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A global overview of the magnitude, disparities and trend of infant mortality in the world. 1950-2011

on Sun, 03/31/2013 - 18:23

Monitoring and evaluation of population health is a core public health function. The infant mortality rate (IMR) is one those core population health indicators as it reveals the quality of life of mothers and other family members, the access to and quality of health services, access to a good nutrition, education, human rights and security, inequity in deprived population groups and the environment. 

 
IMR is measured as the number of babies who die before reaching their first year of age divided by number of live births in a specific place and year. It is interpreted as the risk of a baby dying between birth and one year of age.
 
Magnitude and geographic distribution of IMR
In the World, between 1960 and 2011 infant mortality rate has been significantly reduced in 85%, from 113.7 to 17.3 per 1,000 live births, representing a reduction of 2,120 thousands infant deaths. Consistently over time, the European region shows the best situation. In 2011 the European has an IMR of 4.4 per 1,000 live births (126 000 infant deaths) and the African region has the worst situation with 58.5 per 1,000 live births, a risk 13 times higher compared with Europe. 
 
The geographic distribution of IMR consistently shows clusters of countries with high values of IMR in Africa and South-East Asia from 1960 to 2011. 

Inequalities of IMR

The disparity of IMR among countries has also improved overtime as indicated by the boxplot chart of the data visualization. The interquartile range (difference between 75 and 25 percentiles of IMR) decreased from 120.6 in 1950 to 38.3 in 2011. This is a very important reduction of the gap among countries but still there are significant disparities, for instance, in 2011 the IMR in Sierra Leone which is the country with the highest IMR (119.2 per 1,000 live births) is 42 times higher that  Andorra, the lowest IMR (2.8 per 1,000 live births). 
 
Some interesting cases  
It is important to highlight the case of Republic of Korea which shows the biggest percent change of IMR from 185.1 in 1950 to 4.1 in 2011. Republic of Korea improved significantly its IMR from 1950 to 1990 with annual percent change from 30% to 39%. From 2000 to 2011 this change is around 8% keeping it below 5 per 1,000 live births.
 
In African Region, Sierra Leone is the country with the highest IMR showing two waves of increased in 1965 and 1995, and it is the country with the highest IMR in 2011 with 119.2 per 1,000 live births followed by Democratic Republic of Congo that show an stagnant trend of high IMR from 1970 to 2011 with IMR over 110 per 1,000 live births. 
 
In the European region, which presents the lower IMR in the World, Turkey shows an interesting scenario having the higher IMR (198.1 per 1,000 live births in 1955 that has been consistently decreased to 11.5 per 1,000 live births in 2011. Azerbaijan, Trurkmenistan, Uzbequistan, Kazakhstan and Kyrgyzstan are far from the central trend of IMR in this region sharing a risk of infant mortality 10 times higher that the rest of European countries.  
 
Conclusions
Infant health continues being a priority for countries and the world. National and local governments, NGOs, Civil Society and the general public should continue paying attention to the health of infant and children population. Many efforts should continuously be putting to improve the quality of life, access to high quality health service, education, human security and rights, improve environments, and remove risk factors and determinants of infant health. 
Use of available data, visualizations and analytical tools such as the introduced in the article, can help to explore, analyze and communicate key messages to improve population health. 

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P.S. The data visualization of this article was ranked # 1 by judges (seed # 1) and after three rounds of daily bracket style match-ups, competing for votes on Twitter, it got 2nd place of the Tableau Elite 8 Viz Makeover Contest.

Comments

Isabelle Soule, PhD, RN's picture

Thank you for this important overview of infant mortality. I am looking for international maternal child health work and would appreciate suggestions and leads from this group. My background includes 20 years of neonatal intensive care in the US, PhD in nursing focusing on the development of cultural competence in  healthcare providers, and 15 years of immigrant / refugee health. My goal is to work abroad half of each year contributing to the health of women / children / and communities. My primary areas of interest include sub-Saharan Africa and Latin America, however, would consider anywhere in the world. While I am a researcher, my primary interest is working directly with women's groups, formal and informal healthcare providers, and systems to improve care and outcomes. Thank you in advance for any suggestions you may have.  Isabelle