Child Mortality Estimation Research Articles

Inadequate evidence on stillbirths: rethinking public health

Rates of stillbirths are an indicator of the quality of care around pregnancy and birth. They are increasingly a matter of global health concern, falling within the remit of the Sustainable Development Goal 3 (maternal health), which aims to end preventable deaths of newborn babies and children younger than 5 years by 2030. However, stillbirths continue to be a particular challenge in most low-income and middle-income countries (LMICs), especially in sub-Saharan Africa, 1 Kiguli J Munabi IG Ssegujja E et al. Stillbirths in sub-Saharan Africa: unspoken grief. Lancet. 2016; 387: e16-18 Summary Full Text Full Text PDF PubMed Scopus (22) Google Scholar where more than 0·8 million deaths have been estimated to occur annually. 2 Hug L You D Blencowe H et al. Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment. Lancet. 2021; 398: 772-785 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar Researchers have regularly brought attention to stillbirths and urged for maternal and newborn health policies. 3 UN Inter-agency Group for Child Mortality EstimationLevels and trends in child mortality: report 2018, estimates developed by United Nations Inter-agency Group for Child Mortality Estimation. United Nations International Children's Emergency Fund, New York, NY2020 Google Scholar , 4 Lawn JE Blencowe H Waiswa P et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016; 387: 587-603 Summary Full Text Full Text PDF PubMed Scopus (669) Google Scholar , 5 Waiswa P Akuze J Moyer C et al. Status of birth and pregnancy outcome capture in health demographic surveillance sites in 13 countries. Int J Public Health. 2019; 64: 909-920 Crossref PubMed Scopus (6) Google Scholar Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessmentProgress in reducing the rate of stillbirths has been slow compared with decreases in the mortality rate of children younger than 5 years. Accelerated improvements are most needed in the regions and countries with high stillbirth rates, particularly in sub-Saharan Africa. Future prevention of stillbirths needs increased efforts to raise public awareness, improve data collection, assess progress, and understand public health priorities locally, all of which require investment. Full-Text PDF Open Access

Cherish your children: socio-economic and demographic characteristics associated with child mortality

BackgroundThe United Nations Interagency Group for Child Mortality Estimation (UNIGME) indicates that child mortality is the death rate of children between age zero to five. The importance of this area of research is high where worldwide a number of studies have been led on infant and child mortality, despite limited research discoveries with regards to Sri Lanka. The aim of this study is to investigate the socio-economic and demographic characteristics associated with child mortality in Sri Lanka.MethodsUsing the context of Sri Lanka as a case study, this study carried out based on data gathered from the micro level national survey. Using the logit regression model through the step-wise technique, the study investigate the socio-economic and demographic characteristics associated with child mortality in Sri Lanka.ResultsAccording to the generated results, place of residence province-wise, household head’s education level and source of drinking water have negative effect (lower risk) on child mortality in Sri Lanka. Exceptionally, the Western province has the highest negative effect on child mortality which demonstrates it as the least harmful region in Sri Lanka in child endurance. Household heads who owns private entities and Sri Lankan Moors has a positive effect on child mortality as well.ConclusionThis study is helpful to address the population health of local arena and results can be supportive to the government and policymakers to gain an overview of physical health status of the country and able to uplift their policies based on the new findings.

Potentially Avertable Child Mortality Associated with Surgical Workforce Scale-up in Low- and Middle-Income Countries: A Global Study.

Expansion of access to surgical care can improve health outcomes, although the impact that scale-up of the surgical workforce will have on child mortality is poorly defined. In this study, we estimate the number of child deaths potentially avertable by increasing the surgical workforce globally to meet targets proposed by the Lancet Commission on Global Surgery. To estimate the number of deaths potentially avertable through increases in the surgical workforce, we used log-linear regression to model the association between surgeon, anesthetist and obstetrician workforce (SAO) density and surgically amenable under-5 mortality rate (U5MR), infant mortality rate (IMR), and neonatal mortality rate (NMR) for 192 countries adjusting for potential confounders of childhood mortality, including the non-surgical workforce (physicians, nurses/midwives, community health workers), gross national income per capita, poverty rate, female literacy rate, health expenditure per capita, percentage of urban population, number of surgical operations, and hospital bed density. Surgically amenable mortality was determined using mortality estimates from the UN Inter-agency Group for Child Mortality Estimation adjusted by the proportion of deaths in each country due to communicable causes unlikely to be amenable to surgical care. Estimates of mortality reduction due to upscaling surgical care to support the Lancet Commission on Global Surgery (LCoGS) minimum target of 20-40 SAO/100,000 were calculated accounting for potential increases in surgical volume associated with surgical workforce expansion. Increasing SAO workforce density was independently associated with lower surgically amenable U5MR as well as NMR (p < 0.01 for each model). When accounting for concomitant increases in surgical volume, scale-up of the surgical workforce to 20-40 SAO/100,000 could potentially prevent between 262,709 (95% CI 229,643-295,434) and 519,629 (465,046-573,919) under 5 deaths annually. The majority (61%) of deaths averted would be neonatal deaths. Scale up of surgical workforce may substantially decrease childhood mortality rates around the world. Our analysis suggests that scale-up of surgical delivery through increase in the SAO workforce could prevent over 500,000 children from dying before the age of 5 annually. This would represent significant progress toward meeting global child mortality reduction targets.

