Younes Mohammadi1, Mahboubeh Parsaeian2, Parinaz Mehdipour3, Ardeshir Khosravi4, Bagher Larijani5, Ali Sheidaei6, Anita Mansouri3, Amir Kasaeian7, Kamran Yazdani8, Maziar Moradi-Lakeh9, Elaheh Kazemi4, Saeide Aghamohamadi4, Nazila Rezaei3, Maryam Chegini3, Rosa Haghshenas3, Hamidreza Jamshidi10, Farnaz Delavari3, Mohsen Asadi-Lari11, Farshad Farzadfar12. 1. Modelling of Noncommunicable Diseases Research Center, Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran. 2. Department 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, Iran. 3. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 4. Deputy for Public Health, Ministry of Health and Medical Education, Tehran, Iran. 5. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 6. Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 7. Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran. 8. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 9. Preventive Medicine and Public Health Research Center, Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran. 10. Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 11. Department of Epidemiology, School of Public Health, and Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran. 12. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: f-farzadfar@tums.ac.ir.
Abstract
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.
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.
Authors: Mehdi Varmaghani; Malihe Ghobadi; Farshad Sharifi; Payam Roshanfekr; Ali Sheidaei; Masoume Mansouri; Amin Adel; Mohammad Mohammadi; Mohammad Reza Masjedi Journal: Int J Prev Med Date: 2021-02-24
Authors: Sheikh Jamal Hossain; Mt Jannatul Ferdousi; Md Abu Bakkar Siddique; S M Mulk Uddin Tipu; Mohammad Abdul Qayyum; Mohammad Shawkatuzzaman Laskar Journal: J Family Med Prim Care Date: 2019-03
Authors: Roy Burstein; Nathaniel J Henry; Michael L Collison; Laurie B Marczak; Amber Sligar; Stefanie Watson; Neal Marquez; Mahdieh Abbasalizad-Farhangi; Masoumeh Abbasi; Foad Abd-Allah; Amir Abdoli; Mohammad Abdollahi; Ibrahim Abdollahpour; Rizwan Suliankatchi Abdulkader; Michael R M Abrigo; Dilaram Acharya; Oladimeji M Adebayo; Victor Adekanmbi; Davoud Adham; Mahdi Afshari; Mohammad Aghaali; Keivan Ahmadi; Mehdi Ahmadi; Ehsan Ahmadpour; Rushdia Ahmed; Chalachew Genet Akal; Joshua O Akinyemi; Fares Alahdab; Noore Alam; Genet Melak Alamene; Kefyalew Addis Alene; Mehran Alijanzadeh; Cyrus Alinia; Vahid Alipour; Syed Mohamed Aljunid; Mohammed J Almalki; Hesham M Al-Mekhlafi; Khalid Altirkawi; Nelson Alvis-Guzman; Adeladza Kofi Amegah; Saeed Amini; Arianna Maever Loreche Amit; Zohreh Anbari; Sofia Androudi; Mina Anjomshoa; Fereshteh Ansari; Carl Abelardo T Antonio; Jalal Arabloo; Zohreh Arefi; Olatunde Aremu; Bahram Armoon; Amit Arora; Al Artaman; Anvar Asadi; Mehran Asadi-Aliabadi; Amir Ashraf-Ganjouei; Reza Assadi; Bahar Ataeinia; Sachin R Atre; Beatriz Paulina Ayala Quintanilla; Martin Amogre Ayanore; Samad Azari; Ebrahim Babaee; Arefeh Babazadeh; Alaa Badawi; Soghra Bagheri; Mojtaba Bagherzadeh; Nafiseh