Under-five mortality in The Gambia: Comparison of the results of the first demographic and health survey with those from existing inquiries.

Anne J Rerimoi,Anna Roca,Ian M Timæus,Momodou Jasseh,Schadrac C Agbla,Georges Reniers

doi:10.1371/journal.pone.0219919

Abstract

BackgroundIn The Gambia, national estimates of under-five mortality (U5M) were from censuses and multiple indicator cluster surveys (MICS). The country’s first demographic and health survey (DHS) conducted in 2013 provided empirical disaggregated national estimates of neonatal, post-neonatal and child mortality trends.ObjectiveTo assess the consistency and accuracy of the estimates of U5M from the existing data sources and its age-specific components in rural Gambia and produce reliable up-to-date estimates.MethodsAvailable national data on under-five mortality from 2000 onwards were extracted. Additionally, data from two DHS regions were compared to those from two health and demographic surveillance systems (HDSS) located within them. Indirect and direct estimates from the data were compared and flexible parametric survival methods used to predict mortality rates for all empirical data points up to 2015.FindingsInternal consistency checks on data quality for indirect estimation of U5M suggest that the data were plausible at national level once information from women aged 15–19 years was excluded. The DHS and HDSS data used to make direct U5M estimates were plausible, however HDSS data were of better quality. For 2009–2013, the DHS estimates agreed well with the 2013 census and 2010 MICS reports of U5M but was less accurate about the early births of older women. The most recent estimates from the 2013 DHS, which refer to 2011–12, are an U5M rate of 54/1000 livebirths (95% CI: 43–64) and a neonatal mortality rate of 21/1000 livebirths (95% CI: 15–27), contributing almost 40% of U5M in The Gambia. The DHS showed that for the decade prior to the survey, child mortality dropped by 55% and neonatal mortality by 31%. This indicates the importance of neonatal mortality in The Gambia, and the need to focus on neonatal survival, while maintaining currently successful strategies to further reduce U5M.

Highlights

Under-five mortality is an important indicator of a population’s health and is strongly related to structural factors such as economic status, social wellbeing and environmental factors [1,2,3]
Proportions dead of children ever born were higher for the 15-19-year age group than the 20-24-year age group for the multiple indicator cluster surveys (MICS) in 2000 and 2010
In Basse, the demographic and health survey (DHS) and MICS showed instances of lower proportions dead of children ever born in older age groups

Summary

Introduction

Under-five mortality is an important indicator of a population’s health and is strongly related to structural factors such as economic status, social wellbeing and environmental factors [1,2,3]. Global targets to reduce under-five mortality by two-thirds between 1990 and 2015 were set as part of the Millennium Development Goals. This target was not achieved by 2015, global under-five mortality was halved [2]; and some African countries registered significant gains in child survival [4, 5]. The new Sustainable Development Goals (SDGs) have set a target of reducing neonatal (NMR) and under-five mortality rates by 2030 to 12 and 25 deaths per 1000 livebirths, respectively [6]. The country’s first demographic and health survey (DHS) conducted in 2013 provided empirical disaggregated national estimates of neonatal, post-neonatal and child mortality trends

Methods

Results

Discussion

Conclusion