Dataset Information

Measuring under-five mortality: validation of new low-cost methods.

ABSTRACT: There has been increasing interest in measuring under-five mortality as a health indicator and as a critical measure of human development. In countries with complete vital registration systems that capture all births and deaths, under-five mortality can be directly calculated. In the absence of a complete vital registration system, however, child mortality must be estimated using surveys that ask women to report the births and deaths of their children. Two survey methods exist for capturing this information: summary birth histories and complete birth histories. A summary birth history requires a minimum of only two questions: how many live births has each mother had and how many of them have survived. Indirect methods are then applied using the information from these two questions and the age of the mother to estimate under-five mortality going back in time prior to the survey. Estimates generated from complete birth histories are viewed as the most accurate when surveys are required to estimate under-five mortality, especially for the most recent time periods. However, it is much more costly and labor intensive to collect these detailed data, especially for the purpose of generating small area estimates. As a result, there is a demand for improvement of the methods employing summary birth history data to produce more accurate as well as subnational estimates of child mortality.We used data from 166 Demographic and Health Surveys (DHS) to develop new empirically based methods of estimating under-five mortality using children ever born and children dead data. We then validated them using both in- and out-of-sample analyses. We developed a range of methods on the basis of three dimensions of the problem: (1) approximating the average length of exposure to mortality from a mother's set of children using either maternal age or time since first birth; (2) using cohort and period measures of the fraction of children ever born that are dead; and (3) capturing country and regional variation in the age pattern of fertility and mortality. We focused on improving estimates in the most recent time periods prior to a survey where the traditional indirect methods fail. In addition, all of our methods incorporated uncertainty. Validated against under-five estimates generated from complete birth histories, our methods outperformed the standard indirect method by an average of 43.7% (95% confidence interval [CI] 41.2-45.2). In the 5 y prior to the survey, the new methods resulted in a 53.3% (95% CI 51.3-55.2) improvement. To illustrate the value of this method for local area estimation, we applied our new methods to an analysis of summary birth histories in the 1990, 2000, and 2005 Mexican censuses, generating subnational estimates of under-five mortality for each of 233 jurisdictions.The new methods significantly improve the estimation of under-five mortality using summary birth history data. In areas without vital registration data, summary birth histories can provide accurate estimates of child mortality. Because only two questions are required of a female respondent to generate these data, they can easily be included in existing survey programs as well as routine censuses of the population. With the wider application of these methods to census data, countries now have the means to generate estimates for subnational areas and population subgroups, important for measuring and addressing health inequalities and developing local policy to improve child survival. Please see later in the article for the Editors' Summary.

SUBMITTER: Rajaratnam JK

PROVIDER: S-EPMC2854123 | biostudies-literature | 2010 Apr

REPOSITORIES: biostudies-literature

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Measuring under-five mortality: validation of new low-cost methods.

Rajaratnam Julie Knoll JK Tran Linda N LN Lopez Alan D AD Murray Christopher J L CJ

PLoS medicine 20100413 4

<h4>Background</h4>There has been increasing interest in measuring under-five mortality as a health indicator and as a critical measure of human development. In countries with complete vital registration systems that capture all births and deaths, under-five mortality can be directly calculated. In the absence of a complete vital registration system, however, child mortality must be estimated using surveys that ask women to report the births and deaths of their children. Two survey methods exist ...[more]

