Trends in neonatal and infant mortality in five continents

Trends in the mortality rates for the periods 0-6, 7-27, 28-365 and 0-365 days after birth have been analysed in 48 European, American, African, Asian and Australian countries included in the World Health Organization (WHO) mortality database. From the late 1960s to the early 1990s infant mortality rates declined steadily and markedly in most countries worldwide. Only three countries (Bulgaria, Dominican Republic and Ecuador) showed some increase in rates in the late 1980s after, however, appreciable decreasing trends in earlier calendar periods. In the late 1980s or early 1990s three Latin American countries (Ecuador, Colombia and Dominican Republic) showed the highest rates in all the indicators considered, with the exception of 0-6 days of life mortality, where Sri Lanka ranked second in mortality rates. Intermediate rates (around 10-25/1000 live births for 0-365 days of life mortality) were reported by a number of Latin American, Asian and Central European countries. Rates lower than 10/1000 live births for the 0-365 days of life mortality were reported from the USA. Canada, most western European countries and four Asian countries (Israel, HongKong, Singapore and Japan, which registered the lowest rate). The major decreases were observed in the 0-6 days mortality rates. The proportional reductions were comparable for the period 7-27 and 28-365 days of life in several countries, and generally did not show a consistent pattern, some countries showing greater reduction for 7-27 days of life mortality rates and others vice versa. Thus, in the late 1960s in most countries the large majority of infant deaths occurred in the first month of life, but in the early 1990s this proportion had declined, and the 0-6/7-365 days of life rates ratios were below unity in most countries. In most South American countries, however, the ratio was generally close to unity in both calendar periods.