Baheiraei; Abbas Balouchi; Aleksandra Barac; Quique Bassat; Bernhard T Baune; Mohsen Bayati; Neeraj Bedi; Ettore Beghi; Masoud Behzadifar; Meysam Behzadifar; Yared Belete Belay; Brent Bell; Michelle L Bell; Dessalegn Ajema Berbada; Robert S Bernstein; Natalia V Bhattacharjee; Suraj Bhattarai; Zulfiqar A Bhutta; Ali Bijani; Somayeh Bohlouli; Nicholas J K Breitborde; Gabrielle Britton; Annie J Browne; Sharath Burugina Nagaraja; Reinhard Busse; Zahid A Butt; Josip Car; Rosario Cárdenas; Carlos A Castañeda-Orjuela; Ester Cerin; Wagaye Fentahun Chanie; Pranab Chatterjee; Dinh-Toi Chu; Cyrus Cooper; Vera M Costa; Koustuv Dalal; Lalit Dandona; Rakhi Dandona; Farah Daoud; Ahmad Daryani; Rajat Das Gupta; Ian Davis; Nicole Davis Weaver; Dragos Virgil Davitoiu; Jan-Walter De Neve; Feleke Mekonnen Demeke; Gebre Teklemariam Demoz; Kebede Deribe; Rupak Desai; Aniruddha Deshpande; Hanna Demelash Desyibelew; Sagnik Dey; Samath Dhamminda Dharmaratne; Meghnath Dhimal; Daniel Diaz; Leila Doshmangir; Andre R Duraes; Laura Dwyer-Lindgren; Lucas Earl; Roya Ebrahimi; Soheil Ebrahimpour; Andem Effiong; Aziz Eftekhari; Elham Ehsani-Chimeh; Iman El Sayed; Maysaa El Sayed Zaki; Maha El Tantawi; Ziad El-Khatib; Mohammad Hassan Emamian; Shymaa Enany; Sharareh Eskandarieh; Oghenowede Eyawo; Maha Ezalarab; Mahbobeh Faramarzi; Mohammad Fareed; Roghiyeh Faridnia; Andre Faro; Ali Akbar Fazaeli; Mehdi Fazlzadeh; Netsanet Fentahun; Seyed-Mohammad Fereshtehnejad; João C Fernandes; Irina Filip; Florian Fischer; Nataliya A Foigt; Masoud Foroutan; Joel Msafiri Francis; Takeshi Fukumoto; Nancy Fullman; Silvano Gallus; Destallem Gebremedhin Gebre; Tsegaye Tewelde Gebrehiwot; Gebreamlak Gebremedhn Gebremeskel; Bradford D Gessner; Birhanu Geta; Peter W Gething; Reza Ghadimi; Keyghobad Ghadiri; Mahsa Ghajarzadeh; Ahmad Ghashghaee; Paramjit Singh Gill; Tiffany K Gill; Nick Golding; Nelson G M Gomes; Philimon N Gona; Sameer Vali Gopalani; Giuseppe Gorini; Bárbara Niegia Garcia Goulart; Nicholas Graetz; Felix Greaves; Manfred S Green; Yuming Guo; Arvin Haj-Mirzaian; Arya Haj-Mirzaian; Brian James Hall; Samer Hamidi; Hamidreza Haririan; Josep Maria Haro; Milad Hasankhani; Edris Hasanpoor; Amir Hasanzadeh; Hadi Hassankhani; Hamid Yimam Hassen; Mohamed I Hegazy; Delia Hendrie; Fatemeh Heydarpour; Thomas R Hird; Chi Linh Hoang; Gillian Hollerich; Enayatollah Homaie Rad; Mojtaba Hoseini-Ghahfarokhi; Naznin Hossain; Mostafa Hosseini; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Mowafa Househ; Mohamed Hsairi; Olayinka Stephen Ilesanmi; Mohammad Hasan Imani-Nasab; Usman Iqbal; Seyed Sina Naghibi Irvani; Nazrul Islam; Sheikh Mohammed Shariful Islam; Mikk Jürisson; Nader Jafari Balalami; Amir Jalali; Javad Javidnia; Achala Upendra Jayatilleke; Ensiyeh Jenabi; John S Ji; Yash B Jobanputra; Kimberly Johnson; Jost B Jonas; Zahra Jorjoran Shushtari; Jacek Jerzy Jozwiak; Ali Kabir; Amaha Kahsay; Hamed Kalani; Rohollah Kalhor; Manoochehr Karami; Surendra Karki; Amir Kasaeian; Nicholas J Kassebaum; Peter Njenga Keiyoro; Grant