Child Mortality Data Research Articles

Suitable survival models for analyzing infant and child mortality data

Suitable survival models for analyzing infant and child mortality data

The Hispanic paradox in child maltreatment: Does it fade over time?

BackgroundThe “Hispanic Paradox” refers to a commonly noted tendency for Hispanic immigrants to have good health outcomes relative to risks faced. This paper demonstrates the presence of the Hispanic Paradox relative to child maltreatment, with a focus on how it appears to “fade” generationally. ObjectivesTo use national child maltreatment and census data to determine if the protective effects of the Hispanic Paradox are weaker (“fade”) for counties with fewer foreign-born Hispanics. DesignCensus data, including the percentage of Hispanics in a county who were foreign-born, was used to predict child maltreatment rates as observed in the National Child Abuse and Neglect Data System. The analysis was done at a county level and included a number of covariates (e.g. Hispanic Median Income, Rural/Urban status…). Participants and settingWe included national child maltreatment data at the county level. ResultsA negative binomial mixed effects model showed that for each point of increase in the percentage of the Hispanic foreign-born population of a county, the county Hispanic child maltreatment rate was expected to drop by 1 %. Variation in Hispanic national origin (i.e. Puerto Rico) was found to significantly moderate this relationship. ConclusionCounties with higher percentages of foreign-born Hispanics have lower child maltreatment rates after controlling for other factors. This is consistent with emerging findings in the child mortality data and suggests that for child maltreatment, the Hispanic Paradox may fade generationally.

Problems accessing health care and under-5 mortality: a pooled analysis of 50 low- and middle-income countries.

Access to health care remains suboptimal in low- and middle-income countries (LMICs) and continues to hinder survival in early childhood. We systematically assessed the association between problems accessing health care (PAHC) and under-five mortality (U5M). Child mortality data on 724 335 livebirths came from the latest Demographic and Health Surveys of 50 LMICs (2013-2021). Reasons for PAHC were classified into three domains: 'money needed for treatment' (economic), 'distance to health facility' (physical), 'getting permission' or 'not wanting to go alone' (socio-cultural). Multivariable logistic regression was used to estimate the association between PAHC (any and by each type) and U5M. In our pooled sample, 47.3 children per 1000 livebirths died before age of 5, and 57.1% reported having experienced PAHC (ranging from 45.3% in Europe & Central Asia to 72.7% in Latin America & Caribbean). Children with any PAHC had higher odds of U5M (OR: 1.05, 95% CI: 1.02, 1.09), and this association was especially significant in sub-Saharan Africa. Of different domains of PAHC, socio-cultural PAHC was found to be most significant. Access to health care in LMICs needs to be improved by expanding health care coverage, building health facilities, and focusing more on context-specific socio-cultural barriers.

Epidemic characteristics and trend analysis of major injuries deaths among children and adolescents in Jiangsu Province from 2012 to 2021

Objective: To understand the situation and epidemic characteristics of injury deaths among children aged 5 to 24 years in Jiangsu Province from 2012 to 2021 and the trend of annual changes. Methods: The main injury mortality data of children and adolescents was collected, and the crude and standardized mortality rates of road traffic accidents, drowning, suicide, and accidental falls among children and adolescents over a decade and the annual average percentage of change (AAPC) were calculated. The main injury mortality characteristics and trends of children and adolescents of different age groups and genders were analyzed. Results: The total number of injury deaths among 5 to 24 adolescents in Jiangsu Province was 16 052, with a standardized mortality rate of 9.58/100 000. There was no significant trend in the overall standardized mortality rate of injuries (AAPC=-3.450%, P=0.055). The standardized mortality rate of road traffic injuries among children and adolescents showed a decreasing trend over the past decade, with statistical significance (AAPC=-9.406%, P<0.001). The standardized suicide mortality rate showed an upward trend over the past decade, with statistical significance (AAPC=9.000%, P=0.001). The overall injury mortality rate showed an upward trend with age. Suicide rates in males and females were on the rise and both have statistical significance (AAPC=9.420% and AAPC=9.607%, both P<0.05). The standardized mortality rates of female traffic accidents, drowning, and male traffic accidents showed a decreasing trend and were statistically significant (AAPC for female traffic accidents=-7.364%, AAPC for female drowning=-5.352%, and AAPC for male traffic accidents=-10.242%, all P<0.05). The standardized mortality rate of urban and rural traffic accidents showed a decreasing trend and was statistically significant(AAPC=-7.899% and AAPC=-9.421%, both P<0.001). The standardized suicide mortality rate showed an upward trend and statistical significance (AAPC=11.009% and AAPC=7.528%, both P<0.05). Conclusions: The overall injury situation of children and adolescents in Jiangsu Province improved in the past decade from 2012 to 2021, but the suicide mortality rate was on the rise. It is necessary to focus on the mental health issues of this age group and to strengthen the prevention and control of suicide among children and adolescents, in Jiangsu.

