Color value (light vs. dark) of clothing and facial expression (smiling vs. serious) were varied in photographs of six female job applicants. Male and female business persons (N = 208) judged the photographs on 14 semantic differential scales. Facial expression significantly affected evaluations of Character-Sociability characteristics. Clothing color value was more important in influencing perceptions of Potency, i.e., competence and boldness, but 'only for male interviewers. Results indicate that clothing color may have significant but not substantial impact on hiring decisions made by male business persons.
In: Journal of the Society for Gynecologic Investigation: official publication of the Society for Gynecologic Investigation, Volume 5, Issue 1, p. 126A-126A
Land use in much of sub-Saharan Africa is dominated by legislative frameworks based on a strong colonial legacy, focusing strongly on state control and minimal devolution of management responsibilities to local communities. However, attempts to reconcile conservation and socio-economic development by increasing stakeholder engagement in community-based natural resource management (CBNRM) have been undertaken since the late 1980s. Based on a review of published literature on historical land-use trajectories, the evolution of CBNRM, and key respondent interviews with NRM experts in Ghana and Zambia, this paper asks: What lessons can be learned from CBNRM to inform integrated landscape approaches for more equitable social and ecological outcomes? The paper discusses the positive characteristics and persistent challenges arising from CBNRM initiatives in both countries. The former being, improved rights and resource access, an established institutional structure at the local level, and a conservation approach tailored to the local context. The latter include the absence of multi-scale collaboration, inadequate inclusive and equitable local participation, and limited sustainability of CBNRM initiatives beyond short-term project funding timelines. The paper argues that integrated landscape approaches can address these challenges and improve natural resource management in Ghana and Zambia. We urge landscape practitioners to consider how the lessons learned from CBNRM are being addressed in practice, as they represent both challenges and opportunities for landscape approaches to improve natural resource management.
Despite ongoing debates about the viability of sustaining economic growth while maintaining environmental integrity, international sustainability agendas increasingly propose reconciling socio-economic development and global environmental goals. Achieving these goals is impeded by limited funding and a lack of information on where financial flows to integrate environment and development are targeted. We analyze World Bank and Global Environment Facility data to investigate the extent and distribution of such funding across the tropics. We find a misalignment between funding flows and need with highly biodiverse, low development (HBLD) countries receiving no more funding than non-HBLD countries. Countries with low biodiversity receive more funding than highly biodiverse countries and there was no statistical association between a country's development status and funds received. Rather than environment-development need, funding appears to be driven by governance and political-economic factors. Future research should investigate how such factors and funding flows are associated with conservation and development outcomes.
The Scientific Collaboration on Past Speciation Conditions in Lake Ohrid (SCOPSCO) project is an international research initiative to study the influence of major geological and environmental events on the biological evolution of lake taxa. SCOPSCO drilling campaigns were carried out in 2011 and 2013. In 2011 we used gravity and piston coring at one of the five proposed drill sites, and in 2013 we undertook deep drilling with the Deep Lake Drilling System (DLDS) of Drilling, Observation and Sampling of the Earth's Continental Crust (DOSECC). In April and May 2013, a total of 2100 m sediments were recovered from four drill sites with water depths ranging from 125 to 260 m. The maximum drill depth was 569 m below the lake floor in the centre of the lake. By retrieving overlapping sediment sequences, 95% of the sediment succession was recovered. Initial data from borehole logging, core logging and geochemical measurements indicate that the sediment succession covers >1.2 million years (Ma) in a quasi-continuous sequence. These early findings suggest that the record from Lake Ohrid will substantially improve the knowledge of long-term environmental change and short-term geological events in the northeastern Mediterranean region, which forms the basis for improving understanding of the influence of major geological and environmental events on the biological evolution of endemic species. ; Financial and logistic support for the SCOPSCO coring campaign was provided by ICDP, the German Ministry of Higher Education and Research, the German Research Foundation, the British Geological Survey, the INGV and CNR (both Italy), and the governments of the republics of Macedonia (FYROM) and Albania. The deep drilling by DOSECC was a huge success, so many thanks to the team. ; Peer-reviewed ; Publisher Version
This edition of the U. S. Army War College Guide to National Security Policy and Strategy continues to reflect the structure and approach of the core national security strategy and policy curriculum at the War College. The fourth edition is published in two volumes that correspond roughly to the Department of National Security and Strategy's core courses: "Theory of War and Strategy" and "National Security Policy and Strategy." Like previous editions, this one is largely an expansion of its predecessor rather than a major rewriting. About a quarter of the chapters are new, and several others have undergone significant rewrites or updates. However, approximately half of the book remains unchanged. Although this is not primarily a textbook, it does reflect both the method and manner we use to teach strategy formulation to America's future senior leaders. The book is not a comprehensive or exhaustive treatment of either strategic theory or the policymaking process. Both volumes are organized to proceed from the general to the