Rodgers Kemp; Roghayeh Khabiri; Yousef Saleh Khader; Morteza Abdullatif Khafaie; Ejaz Ahmad Khan; Junaid Khan; Muhammad Shahzeb Khan; Young-Ho Khang; Khaled Khatab; Amir Khater; Mona M Khater; Alireza Khatony; Mohammad Khazaei; Salman Khazaei; Maryam Khazaei-Pool; Jagdish Khubchandani; Neda Kianipour; Yun Jin Kim; Ruth W Kimokoti; Damaris K Kinyoki; Adnan Kisa; Sezer Kisa; Tufa Kolola; Soewarta Kosen; Parvaiz A Koul; Ai Koyanagi; Moritz U G Kraemer; Kewal Krishan; Kris J Krohn; Nuworza Kugbey; G Anil Kumar; Manasi Kumar; Pushpendra Kumar; Desmond Kuupiel; Ben Lacey; Sheetal D Lad; Faris Hasan Lami; Anders O Larsson; Paul H Lee; Mostafa Leili; Aubrey J Levine; Shanshan Li; Lee-Ling Lim; Stefan Listl; Joshua Longbottom; Jaifred Christian F Lopez; Stefan Lorkowski; Sameh Magdeldin; Hassan Magdy Abd El Razek; Muhammed Magdy Abd El Razek; Azeem Majeed; Afshin Maleki; Reza Malekzadeh; Deborah Carvalho Malta; Abdullah A Mamun; Navid Manafi; Ana-Laura Manda; Morteza Mansourian; Francisco Rogerlândio Martins-Melo; Anthony Masaka; Benjamin Ballard Massenburg; Pallab K Maulik; Benjamin K Mayala; Mohsen Mazidi; Martin McKee; Ravi Mehrotra; Kala M Mehta; Gebrekiros Gebremichael Meles; Walter Mendoza; Ritesh G Menezes; Atte Meretoja; Tuomo J Meretoja; Tomislav Mestrovic; Ted R Miller; Molly K Miller-Petrie; Edward J Mills; George J Milne; G K Mini; Seyed Mostafa Mir; Hamed Mirjalali; Erkin M Mirrakhimov; Efat Mohamadi; Dara K Mohammad; Aso Mohammad Darwesh; Naser Mohammad Gholi Mezerji; Ammas Siraj Mohammed; Shafiu Mohammed; Ali H Mokdad; Mariam Molokhia; Lorenzo Monasta; Yoshan Moodley; Mahmood Moosazadeh; Ghobad Moradi; Masoud Moradi; Yousef Moradi; Maziar Moradi-Lakeh; Mehdi Moradinazar; Paula Moraga; Lidia Morawska; Abbas Mosapour; Seyyed Meysam Mousavi; Ulrich Otto Mueller; Atalay Goshu Muluneh; Ghulam Mustafa; Behnam Nabavizadeh; Mehdi Naderi; Ahamarshan Jayaraman Nagarajan; Azin Nahvijou; Farid Najafi; Vinay Nangia; Duduzile Edith Ndwandwe; Nahid Neamati; Ionut Negoi; Ruxandra Irina Negoi; Josephine W Ngunjiri; Huong Lan Thi Nguyen; Long Hoang Nguyen; Son Hoang Nguyen; Katie R Nielsen; Dina Nur Anggraini Ningrum; Yirga Legesse Nirayo; Molly R Nixon; Chukwudi A Nnaji; Marzieh Nojomi; Mehdi Noroozi; Shirin Nosratnejad; Jean Jacques Noubiap; Soraya Nouraei Motlagh; Richard Ofori-Asenso; Felix Akpojene Ogbo; Kelechi E Oladimeji; Andrew T Olagunju; Meysam Olfatifar; Solomon Olum; Bolajoko Olubukunola Olusanya; Mojisola Morenike Oluwasanu; Obinna E Onwujekwe; Eyal Oren; Doris D V Ortega-Altamirano; Alberto Ortiz; Osayomwanbo Osarenotor; Frank B Osei; Aaron E Osgood-Zimmerman; Stanislav S Otstavnov; Mayowa Ojo Owolabi; Mahesh P A; Abdol Sattar Pagheh; Smita Pakhale; Songhomitra Panda-Jonas; Animika Pandey; Eun-Kee Park; Hadi Parsian; Tahereh Pashaei; Sangram Kishor Patel; Veincent Christian Filipino Pepito; Alexandre Pereira; Samantha Perkins; Brandon V Pickering; Thomas Pilgrim; Majid Pirestani; Bakhtiar Piroozi; Meghdad Pirsaheb; Oleguer Plana-Ripoll; Hadi Pourjafar; Parul Puri; Mostafa