Global vaccine coverage and childhood survival estimates: 1990-2019.

To quantify the association between reduction in child mortality and routine immunization across 204 countries and territories from 1990 to 2019. We used child mortality and vaccine coverage data from the Global Burden of Disease Study. We used a modified child survival framework and applied a mixed-effects regression model to estimate the reduction in deaths in children younger than 5years associated with eight vaccines. Between 1990 and 2019, the diphtheria-tetanus-pertussis (DTP), measles, rotavirus and Haemophilus influenzae type b vaccines were significantly associated with an estimated 86.9 (95% confidence interval, CI: 57.2 to 132.4) million fewer deaths in children younger than 5years worldwide. This decrease represented a 24.2% (95% CI: 19.8 to 28.9) reduction in deaths relative to a scenario without vaccines. The DTP and measles vaccines averted 46.7 (95% CI: 30.0 to 72.7) million and 37.9 (95% CI: 25.4 to 56.8) million deaths, respectively. Of the total reduction in child mortality associated with vaccines, 84.2% (95% CI: 83.0 to 85.1) occurred in 73 countries supported by Gavi, the Vaccine Alliance, with an estimated 45.4 (95% CI: 29.8 to 69.2) million fewer deaths from 2000 to 2019. The largest reductions in deaths associated with these four vaccines were in India, China, Ethiopia, Pakistan and Bangladesh (in order of the size of reduction). Vaccines continue to reduce childhood mortality significantly, especially in Gavi-supported countries, emphasizing the need for increased investment in routine immunization programmes.

Causes of preventable death among children of female sex worker mothers in low- and middle-income countries: A community knowledge approach investigation.

Female sex workers (FSW) in low- and middle-income countries (LMIC) are disproportionately vulnerable to poor health, social, and economic outcomes. The children of female sex workers (CFSW) experience health risks based on these challenging circumstances and the unique conditions to which they are exposed. Although country child mortality data exist, little is known about the causes of death among CFSW specifically, thereby severely limiting an effective public health response to the needs of this high-risk group of children. The Community Knowledge Approach (CKA) was employed between January and October 2019 to survey a criterion sample of 1280 FSW participants across 24 cities in eight LMIC countries. Participants meeting pre-determined criteria provided detailed reports of deaths among the CFSW within their community of peers. Newborn deaths were gleaned from FSW maternal death reports where the infants also died following birth. Of the 668 child deaths reported, 589 were included in the analysis. Nutritional deficiencies comprised the leading cause of mortality accounting for 20.7% of deaths, followed closely by accidents (20.0%), particularly house fires, overdoses (19.4%), communicable diseases (18.5%), and homicides (9.8%). Other reported causes of death included neonatal conditions, respiratory illnesses, and suicides. The causes of CFSW death in these eight countries are preventable with improved protections. Governments, intergovernmental organisations like the United Nations, nongovernmental stakeholder organisations (e.g. sex worker organisations), and funders can implement targeted policies and programmes to protect CFSW and assist vulnerable FSW who are pregnant and raising children. Further research is needed to identify effective child welfare safeguards for CFSW.