Correlation of Caesarean Section Rates to Maternal and Neonatal Mortality in the Eastern Mediterranean Region; A Population-Based Ecological Study

Purpose: This study aims to explore the relationship between population-level caesarean section rates (CSRs) with maternal and neonatal mortality rates (MMR, NMR) in the Eastern Mediterranean Region (EMR). Design: A populationbased ecological study was performed with data obtained from the World Health Organization, Global Health Observatory database, 2015, United Nations Inter-agency Group for Child Mortality Estimation (UN-IGME) and the United Nations Maternal Mortality Estimation Inter-Agency Group (UN-MMEIG) 2015). Mean ± standard deviation (SD), range, median and Interquartile range (IQR) were used to describe the quantitative data. We performed multivariate logistic regression analysis to explore the effect (a) of (a) Antenatal clinic visits (ANC %), (b), Skilled Birth Attendance (SBA) rate (% of deliveries attended by SBA), (c) Total Health Expenditure (THE) per capita and (d) Female Literacy Rate (FLR%) on the studied relationship. Spline linear regression was used to find the most predictive variable for MMR, and the NMR. Statistical significance was accepted at P&lt;0.05. Results: The mean CSR was 21.20±13.38, (1.8-52). The CSR of &lt;10% was linked with the highest NMR and MMR, 33.0 (24.0-39.0) and 390.5(329.5-648.0) respectively. The most predictable variables for NMR and MMR were SBA % [B=-0.875; p&lt; .001; R2=0.766 and adjusted R2=0.754] and FLR (F=15-24) [B=0.877; P&lt;0.001; R2=0.77 and adjusted R2=0.758] respectively. Conclusions: We found a statistically significant inverse relationship between CSRs and maternal and neonatal mortality in MSs with &lt;10% of CSR. The improved mortality rates in MSs with &gt;15% of CSR were significantly linked with better socioeconomic and healthcare variables than higher CSRs. Keywords: Caesarean Section, Maternal and Neonatal Mortality, Eastern Mediterranean Region.

Mexican mortality 1990‒2016: Comparison of unadjusted and adjusted estimates

Background: Vital statistics registration and census counts for Mexico may be incomplete, resulting in unreliable mortality indicators. Objective: We evaluate unadjusted mortality estimates for Mexico during 1990‒2016 and compare them with other published estimates for Mexico and with the historical mortality patterns observed among the 41 Human Mortality Database (HMD) populations. Finally, we investigate the effect of various adjustments on estimated life expectancy. Methods: We apply the HMD methodology to the official vital statistics and census counts to construct unadjusted life table series for Mexico. Then we make adjustments by substituting revised estimates for child mortality and by fitting a log-quadratic model. Results: Adjusted estimates of mortality below age 5 derived by the UN Inter-agency Group for Child Mortality Estimation (IGME) are up to 48% higher than our unadjusted estimates. Even in 2015, the IGME-adjusted estimates of child mortality remain at least 10% higher than our unadjusted estimates. Our analysis suggests that there may also be underestimation of mortality at both prime adult ages and the oldest ages. The log-quadratic model produced the lowest estimates of life expectancy at birth (3.8‒4.4 years lower than the unadjusted values in 1995). Conclusions: Unadjusted estimates are likely to underestimate mortality in Mexico, even in recent years. Adjustments may improve the accuracy of the mortality estimates, but we cannot adjudicate which set of adjusted estimates is closest to reality. Contribution: This is the first time the HMD methodology has been applied to the Mexican data.

A Critique of Infant Mortality Estimates in India

Background: Brass developed a procedure for converting proportions dead of children ever born reported by women in childbearing ages into estimates of the probability of dying before attaining certain exact childhood ages. The method has become very popular in less developed countries where direct mortality estimation is not possible due to incomplete death registration. However, the estimates of q(x), the probability of dying before age x, obtained by Trussell's variant of Brass method are sometimes unrealistic, q(x) being not monotonically increasing for increasing x.Method: State level child mortality estimates obtained by Trussell's variant of Brass method from 1991 and 2001 Indian census data were made monotonically increasing by logit smoothing. Using two of the smoothed child mortality estimates, infant mortality estimate is obtained by fitting a two parameter Weibull survival function.Results: It has been found that in many states and union territories infant mortality rates have increased between 1991 and 2001. Cross checking with the 1991 and 2001 census data on the increase/decrease of percentage of children died establishes the reliability of the estimates.Conclusion: We have reason to suspect the trend of declining infant mortality as shown by the different agencies and researchers.

