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

Julie Knoll Rajaratnam1, Linda N Tran, Alan D Lopez

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New methods improve under-five mortality estimation using summary birth histories, providing accurate child mortality data even without vital registration. These advancements enable better local policy and health inequality measurement.

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Area of Science:

  • Demography
  • Public Health
  • Biostatistics

Background:

  • Under-five mortality is a key indicator of human development.
  • Estimating child mortality relies on surveys in areas lacking vital registration.
  • Summary birth histories offer a cost-effective alternative to complete birth histories for child mortality estimation.

Purpose of the Study:

  • To develop and validate improved methods for estimating under-five mortality using summary birth history data.
  • To enhance the accuracy of child mortality estimates, particularly in the most recent periods before a survey.
  • To enable more precise subnational and small area estimations of child mortality.

Main Methods:

  • Utilized data from 166 Demographic and Health Surveys (DHS).
  • Developed new methods based on maternal age or time since first birth, cohort/period measures of child deaths, and fertility/mortality patterns.
  • Incorporated uncertainty quantification into all developed methods.

Main Results:

  • New methods outperformed the standard indirect method by 43.7% in estimating under-five mortality.
  • Showed a 53.3% improvement in accuracy for the 5 years preceding a survey.
  • Successfully generated subnational under-five mortality estimates for Mexican jurisdictions using census data.

Conclusions:

  • The developed methods significantly enhance the accuracy of under-five mortality estimation from summary birth history data.
  • Summary birth histories, with these new methods, can provide reliable child mortality estimates in data-scarce regions.
  • Facilitates subnational and subgroup-specific mortality estimation, crucial for targeted health policies and reducing inequalities.