An Inflated Modelling of Zero Truncated Poisson Ailamujia Distribution and Its Application to Child Mortality and Genetics Count Data

In this paper, an attempt has been made to develop a model as Inflated form of zero truncated Poisson Ailamujia distribution. The proposed model involved two parameters, estimated by the maximum likelihood estimation method and derived as an expression of the Fisher Information Matrix. To evaluate the adequacy and applicability of the proposed model, it is applied to real data sets on child mortality and genetic count data.

Modelling the Linear and Nonlinear Effects of Malaria Risk Factors on Child Mortality

Generalized additive model was used to analyse data from Nigeria standard demographic and health survey (NDHS) 2018. The sample consists of 10609 children aged 6-59 months who were tested for malaria parasitemia through the rapid diagnostic test (RDT). Child mortality data was obtained by calculating the difference between the number of children ever born and the proportion of children alive during the survey. The analysis was carried out in R version 4.1.1 via mgcv package. The results obtained indicated linear and nonlinear effects of malaria risk factors on child mortality. The findings also revealed mosquito bed net usage, wealth index, maternal education, type of place of residence and malaria test outcome as significant predictors of child malaria mortality.

Problems in accessing health care and child survival in 49 low- and middle-income countries

Abstract Background Access to health care remains suboptimal in many LMICs and continues to hinder children's survival. We aimed to systematically assess the association between problems accessing health care (PAHC) and U5M at the global-, regional-, and country level. Methods Data came from the latest Demographic and Health Surveys of 49 LMICs (2013-2021). Child mortality data were available on 721,658 live births born to mothers aged 15-49 years within the five years preceding the survey. Three domains of PAHC were defined for women who identified the following reasons as PAHC for themselves when they are sick: “money needed for treatment” (economic), “distance to health facility” (physical), “getting permission” or “not wanting to go alone” (socio-cultural). Multivariable logistic regression models were used to estimate the association between PAHC (any and by each type) and U5M. Results In our pooled sample, 4.7% of children died before age of five and 58.4% of mothers reported experiencing PAHC (ranging from 43.2% in Europe &amp; Central Asia to 71.0% in Latin America &amp; Caribbean). Economic PAHC was the most prevalent (42.7%), followed by physical (36.9%) and socio-cultural (35.2%). After adjusting for a comprehensive set of covariates, children of mothers with any PAHC had higher odds of U5M (OR: 1.05, 95% CI: 1.01, 1.08), and this association was especially significant in Sub-Saharan Africa. Of the different domains of PAHC, socio-cultural PAHC was found to have the strongest association with U5M. Conclusions Our findings suggest the need to improve access to health care in LMICs by expanding health care coverage, building health facilities, and focusing more on context-specific socio-cultural barriers to encompass marginalised populations. Key messages • More than half of mothers in low-and middle-income countries had problems accessing health care, and it was associated with increased risk of under-five mortality in children. • To improve child survival in low-and middle-income countries, economic, physical, and socio-cultural barriers to health care should be improved.

A Shared Frailty Model for Left-Truncated and Right-Censored Under-Five Child Mortality Data in South Africa

Many African nations continue to grapple with persistently high under-five child mortality rates, particularly those situated in the Sub-Saharan region, including South Africa. A multitude of socio-economic factors are identified as key contributors to the elevated under-five child mortality in numerous African nations. This research endeavors to investigate various factors believed to be associated with child mortality by employing advanced statistical models. This study utilizes child-level survival data from South Africa, characterized by left truncation and right censoring, to fit a Cox proportional hazards model under the assumption of working independence. Additionally, a shared frailty model is applied, clustering children based on their mothers. Comparative analysis is performed between the results obtained from the shared frailty model and the Cox proportional hazards model under the assumption of working independence. Within the scope of this analysis, several factors stand out as significant contributors to under-five child mortality in the study area, including gender, birth province, birth year, birth order, and twin status. Notably, the shared frailty model demonstrates superior performance in modeling the dataset, as evidenced by a lower likelihood cross-validation score compared to the Cox proportional hazards model assuming independence. This improvement can be attributed to the shared frailty model’s ability to account for heterogeneity among mothers and the inherent association between siblings born to the same mother, ultimately enhancing the quality of the study’s conclusions.

