by
Nafsiah Mboi;
Indra Murty Surbakti;
Indang Trihandini;
Iqbal Elyazar;
Karen Houston Smith;
Pungkas Bahjuri Ali;
Soewarta Kosen;
Kristin Flemons;
Sarah E. Ray;
Jackie Cao;
Scott D. Glenn;
Molly K. Miller-Petrie;
Meghan D. Mooney;
Jeffrey L. Ried;
Dina Nur Anggraini Ningrum;
Fachmi Idris;
Kemal N Siregar;
Robert S. Bernstein;
Pandu Harimurti;
Tikki Pangestu;
Yuwono Sidharta;
Mohsen Naghavi;
Christopher J L Murray;
Simon I Hay
Background: As Indonesia moves to provide health coverage for all citizens, understanding patterns of morbidity and mortality is important to allocate resources and address inequality. The Global Burden of Disease 2016 study (GBD 2016) estimates sources of early death and disability, which can inform policies to improve health care. Methods: We used GBD 2016 results for cause-specific deaths, years of life lost, years lived with disability, disability-adjusted life-years (DALYs), life expectancy at birth, healthy life expectancy, and risk factors for 333 causes in Indonesia and in seven comparator countries. Estimates were produced by location, year, age, and sex using methods outlined in GBD 2016. Using the Socio-demographic Index, we generated expected values for each metric and compared these against observed results. Findings: In Indonesia between 1990 and 2016, life expectancy increased by 8·0 years (95% uncertainty interval [UI] 7·3–8·8) to 71·7 years (71·0–72·3): the increase was 7·4 years (6·4–8·6) for males and 8·7 years (7·8–9·5) for females. Total DALYs due to communicable, maternal, neonatal, and nutritional causes decreased by 58·6% (95% UI 55·6–61·6), from 43·8 million (95% UI 41·4–46·5) to 18·1 million (16·8–19·6), whereas total DALYs from non-communicable diseases rose. DALYs due to injuries decreased, both in crude rates and in age-standardised rates. The three leading causes of DALYs in 2016 were ischaemic heart disease, cerebrovascular disease, and diabetes. Dietary risks were a leading contributor to the DALY burden, accounting for 13·6% (11·8–15·4) of DALYs in 2016. Interpretation: Over the past 27 years, health across many indicators has improved in Indonesia. Improvements are partly offset by rising deaths and a growing burden of non-communicable diseases. To maintain and increase health gains, further work is needed to identify successful interventions and improve health equity. Funding: The Bill & Melinda Gates Foundation.
by
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;
Robert S. Bernstein;
Kabayam Venkat Narayan
Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.