 2015 |
publisher |
Elsevier |
series |
The Lancet Global Health |
issn |
2214-109X |
publishDate |
2017-05-01 |
description |
Summary: Background: Child mortality as one of the key Millennium Development Goals (MDG 4—to reduce child mortality by two-thirds from 1990 to 2015), is included in the Sustainable Development Goals (SDG 3, target 2—to reduce child mortality to fewer than 25 deaths per 1000 livebirths for all countries by 2030), and is a key indicator of the health system in every country. In this study, we aimed to estimate the level and trend of child mortality from 1990 to 2015 in Iran, to assess the progress of the country and its provinces toward these goals. Methods: We used three different data sources: three censuses, a Demographic and Health Survey (DHS), and 5-year data from the death registration system. We used the summary birth history data from four data sources (the three censuses and DHS) and used maternal age cohort and maternal age period methods to estimate the trends in child mortality rates, combining the estimates of these two indirect methods using Loess regression. We also used the complete birth history method to estimate child mortality rate directly from DHS data. Finally, to synthesise different trends into a single trend and calculate uncertainty intervals (UI), we used Gaussian process regression. Findings: Under-5 mortality rates (deaths per 1000 livebirths) at the national level in Iran in 1990, 2000, 2010, and 2015 were 63·6 (95% UI 63·1–64·0), 38·8 (38·5–39·2), 24·9 (24·3–25·4), and 19·4 (18·6–20·2), respectively. Between 1990 and 2015, the median annual reduction and total overall reduction in these rates were 4·9% and 70%, respectively. At the provincial level, the difference between the highest and lowest child mortality rates in 1990, 2000, and 2015 were 65·6, 40·4, and 38·1 per 1000 livebirths, respectively. Based on the MDG 4 goal, five provinces had not decreased child mortality by two-thirds by 2015. Furthermore, six provinces had not reached SDG 3 (target 2). Interpretation: Iran and most of its provinces achieved MDG 4 and SDG 3 (target 2) goals by 2015. However, at the subnational level in some provinces, there is substantial inequity. Local policy makers should use effective strategies to accelerate the reduction of child mortality for these provinces by 2030. Possible recommendations for such strategies include enhancing the level of education and health literacy among women, tackling sex discrimination, and improving incomes for families. Funding: Iran Ministry of Health and Education. |
url |
http://www.sciencedirect.com/science/article/pii/S2214109X17301055 |
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doaj-459f0bc87f284cdba18bf126a32a1b212020-11-25T02:46:38ZengElsevierThe Lancet Global Health2214-109X2017-05-0155e537e544Measuring Iran's success in achieving Millennium Development Goal 4: a systematic analysis of under-5 mortality at national and subnational levels from 1990 to 2015Younes Mohammadi, PhD0Mahboubeh Parsaeian, PhD1Parinaz Mehdipour, MSc2Ardeshir Khosravi3Bagher Larijani, ProfMD4Ali Sheidaei5Anita Mansouri, MSc6Amir Kasaeian, PhD7Kamran Yazdani, MD8Maziar Moradi-Lakeh, MD9Elaheh Kazemi10Saeide Aghamohamadi11Nazila Rezaei, MD12Maryam Chegini, MPH13Rosa Haghshenas, BSc14Hamidreza Jamshidi, PhD15Farnaz Delavari16Mohsen Asadi-Lari, ProfMD17Farshad Farzadfar, DrMD18Modelling of Noncommunicable Diseases Research Center, Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, IranDepartment of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, IranNon-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, IranDeputy for Public Health, Ministry of Health and Medical Education, Tehran, IranEndocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, IranDepartment of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranNon-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, IranHematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, IranDepartment of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IranPreventive Medicine and Public Health Research Center, Department of Community Medicine, Iran University of Medical Sciences, Tehran, IranDeputy for Public Health, Ministry of Health and Medical Education, Tehran, IranDeputy for Public Health, Ministry of Health and Medical Education, Tehran, IranNon-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, IranNon-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, IranNon-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, IranDepartment of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IranNon-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, IranDepartment of Epidemiology, School of Public Health, and Oncopathology Research Center, Iran University of Medical Sciences, Tehran, IranNon-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Correspondence to: Dr Farshad Farzadfar, Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran 1599666615, IranSummary: Background: Child mortality as one of the key Millennium Development Goals (MDG 4—to reduce child mortality by two-thirds from 1990 to 2015), is included in the Sustainable Development Goals (SDG 3, target 2—to reduce child mortality to fewer than 25 deaths per 1000 livebirths for all countries by 2030), and is a key indicator of the health system in every country. In this study, we aimed to estimate the level and trend of child mortality from 1990 to 2015 in Iran, to assess the progress of the country and its provinces toward these goals. Methods: We used three different data sources: three censuses, a Demographic and Health Survey (DHS), and 5-year data from the death registration system. We used the summary birth history data from four data sources (the three censuses and DHS) and used maternal age cohort and maternal age period methods to estimate the trends in child mortality rates, combining the estimates of these two indirect methods using Loess regression. We also used the complete birth history method to estimate child mortality rate directly from DHS data. Finally, to synthesise different trends into a single trend and calculate uncertainty intervals (UI), we used Gaussian process regression. Findings: Under-5 mortality rates (deaths per 1000 livebirths) at the national level in Iran in 1990, 2000, 2010, and 2015 were 63·6 (95% UI 63·1–64·0), 38·8 (38·5–39·2), 24·9 (24·3–25·4), and 19·4 (18·6–20·2), respectively. Between 1990 and 2015, the median annual reduction and total overall reduction in these rates were 4·9% and 70%, respectively. At the provincial level, the difference between the highest and lowest child mortality rates in 1990, 2000, and 2015 were 65·6, 40·4, and 38·1 per 1000 livebirths, respectively. Based on the MDG 4 goal, five provinces had not decreased child mortality by two-thirds by 2015. Furthermore, six provinces had not reached SDG 3 (target 2). Interpretation: Iran and most of its provinces achieved MDG 4 and SDG 3 (target 2) goals by 2015. However, at the subnational level in some provinces, there is substantial inequity. Local policy makers should use effective strategies to accelerate the reduction of child mortality for these provinces by 2030. Possible recommendations for such strategies include enhancing the level of education and health literacy among women, tackling sex discrimination, and improving incomes for families. Funding: Iran Ministry of Health and Education.http://www.sciencedirect.com/science/article/pii/S2214109X17301055 |