1. 2,506 (88%) of 2,851 counties have experienced decreases in under-5 mortality exceeding the Millennium Development Goal 4 (MDG 4) pace per year between 1996 and 2012.
2. There was substantial variations between counties. Some counties in China were found to have under-5 mortality rates similar to those in the most developed nations in 2012 while others had similar rates to those recorded in Burkina Faso or Cameroon.
Evidence Rating Level: 2 (Good)
Study Rundown: At the subnational level, progress toward Millennium Development Goal 4 has not been quantified in China. This study aimed to estimate under-5 mortality rates from 1996-2012 in China. Data from censuses, surveys, surveillance sites, disease surveillance points, and the Annual Report System of Maternal and Child Health were used to create provincial and county-level estimates of under-5 mortality rates in 31 provinces of China. Some counties in China had under-5 mortality rates similar to those in the most developed nations in 2012. However, others have similar rates to those recorded in Burkina Faso or Cameroon. Only 2 provinces will not achieve MDG 4 by 2015, while 29 provinces have achieved a decrease in under-5 mortality rates twice as fast as the MDG 4 target rate. These successful reductions in under-5 mortality serve as an example to be emulated in other counties within China as well as other countries attempting to reduce under-5 mortality. Though this study is the first-ever analysis of under-5 mortality rates at the county level in China, it is limited by incomplete data of the surveillance systems used. Study results may provide additional insights that could be replicated within China and in other developing nations to further reduce under-5 mortality.
In-Depth [retrospective cohort]: This study aimed to estimate the under-5 mortality rate from 1996-2012 using several surveillance systems, surveys, censuses and vital registration sources. The study authors utilized a small area mortality estimation model, spatiotemporal smoothing, and Gaussian process regression to synthesize data and create consistent county-level estimates and provincial estimates. Using an econometric model, expected progress based on income and educational attainment was compared to progress at the country level. From 1996 to 2012, under-5 mortality rate in China decreased by 70%, from 46.0 per 1000 livebirths to 13.7 per 1000 livebirths. There was substantial variation between counties. The ratio of maximum and minimum under-5 mortality rate within a province ranges from 1.9 in Beijing to 14.6 in Sichuan Province. Overall, 2,506 (88%) of 2,851 counties have experienced decreases of more than 4.4% per year between 1996 and 2012.
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