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

<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 cal...

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Autores principales:	Julie Knoll Rajaratnam, Linda N Tran, Alan D Lopez, Christopher J L Murray
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2010
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/9194c8a5ae6348f881f23ce2cfdf79f9
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record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Julie Knoll Rajaratnam Linda N Tran Alan D Lopez Christopher J L Murray Measuring under-five mortality: validation of new low-cost methods.
description	<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 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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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.
format	article
author	Julie Knoll Rajaratnam Linda N Tran Alan D Lopez Christopher J L Murray
author_facet	Julie Knoll Rajaratnam Linda N Tran Alan D Lopez Christopher J L Murray
author_sort	Julie Knoll Rajaratnam
title	Measuring under-five mortality: validation of new low-cost methods.
title_short	Measuring under-five mortality: validation of new low-cost methods.
title_full	Measuring under-five mortality: validation of new low-cost methods.
title_fullStr	Measuring under-five mortality: validation of new low-cost methods.
title_full_unstemmed	Measuring under-five mortality: validation of new low-cost methods.
title_sort	measuring under-five mortality: validation of new low-cost methods.
publisher	Public Library of Science (PLoS)
publishDate	2010
url	https://doaj.org/article/9194c8a5ae6348f881f23ce2cfdf79f9
work_keys_str_mv	AT julieknollrajaratnam measuringunderfivemortalityvalidationofnewlowcostmethods AT lindantran measuringunderfivemortalityvalidationofnewlowcostmethods AT alandlopez measuringunderfivemortalityvalidationofnewlowcostmethods AT christopherjlmurray measuringunderfivemortalityvalidationofnewlowcostmethods
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spelling	oai:doaj.org-article:9194c8a5ae6348f881f23ce2cfdf79f92021-11-25T05:37:43ZMeasuring under-five mortality: validation of new low-cost methods.1549-12771549-167610.1371/journal.pmed.1000253https://doaj.org/article/9194c8a5ae6348f881f23ce2cfdf79f92010-04-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/20405055/pdf/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<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 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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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.Julie Knoll RajaratnamLinda N TranAlan D LopezChristopher J L MurrayPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 7, Iss 4, p e1000253 (2010)

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

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