Between 2000 and 2017*, all Exemplar countries achieved substantial declines in U5M, mostly led by reductions in neonatal disorders, lower respiratory infections, diarrheal diseases, and malaria, with variation across countries.
Reductions in under-five mortality (in absolute number of deaths) ranged from 69 percent in Bangladesh to 49 percent in Senegal over the same time period, representing impressive progress relative to other countries that experienced similar economic growth during these years.2
Much of the decline in U5M is due to the interventions and strategies that countries used – either by directly addressing amenable mortality or more broadly reducing the burden of disease and improving the resiliency of children and families.
Further analysis from the University of Washington’s Institute for Health Metrics and Evaluation indicates that nearly two-thirds (an estimated 61 percent) of the U5M reduction in Bangladesh was related to changes in either interventions delivered through the health system, such as vaccines or medications, or risk factors that may be addressed through health initiatives, such as suboptimal breastfeeding or vitamin A deficiency. The remaining third was found to be related to changes in population, infrastructure, and environmental risk factors .1
Just as the Exemplar countries varied in the extent of their overall U5M reductions, the proportion of reductions attributable to health interventions also varied. For example, of the 54 percent decline in U5M in Peru, 62 percent was estimated to be due to health systems or health-related changes. In Senegal, on the other hand, the number of under-five deaths declined by 49 percent, of which only 48 percent was related to these factors .1 The table below shows these data points for each country.
| Country | Percent Decline in U5M (number of deaths) | Percent of Decline Attributable to Health Systems Interventions** | Percent of Decline Attributable to Program-related Risk Factors*** |
|---|---|---|---|
|
Bangladesh |
69% |
42% | 24% |
|
Ethiopia |
54% |
51% | 34% |
| Nepal |
68% |
33% | 22% |
| Peru |
53% |
53% | 33% |
| Rwanda |
68% |
51% | 38% |
| Senegal |
49% |
58% | 24% |
** Estimated percentage of U5M decline that was attributable to changes in interventions delivered through health systems or risk factors affected by health programs. These estimates are based on trends in causes of death; trends in risk factors; estimates of population-attributable fractions from scientific literature; and demographic methods known as decomposition analyses.1
*** Program-related risk factors include changes in child growth failure, low birth weight, sub-optimal breastfeeding, and vitamin A and zinc deficiency.1
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1
GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet 390.10100 (2017): 1345-1422.
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2
Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease Study (GBD 2017). Seattle, WA: IHME; 2018. http://www.healthdata.org/gbd.