specific. Thus the first volume opens with general thoughts on the nature and theory of war and strategy, proceeds to look at the complex aspect of power, and concludes with specific theoretical issues. Similarly, the second volume begins by examining the policy/strategy process, moves to a look at the strategic environment, and concludes with some specific issues. This edition adds several short case studies that can be used to illustrate the primary material in the volume. ; "July 2010." ; Includes bibliographical references. ; V. II. National security policy and strategy -- The national system and environment. Crafting national interests in the 21st century / Alan G. Stolberg -- The national security community, revisited / Walter H. Leach -- Making national security policy in the 21st century / Alan G. Stolberg -- National security and the interagency process / Gabriel Marcella -- PDD-56 : a glass half-full / John F. Troxell -- National security powers : are the checks in balance? / Marybeth P. Ulrich -- National military strategies : 1990-2009 / Richard M. Meinhart -- Present at the counterrevolution : an essay on the 2005 national defense strategy and its impact on policy / Nathan P. Freier -- Securing America from attack : the Defense Department's evolving role after 9/11 / Frank L. Jones -- The appropriate role of intelligence in the making of national security policy / Anthony R. Williams -- The international system and environment. The international system in the 21st century / Alan G. Stolberg -- International relations theory and American grand strategy / Janeen M. Klinger -- Multilateralism and unilateralism / James A. Helis -- Regional studies in a global age / R. Craig Nation -- "Lawyers, guns, and money" : transnational threats and U.S. national security / Paul Rexton Kan -- Ethical issues in war : an overview / Martin L. Cook -- Strategic issues and considerations. Ethics and war in comparative religious perspective / David L. Perry -- International law and the new world order : redefining sovereignty / Thomas W. McShane -- A nationalist's view of lawfare / David G. Bolgiano -- The United States and the International Criminal Court / Thomas W. McShane -- Retooling U.S. public diplomacy as a strategic instrument of foreign policy / Marybeth P. Ulrich -- A primer on civil-military relations for senior leaders / Marybeth P. Ulrich -- New requirements for a new challenge : the military's role in border security / Bert B. Tussing -- Creating strategy in an era of change : the Plains Indian wars / Clayton K.S. Chun -- U.S. relations with North Korea, 1991-2000 / J. Boone Bartholomees, Jr. -- Painting yourself into a corner : conflict termination, unconditional surrender, and the case of Japan / Clayton K.S. Chun -- The guerrilla warfare problem : revolutionary war and the Kennedy administration response, 1961-1964 / Frank L. Jones. ; V. I. Theory of war and strategy -- Introduction / J. Boone Bartholomees, Jr. -- Strategic theory. Why is strategy difficult? / David Jablonsky -- A survey of the theory of strategy / J. Boone Bartholomees, Jr. -- Toward a theory of strategy : Art Lykke and the U.S. Army War College strategy model / H. Richard Yarger -- The strategic appraisal : the key to effective strategy / H. Richard Yarger -- Managing strategic risk / James F. Holcomb -- A theory of victory / J. Boone Bartholomees, Jr. -- Toward a strategic theory of terrorism : defining boundaries in the ongoing search for security / Frank L. Jones -- Thucydides and contemporary strategy / R. Craig Nation -- The elements of power. National power / David Jablonsky -- National power / R. Craig Nation -- Strategic communication : wielding the information element of power / Dennis M. Murphy -- Diplomacy as an instrument of national power / Reed J. Fendrick -- Theory and practice of modern diplomacy : origins and development to 1914 / Louis J. Nigro, Jr. -- Economic diplomacy : views of a practitioner / Constance Phlipot -- Economics : a key element of national power / Clayton K.S. Chun -- Political economy and national security : a primer / Janeen M. Klinger -- Military power and the use of force / John F. Troxell -- Strategic issues and considerations. Systems thinking in campaign design / Charles D. Allen and Glenn K. Cunningham -- Intelligence as a tool of strategy / John Aclin -- Air power theory : an analytical narrative from the First World War to the present / Tami Davis Biddle -- John Warden's five ring model and the indirect approach to war / Clayton K. S. Chun -- Naval theory for soldiers / J. Boone Bartholomees, Jr. -- The network-centric warfare journey : realizing the power of information / Jeffrey L. Groh -- Space power : a strategic assessment and a way forward / Jeffrey A. Farnsworth. ; This edition of the U. S. Army War College Guide to National Security Policy and Strategy continues to reflect the structure and approach of the core national security strategy and policy curriculum at the War College. The fourth edition is published in two volumes that correspond roughly to the Department of National Security and Strategy's core courses: "Theory of War and Strategy" and "National Security Policy and Strategy." Like previous editions, this one is largely an expansion of its predecessor rather than a major rewriting. About a quarter of the chapters are new, and several others have undergone significant rewrites or updates. However, approximately half of the book remains unchanged. Although this is not primarily a textbook, it does reflect both the method and manner we use to teach strategy formulation to America's future senior leaders. The book is not a comprehensive or exhaustive treatment of either strategic theory or the policymaking process. Both volumes are organized to proceed from the general to the specific. Thus the first volume opens with general thoughts on the nature and theory of war and strategy, proceeds to look at the complex aspect of power, and concludes with specific theoretical issues. Similarly, the second volume begins by examining the policy/strategy process, moves to a look at the strategic environment, and concludes with some specific issues. This edition adds several short case studies that can be used to illustrate the primary material in the volume. ; Mode of access: Internet. ; Previously titled: U.S. Army War College guide to national security policy and strategy.