Social protection and the level and inequality of child mortality in 101 low- and middle-income countries: A statistical modelling analysis.

BackgroundExpanding social protection programme is a major target of the Sustainable Development Goals. Previous studies provided evidence for the relationship of social protection programme to greater use of health services and some improved health outcomes for children. Yet, its impact on child mortality has not been clearly revealed. In this study, we examined the association between social protection programmes and child mortality.MethodsWe obtained child mortality data from 379 nationally representative surveys involving 101 low- and middle-income countries (LMICs). We included five child mortality outcomes in the study, which were neonatal mortality rate (NMR), post-neonatal mortality rate (PMR), childhood mortality rate (CMR), infant mortality rate (IMR), and under-5 mortality rate (U5MR). We extracted data on social protection programmes from multiple data sources (eg, Atlas of Social Protection Indicators of Resilience and Equity). Social protection and labour programme (SPL) was the major type of social protection we included. We also included four subtypes of SPL - social assistance, cash transfer, social insurance, and labour market protection. Both unadjusted and adjusted regressions were conducted to measure the associations between characteristics of social protection programmes and child mortality, as well as inequalities in child mortality.ResultsAmong the 101 countries, the median coverage rate of SPL was 28.5%, with an interquartile range between 6.5% and 55.2%. Using the adjusted model, we found a one-percentage-point increase in SPL coverage is associated with a reduction of 0.09 (95% confidence interval (CI) = 0.04, 0.14) per 1000 live births in NMR, 0.11 (95% CI = 0.04, 0.18) in PMR, and 0.25 (95% CI = 0.11, 0.38) in CMR. Social assistance programme was the only subtype of SPL to be significantly associated with lower mortality rates. A higher SPL coverage was associated with better equity in child mortality – as the coverage of SPL increased by one percentage point, the concentration index of CMR would increase by 0.08 (95% CI = 0.03, 0.13) in the adjusted model, suggesting an improvement in equity.ConclusionsThe strong association between social protection programme and child mortality suggests that to achieve the SDG targets of universal social protection and to reduce child mortality, LMICs shall consider prioritizing the expansion of social protection programmes.

Neonatal and child mortality data in retrospective population-based surveys compared with prospective demographic surveillance: EN-INDEPTH study

BackgroundGlobal mortality estimates remain heavily dependent on household surveys in low- and middle-income countries, where most under-five deaths occur. Few studies have assessed the accuracy of mortality data or determinants of capturing births in surveys.MethodsThe Every Newborn-INDEPTH study (EN-INDEPTH) included a large, multi-country survey of women aged 15–49 interviewed about livebirths and their survival status in five Health and Demographic Surveillance Systems (HDSSs). The HDSSs undertake regular household visits to register births and deaths for a given population. We analysed EN-INDEPTH survey data to assess background factors associated with not recalling a complete date-of-birth. We calculated Kaplan-Meier survival estimates for both survey and HDSS data and describe age-at-death distributions during the past 5 years for children born to the same women. We assessed the proportion of HDSS-births that could be matched on month-of-birth to survey-births and used regression models to identify factors associated with matching.Results69,176 women interviewed in the survey reported 109,817 births and 3064 deaths in children under 5 years in the 5 years prior to the survey. In the HDSS data, the same women had 83,768 registered births and 2335 under-five deaths in the same period. A complete date-of-birth was not reported for 1–7% of survey-births. Birthdates were less likely to be complete for dead children and children born to women of higher parity or with little/no education. Distributions of reported age-at-death indicated heaping at full weeks (neonatal period) and at 12 months. Heaping was more pronounced in the survey data. Survey estimates of under-five mortality rates were similar to HDSS estimates of under-five mortality in two of five sites, higher in the survey in two sites (15%, 41%) and lower (24%) in one site. The proportion of HDSS-births matched to survey-births ranged from 51 to 89% across HDSSs and births of children who had died were less likely to be matched.ConclusionsMortality estimates in the survey and HDSS were not markedly different for most sites. However, neither source is a “gold standard” and both sources miss some events. Research is required to improve capture and accuracy to better track newborn and child survival targets.