PMID: 20405055

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Project description:BackgroundIn the year 2019, around 5 million children under age five died and most of the deaths happened in developing countries. Though large numbers of deaths are reported in such countries, limited availability of data poses a substantial challenge on generating reliable estimates. Hence, this study aims to assess the prevalence and factors associated with under-five mortality in southeastern Ethiopia.MethodsA register based cross sectional study was conducted from 1st September 2014 to July 2019 in Asella teaching and referral hospital. A total of 4901 under-five age children registered on the admission and discharge book of pediatric ward with complete information were included for the analysis. Data entry and analysis were conducted using Epidata Version 7 and SPSS version 21, respectively. Descriptive statistics were used to explore the characteristics of the study participants and their condition at discharge. Adjusted Odds Ratio (AOR) with its 95% Confidence interval and P-value less than 5% was used to decide the statistically significant association.ResultsThe prevalence of under-five mortality among admitted children in Asella Teaching and Referral hospital was 8.7% (95% CI 7.91-9.50%). Post-Neonatal and Child mortality were found to be 9.1% and 8.18%, respectively. Moreover, large numbers of death (45.2%) were seen within the first 2 days of admission. Address (AOR:1.4(1.08-1.81)), HIV status (AOR:4.64 (2.19-9.8)), severe acute malnutrition (AOR:2.82 (2.03-3.91)), hypovolemic shock (AOR:4.32 (2.31-8.1)), type I diabetes with DKA (AOR:3.53(1.34-9.29) and length of stay in the hospital for ≤2 days (AOR: 4.28 (3.09-5.95)) as well as 3-4 days (AOR: 1.48 (1.02-2.15)) were among the identified predictors.ConclusionsThough childhood mortality is swiftly decreasing, and access and utilization of health care is improving in Ethiopia, our study found large prevalence of under-five mortality, 8.7% and higher number of deaths in early days of admission. Improving the quality of service has a paramount importance in reducing the mortality and managing associated factors contributing to under-five mortality among admitted children.

Project description:BackgroundUnder-five mortality refers to the likelihood of dying between the ages of birth and five. The number of children under the age of five who die each year continues to climb worldwide. Over the previous few decades, the industry has made great progress in reducing mortality among children under the age of five. The study aims to identify the factors associated with under-five mortality in Ethiopia.Subject and methodCommunity-based Cross-sectional data came from Ethiopia's Mini Demographic and Health Survey 2019. In two stages, the 2019 EMDHS sample was stratified and selected. 8855 women of reproductive age were interviewed using a nationally representative Woman (ages 15 to 49) and 5753 children were included. Ethiopia's under-five mortality served as the study's dependent (response) or outcome variable. Binary logistic regression was used to see if there is an association between the dependent and independent variables. All variables with a p-value of less than 0.25 in the bivariate analysis were chosen for the multivariable logistic regression to compensate for putative confounders. Significant predictors were defined as factors with a p-value of less than 0.05.ResultsA total of 5753 under-5 mortality were enrolled in this study. 339 (5.9%) of under-five Mortality have been declared lifeless before reaching the age of five. There were 1328(23.1%) and 4425(76.1%) with 72 (5.42%) and 267 (6.02%) of under-five mortality occurring in urban and rural respectively. Under-five mortality in the Afar region was 2.280 times more likely Compared to Children born in Tigray Region (AOR = 2.280 95% CI = 1.137-4.568, P = .020). Under-five Mortality in Rural residences was 1.908 times more likely as Compared to Urban Residence (AOR = 1.908, 95% CI = 1.257-4.539, P = .035). Under-five mortality in Poorer index Households was 0.343 times Less likely as compared to children born in the poorest index Household (AOR = 0.343,95% CI = 0.128-0.910, P = ). Under-five mortality in the public sector was 1.763 times less likely than among children born at Home (AOR = 1.763, 95% CI = 1.252-2.482, P = .033). Under-five Mortality of second multiple births was 2.389 times more likely Compared to Single birth (AOR = 2.389, 95% CI = 1.257-4.539, P = .008).ConclusionThis study found that the prevalence of under-five mortality, is 5.9% (59/1000) or 59 death per one thousand live children in Ethiopia. The under-five mortality rate is rapidly declining, and access to and utilization of health care is improving. Region, residence, level of education, wealth index, Place of Delivery and multiple births have all been statistically significant factors of under-five mortality in Ethiopia. The government and all stockholders should be given attention to maternal and infant health care to reduce under-five mortality.

Dataset Information

Measuring under-five mortality: validation of new low-cost methods.

Publications

Measuring under-five mortality: validation of new low-cost methods.

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