Support for this work was provided by the NASA Solar System Observations program (80NSSC20K0673), the Space Telescope Science Institute (HST-GO-15372), the National Science Foundation (PHY-2010970), the National Research Foundation (NRF; No. 2019R1I1A1A01059609), the MINEDUC-UA project ESR1795, the European Union H2020-MSCA-ITN-2019 under Grant no. 860470 (CHAMELEON), and by the Novo Nordisk Foundation Interdisciplinary Synergy Program (NNF19OC0057374). ; Cometary activity is a manifestation of sublimation-driven processes atthe surface of nuclei. However, cometary outbursts may arise from other processes that are not necessarily driven by volatiles. In order to fully understand nuclear surfaces and their evolution, we must identify the causes of cometary outbursts. In that context, we present a study of mini-outbursts of comet 46P/Wirtanen. Six events are found in our long-term lightcurve of the comet around its perihelion passage in 2018. The apparent strengths range from -0.2 to -1.6 mag in a 5" radius aperture, and correspond to dust masses between ∼104 to 106 kg, but with large uncertainties due to the unknown grain size distributions. However, the nominal mass estimates are the same order of magnitude as the mini-outbursts at comet 9P/Tempel 1 and 67P/Churyumov-Gerasimenko, events which were notably lacking at comet 103P/Hartley 2. We compare the frequency of outbursts at the four comets, and suggest that the surface of 46P has large-scale (∼10-100 m) roughness that is intermediate to that of 67P and 103P, if not similar to the latter. The strength of the outbursts appear to be correlated with time since the last event, but a physical interpretation with respect to solar insolation is lacking. We also examine Hubble Space Telescope images taken about 2 days following a near-perihelion outburst. No evidence for macroscopic ejecta was found in the image, with a limiting radius of about 2 m. ; Publisher PDF ; Peer reviewed
Achieving universal health coverage (UHC) requires health financing systems that provide prepaid pooled resources for key health services without placing undue financial stress on households. Understanding current and future trajectories of health financing is vital for progress towards UHC. We used historical health financing data for 188 countries from 1995 to 2015 to estimate future scenarios of health spending and pooled health spending through to 2040.We extracted historical data on gross domestic product (GDP) and health spending for 188 countries from 1995 to 2015, and projected annual GDP, development assistance for health, and government, out-of-pocket, and prepaid private health spending from 2015 through to 2040 as a reference scenario. These estimates were generated using an ensemble of models that varied key demographic and socioeconomic determinants. We generated better and worse alternative future scenarios based on the global distribution of historic health spending growth rates. Last, we used stochastic frontier analysis to investigate the association between pooled health resources and UHC index, a measure of a country's UHC service coverage. Finally, we estimated future UHC performance and the number of people covered under the three future scenarios.