Harmonizing child mortality data at disparate geographic levels.

There is an increasing focus on reducing inequalities in health outcomes in developing countries. Subnational variation is of particular interest, with geographically-indexed data being used to understand the spatial risk of detrimental outcomes and to identify who is at greatest risk. While some health surveys provide observations with associated geographic coordinates (point data), many others provide data that have their locations masked and instead only report the strata (polygon information) within which the data resides (masked data). How to harmonize these data sources for spatial analysis has been previously considered although only ad hoc methods and comparison of methods is lacking. In this paper, we present a new method for analyzing masked survey data, using a method that is consistent with the data-generating process. In addition, we critique two previously proposed approaches to analyzing masked data and illustrate that they are fundamentally flawed methodologically. To validate our method, we compare our approach with previously formulated solutions in several realistic simulation environments in which the underlying structure of the risk field is known. We simulate samples from spatiotemporal fields in a way that mimics the sampling frame implemented in the most common health surveys in low- and middle-income countries, the Demographic and Health Surveys and Multiple Indicator Cluster Surveys. In simulations, the newly proposed approach outperforms previously proposed approaches in terms of minimizing error while increasing the precision of estimates. The approaches are subsequently compared using child mortality data from the Dominican Republic where our findings are reinforced. The ability to accurately increase precision of child mortality estimates, and health outcomes in general, by leveraging various types of data, improves our ability to implement precision public health initiatives and better understand the landscape of geographic health inequalities.

Vitamin A supplementation and estimated number of averted child deaths in Ethiopia: 15 years in practice (2005-2019).

Vitamin A supplementation (VAS), started as a short‐term strategy pending dietary improvements, has been implemented in Ethiopia for the last 15 years. We aimed to describe the trends in VAS coverage and estimated the associated reductions in child mortality. VAS coverage data obtained from the District Health Information System and the Demographic and Health Surveys were linked to child mortality data from the United Nations Interagency Group for Child Mortality Estimation (UN IGME). The number of child deaths averted was modelled assuming 12% and 24% reductions in all‐cause mortality. From 2006 to 2011, VAS was delivered through campaigns, and coverage was above 85%. However, from 2011 onwards, VAS delivery was integrated to the routine health system, and the coverage declined to <60% with significant disparities by wealth quintile and rural–urban residence. VAS has saved between 167,563 to 376,030 child lives (2005–2019), but additional lives (>42,000) could have been saved with a universal coverage (95%). Inconsistent supply of vitamin A capsules, but more importantly, low access to health care, and the limited contact opportunities for children after 24 months may have contributed to the declining VAS coverage. Any changes in target or scale‐up should thus consider these spatial and socioeconomic variations. Increasing the coverage of VAS and closing the equity gap in access to nutrition services is critical. However, with alternative programmes like vitamin A fortification being set‐up, the benefits and safety of VAS need to be closely monitored, particularly in areas where there will be overlap.

Child mortality levels and trends: A new compositional approach

Trend analysis of child mortality is vital to evaluate countries’ progress towards achieving the Sustainable Development Goal on health (SDG 3). However, strictly speaking, child mortality data are probabilities, and thus subject to non-negativity and cons

Child health research and planning in Europe disadvantaged by major gaps and disparities in published statistics.

Population data, such as mortality and morbidity statistics, are essential for many reasons, including giving context for research, supporting action on health determinants, formulation of evidence-based policy for health care and outcome evaluation. However, when considering children, it is difficult to find such data, despite children comprising one-fifth of the European population and being in a key formative life stage and dependent on societal support. Moreover, it would be expected that there should be confidence in the key child health data available, with little to no discrepancy between recognized health statistic databases. This study explored the main health databases in or including Europe to collate child mortality data, for both all-cause and specific-cause mortality. Tables were constructed for comparison of values and rankings. The results show that there are major differences in reported mortality data between two prominent health statistic databases, difference in coding systems, and unannounced changes within one of the databases. The lack of health data for children seems compounded by challenges to the trust and credibility, which are vital if these data are to have utility. Children and society are the losers, and resolution is needed as a priority.

