Abstract
BackgroundChild mortality is an important indication of an effective public health system. Data sources available for the estimation of child mortality in Papua New Guinea (PNG) are limited.ObjectiveThe objective of this study was to provide child mortality estimates at the sub-national level in PNG using new data from the integrated Health and Demographic Surveillance System (iHDSS).MethodUsing direct estimation and indirect estimation methods, household vital statistics and maternal birth history data were analysed to estimate three key child health indicators: Under 5 Mortality Rate (U5MR), Infant Mortality Rate (IMR) and Neonatal Mortality Rate (NMR) for the period 2014–2017. Differentials of estimates were evaluated by comparing the mean relative differences between the two methods.ResultsThe direct estimations showed U5MR of 93, IMR of 51 and NMR of 34 per 1000 live births for all the sites in the period 2014–2017. The indirect estimations reported an U5MR of 105 and IMR of 67 per 1000 live births for all the sites in 2014. The mean relative differences in U5MR and IMR estimates between the two methods were 3 and 24 percentage points, respectively. U5MR estimates varied across the surveillance sites, with the highest level observed in Hela Province (136), and followed by Eastern Highlands (122), Madang (105), and Central (42).DiscussionThe indirect estimations showed higher estimates for U5MR and IMR than the direct estimations. The differentials between IMR estimates were larger than between U5MR estimates, implying the U5MR estimates are more reliable than IMR estimates. The variations in child mortality estimates between provinces highlight the impact of contextual factors on child mortality. The high U5MR estimates were likely associated with inequality in socioeconomic development, limited access to healthcare services, and a result of the measles outbreaks that occurred in the highlands region from 2014-2017.ConclusionThe iHDSS has provided reliable data for the direct and indirect estimations of child mortality at the sub-national level. This data source is complementary to the existing national data sources for monitoring and reporting child mortality in PNG.
Highlights
In 1990, approximately 12 million children died globally before they reached their fifth birthday [1]
This study reports on three key child mortality indicators: (i) neonatal mortality rate (NMR) is the proportion of children dying within the first month of life; (ii) infant mortality rate (IMR) is the proportion of children dying before their first birthday (age at death is between 0 and 11 months; (iii) U5MR is the proportion of children dying before their fifth birthday
Unlike the varied U5MR estimates, IMR estimates were relatively stable with 50 deaths per 1,000 live births for all sites from 2014∼2017, with highest estimates observed in Eastern Highlands Province (EHP) and Hela (∼70–80 per 1,000 live births), and lowest in Central (∼15∼20 per 1,000 live births)
Summary
In 1990, approximately 12 million children died globally before they reached their fifth birthday [1]. In 2000, the United Nations’ Millennium Development Goal 4 (MDG 4) set out a target to reduce child mortality by two-thirds by 2015 [2]. Significant progress in the improvement of child health has been made. There has been a 50% decline in child mortality, from 12.7 million in the 1990’s to 6.3 million in 2013 [3]. To date only 31 countries reported having met the MDG targets for child mortality [4, 5]. Addressing high child mortality remains a global health priority in the United Nations’ Sustainable Development Goals (SDG). Child mortality is an important indication of an effective public health system. Data sources available for the estimation of child mortality in Papua New Guinea (PNG) are limited
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