BACKGROUND: Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. METHODS: For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. FINDINGS: Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1-3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5-2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6-40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7-1·9 million) in 2005, to 1·2 million deaths (1·1-1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. INTERPRETATION: Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030. ; Funding: We thank the countless individuals who have contributed to the Global Burden of Disease (GBD) Study 2015 in various capacities. We specifically thank Jeffrey Eaton and John Stover. HW and CJLM received funding for this study from the Bill & Melinda Gates Foundation; the National Institute of Mental Health, National Institutes of Health (NIH; R01MH110163); and the National Institute on Aging, NIH (P30AG047845). LJAR acknowledges the support of Qatar National Research Fund (NPRP 04-924-3-251) who provided the main funding for generating the data provided to the GBD-Institute for Health Metrics and Evaluation effort. BPAQ acknowledges institutional support from PRONABEC (National Program of Scholarship and Educational Loan), provided by the Peruvian government. DB is supported by the Bill & Melinda Gates Foundation (grant number OPP1068048). JDN was supported in his contribution to this work by a Fellowship from Fundacao para a Ciencia e a Tecnologia, Portugal (SFRH/BPD/92934/2013). KD is supported by a Wellcome Trust Fellowship in Public Health and Tropical Medicine (grant number 099876). TF received financial support from the Swiss National Science Foundation (SNSF; project number P300P3-154634). AG acknowledges funding from Sistema Nacional de Investigadores de Panama-SNI. PJ is supported by Wellcome Trust-DBT India Alliance Clinical and Public Health Intermediate Fellowship. MK receives research support from the Academy of Finland, the Swedish Research Council, Alzheimerfonden, Alzheimer's Research & Prevention Foundation, Center for Innovative Medicine (CIMED) at Karolinska Institutet South Campus, AXA Research Fund, Wallenberg Clinical Scholars Award from the Knut och Alice Wallenbergs Foundation, and the Sheika Salama Bint Hamdan Al Nahyan Foundation. AK's work was supported by the Miguel Servet contract financed by the CP13/00150 and PI15/00862 projects, integrated into the National R&D&I and funded by the ISCIII (General Branch Evaluation and Promotion of Health Research), and the European Regional Development Fund (ERDF-FEDER). SML is funded by a National Institute for Health Research (NIHR) Clinician Scientist Fellowship (grant number NIHR/CS/010/014). HJL reports grants from the NIHR, EU Innovative Medicines Initiative, Centre for Strategic & International Studies, and WHO. WM is Program analyst, Population and Development, in the Peru Country Office of the United Nations Population Fund, which does not necessarily endorse this study. For UOM, funding from the German National Cohort Consortium (O1ER1511D) is gratefully acknowledged. KR reports grants from NIHR Oxford Biomedical Research Centre, NIHR Career Development Fellowship, and Oxford Martin School during the conduct of the study. GR acknowledges that work related to this paper has been done on the behalf of the GBD Genitourinary Disease Expert Group supported by the International Society of Nephrology (ISN). ISS reports grants from FAPESP (Brazilian public agency). RSS receives institutional support from Universidad de Ciencias Aplicadas y Ambientales, UDCA, Bogota Colombia. SS receives postdoctoral funding from the Fonds de la recherche en sante du Quebec (FRSQ), including its renewal. RTS was supported in part by grant number PROMETEOII/2015/021 from Generalitat Valenciana and the national grant PI14/00894 from ISCIII-FEDER. PY acknowledges support from Strategic Public Policy Research (HKU7003-SPPR-12).
Background: timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. Methods: for countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. Findings: global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1–3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5–2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6–40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7–1·9 million) in 2005, to 1·2 million deaths (1·1–1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. Interpretation: scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030. Funding Bill & Melinda Gates Foundation, and National Institute of Mental Health and National Institute on Aging, National Institutes of Health
Background Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. Methods For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. Findings Global HIV incidence reached its peak in 1997, at 3.3 million new infections (95% uncertainty interval [UI] 3.1-3.4 million). Annual incidence has stayed relatively constant at about 2.6 million per year (range 2.5-2.8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38.8 million (95% UI 37.6-40.4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1.8 million deaths (95% UI 1.7-1.9 million) in 2005, to 1.2 million deaths (1.1-1.3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. Interpretation Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license
Background: Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. Methods: Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1–4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980–2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age–sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings: Globally, 5·8 million (95% uncertainty interval [UI] 5·7–6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7–53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3–43·6) to 2·6 million (2·6–2·7) neonatal deaths and 47·0% (35·1–57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6–3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. Interpretation: Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030.
Background Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. Methods Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1-4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980-2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age-sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, 5.8 million (95% uncertainty interval [UI] 5.7-6.0) children younger than 5 years died in 2015, representing a 52.0% (95% UI 50.7-53.3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42.4% (41.3-43.6) to 2.6 million (2.6-2.7) neonatal deaths and 47.0% (35.1-57.0) to 2.1 million (1.8-2.5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3.0% (2.6-3.3), falling short of the 4.4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4.4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10.3 million fewer under-5 deaths than expected on the basis of improving SDI alone. Interpretation Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030.