Qorbani; Hedley Quintana; Mohammad Rabiee; Navid Rabiee; Amir Radfar; Alireza Rafiei; Fakher Rahim; Zohreh Rahimi; Vafa Rahimi-Movaghar; Shadi Rahimzadeh; Fatemeh Rajati; Sree Bhushan Raju; Azra Ramezankhani; Chhabi Lal Ranabhat; Davide Rasella; Vahid Rashedi; Lal Rawal; Robert C Reiner; Andre M N Renzaho; Satar Rezaei; Aziz Rezapour; Seyed Mohammad Riahi; Ana Isabel Ribeiro; Leonardo Roever; Elias Merdassa Roro; Max Roser; Gholamreza Roshandel; Daem Roshani; Ali Rostami; Enrico Rubagotti; Salvatore Rubino; Siamak Sabour; Nafis Sadat; Ehsan Sadeghi; Reza Saeedi; Yahya Safari; Roya Safari-Faramani; Mahdi Safdarian; Amirhossein Sahebkar; Mohammad Reza Salahshoor; Nasir Salam; Payman Salamati; Farkhonde Salehi; Saleh Salehi Zahabi; Yahya Salimi; Hamideh Salimzadeh; Joshua A Salomon; Evanson Zondani Sambala; Abdallah M Samy; Milena M Santric Milicevic; Bruno Piassi Sao Jose; Sivan Yegnanarayana Iyer Saraswathy; Rodrigo Sarmiento-Suárez; Benn Sartorius; Brijesh Sathian; Sonia Saxena; Alyssa N Sbarra; Lauren E Schaeffer; David C Schwebel; Sadaf G Sepanlou; Seyedmojtaba Seyedmousavi; Faramarz Shaahmadi; Masood Ali Shaikh; Mehran Shams-Beyranvand; Amir Shamshirian; Morteza Shamsizadeh; Kiomars Sharafi; Mehdi Sharif; Mahdi Sharif-Alhoseini; Hamid Sharifi; Jayendra Sharma; Rajesh Sharma; Aziz Sheikh; Chloe Shields; Mika Shigematsu; Rahman Shiri; Ivy Shiue; Kerem Shuval; Tariq J Siddiqi; João Pedro Silva; Jasvinder A Singh; Dhirendra Narain Sinha; Malede Mequanent Sisay; Solomon Sisay; Karen Sliwa; David L Smith; Ranjani Somayaji; Moslem Soofi; Joan B Soriano; Chandrashekhar T Sreeramareddy; Agus Sudaryanto; Mu'awiyyah Babale Sufiyan; Bryan L Sykes; P N Sylaja; Rafael Tabarés-Seisdedos; Karen M Tabb; Takahiro Tabuchi; Nuno Taveira; Mohamad-Hani Temsah; Abdullah Sulieman Terkawi; Zemenu Tadesse Tessema; Kavumpurathu Raman Thankappan; Sathish Thirunavukkarasu; Quyen G To; Marcos Roberto Tovani-Palone; Bach Xuan Tran; Khanh Bao Tran; Irfan Ullah; Muhammad Shariq Usman; Olalekan A Uthman; Amir Vahedian-Azimi; Pascual R Valdez; Job F M van Boven; Tommi Juhani Vasankari; Yasser Vasseghian; Yousef Veisani; Narayanaswamy Venketasubramanian; Francesco S Violante; Sergey Konstantinovitch Vladimirov; Vasily Vlassov; Theo Vos; Giang Thu Vu; Isidora S Vujcic; Yasir Waheed; Jon Wakefield; Haidong Wang; Yafeng Wang; Yuan-Pang Wang; Joseph L Ward; Robert G Weintraub; Kidu Gidey Weldegwergs; Girmay Teklay Weldesamuel; Ronny Westerman; Charles Shey Wiysonge; Dawit Zewdu Wondafrash; Lauren Woyczynski; Ai-Min Wu; Gelin Xu; Abbas Yadegar; Tomohide Yamada; Vahid Yazdi-Feyzabadi; Christopher Sabo Yilgwan; Paul Yip; Naohiro Yonemoto; Javad Yoosefi Lebni; Mustafa Z Younis; Mahmoud Yousefifard; Hebat-Allah Salah A Yousof; Chuanhua Yu; Hasan Yusefzadeh; Erfan Zabeh; Telma Zahirian Moghadam; Sojib Bin Zaman; Mohammad Zamani; Hamed Zandian; Alireza Zangeneh; Taddese Alemu Zerfu; Yunquan Zhang; Arash Ziapour; Sanjay Zodpey; Christopher J L Murray; Simon I Hay Journal: Nature Date: 2019-10-16 Impact factor: 49.962