Trend Analysis of Mortality Rates for Leading Causes of Death Among Under-Five Children in Iran, 2000 - 2015

Background: This secondary study is the first to assess the trend of mortality rate and its variations among Iranian children. Methods: The mortality data of under-five children were extracted from the WHO reports. All-cause and cause-specific mortality rates were calculated per 1000 live births and by age groups for each year from 2000 to 2015. The average annual rate of reduction (AARR) was used to determine the changes in mortality rates. Results: Of 21011 under-five children who died in 2015, 52.3% were attributed to infectious causes. The overall mortality rate among children under five years decreased from 35 per 1000 live births in 2000 to 16 per 1000 live births in 2015, representing a decline of 55.5% over the 16-year period with an AARR of 5.5%. There was a significant decreasing trend in the mortality rates of all causes except for HIV/AIDS and pertussis. Conclusions: The overall all-cause mortality rate decreased from 2000 to 2015 in Iran although this pattern varied according to the causes of death. There is still a relatively high proportion of mortality rates among children due to congenital anomalies, prematurity, birth asphyxia, sepsis, and acute lower respiratory infections. Keywords: Mortality Rate, Children, Infant, Iran

The status of drowning in 1 to 5-month-old children outside the hospital, Tabriz between 2013 and 2017

Background: Out of all types of accidents, falling into water, immersion and the resulting drowning, are among the unintentional accidents in children which can be prevented. The purpose of this study was to investigate the status of drowning of children aged 1 to 59 months outside hospital in Tabriz from 2013 to 2017. Methods: In this descriptive cross-sectional study, the mortality data of children and referrals from suburban cities affiliated to Tabriz University of Medical Sciences were investigated. Results: Of 14 reported deaths in children due to drowning, three cases (21%) were drowned in the swimming pool/traditional Iranian pool (howz), four cases (29%) due to flood, and seven cases (50%) in natural water resources and rivers. Sixty percent of deaths had occurred in rural and 40% in urban areas. The most common age was 12 months to 4 years old. Conclusions: Since children under the age of 5 and especially between the ages of 1-4 years old were the groups with the highest risk of drowning, this age group should be focused for prevention strategies, by fencing the pools, preventing children from playing under the bridges and on the way of flood, and not leaving them alone.

Validation of verbal autopsy methods for assessment of child mortality in sub-Saharan Africa and the policy implication: a rapid review.

Reliable data on the cause of child death is the cornerstone for evidence-informed health policy making towards improving child health outcomes. Unfortunately, accurate data on cause of death is essentially lacking in most countries of sub-Saharan Africa due to the widespread absence of functional Civil Registration and Vital Statistics (CRVS) systems. To address this problem, verbal autopsy (VA) has gained prominence as a strategy for obtaining Cause of Death (COD) information in populations where CRVS are absent. This study reviewed publications that investigated the validation of VA methods for assessment of COD. A MEDLINE PubMed search was undertaken in June 2018 for studies published in English that investigated the validation of VA methods in sub-Saharan Africa from 1990-2018. Of the 17 studies identified, 9 fulfilled the study inclusion criteria from which additional five relevant studies were found by reviewing their references. The result showed that Physician-Certified Verbal Autopsy (PCVA) was the most widely used VA method. Validation studies comparing PCVA to hospital records, expert algorithm and InterVA demonstrated mixed and highly varied outcomes. The accuracy and reliability of the VA methods depended on level of healthcare the respondents have access to and the knowledge of the physicians on the local disease aetiology and epidemiology. As the countries in sub-Saharan Africa continue to battle with dysfunctional CRVS system, VA will remain the only viable option for the supply of child mortality data necessary for policy making.

Themes emerging from State of Child Health: UK and Australia

Some 20 years ago, it was suggested to the relatively newly established Royal College that it might be advisable to develop a regular report on the health of children of...