Patterns and trends in causes of child and adolescent mortality 2000–2016: setting the scene for child health redesign

The under-5 mortality rate has declined from 93 deaths per 1000 live births in 1990 to 39 per 1000 live births in 2018. This improvement in child survival warrants an...

Global, regional, and national mortality trends in youth aged 15–24 years between 1990 and 2019: a systematic analysis

SummaryBackgroundThe global health community is devoting considerable attention to adolescents and young people, but risk of death in this population is poorly measured. We aimed to reconstruct global, regional, and national mortality trends for youths aged 15–24 years between 1990 and 2019.MethodsIn this systematic analysis, we used all publicly available data on mortality in the age group 15–24 years for 195 countries, as compiled by the UN Inter-agency Group for Child Mortality Estimation. We used nationally representative vital registration data, estimated the completeness of death registration, and extracted mortality rates from surveys with sibling histories, household deaths reported in censuses, and sample registration systems. We used a Bayesian B-spline bias-reduction model to generate trends in 10q15, the probability that an adolescent aged 15 years would die before reaching age 25 years. This model treats observations of the 10q15 probability as the product of the actual risk of death and an error multiplier that varies depending on the data source. The main outcome that we assessed was the levels of and trends in youth mortality and the global and regional mortality rates from 1990 to 2019.FindingsGlobally, the probability of an individual dying between age 15 years and 24 years was 11·2 deaths (90% uncertainty interval [UI] 10·7–12·5) per 1000 youths aged 15 in 2019, which is about 2·5 times less than infant mortality (28·2 deaths [27·2–30·0] by age 1 year per 1000 live births) but is higher than the risk of dying from age 1 to 5 (9·7 deaths [9·1–11·1] per 1000 children aged 1 year). The probability of dying between age 15 years and 24 years declined by 1·4% per year (90% UI 1·1–1·8) between 1990 and 2019, from 17·1 deaths (16·5–18·9) per 1000 in 1990; by contrast with this total decrease of 34% (27–41), under-5 mortality declined by 59% (56–61) in this period. The annual number of deaths declined from 1·7 million (90% UI 1·7–1·9) in 1990 to 1·4 million (1·3–1·5) in 2019. In sub-Saharan Africa, the number of deaths increased by 20·8% from 1990 to 2019. Although 18·3% of the population aged 15–24 years were living in sub-Saharan Africa in 2019, the region accounted for 37·9% (90% UI 34·8–41·9) of all worldwide deaths in youth.InterpretationIt is urgent to accelerate progress in reducing youth mortality. Efforts are particularly needed in sub-Saharan Africa, where the burden of mortality is increasingly concentrated. In the future, a growing number of countries will see youth mortality exceeding under-5 mortality if current trends continue.FundingUN Children's Fund, Bill & Melinda Gates Foundation, United States Agency for International Development.

The Global Burden of Meningitis in Children: Challenges with Interpreting Global Health Estimates.

The World Health Organization (WHO) has developed a global roadmap to defeat meningitis by 2030. To advocate for and track progress of the roadmap, the burden of meningitis as a syndrome and by pathogen must be accurately defined. Three major global health models estimating meningitis mortality as a syndrome and/or by causative pathogen were identified and compared for the baseline year 2015. Two models, (1) the WHO and the Johns Hopkins Bloomberg School of Public Health’s Maternal and Child Epidemiology Estimation (MCEE) group’s Child Mortality Estimation (WHO-MCEE) and (2) the Institute for Health Metrics and Evaluation (IHME) Global Burden of Disease Study (GBD 2017), identified meningitis, encephalitis and neonatal sepsis, collectively, to be the second and third largest infectious killers of children under five years, respectively. Global meningitis/encephalitis and neonatal sepsis mortality estimates differed more substantially between models than mortality estimates for selected infectious causes of death and all causes of death combined. Estimates at national level and by pathogen also differed markedly between models. Aligning modelled estimates with additional data sources, such as national or sentinel surveillance, could more accurately define the global burden of meningitis and help track progress against the WHO roadmap.

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.

Age patterns of under-5 mortality in sub-Saharan Africa during 1990-2018: A comparison of estimates from demographic surveillance with full birth histories and the historic record.

BACKGROUNDEstimates of under-5 mortality (U5M) for sub-Saharan African populations often rely heavily on full birth histories (FBHs) collected in surveys and model age patterns of mortality calibrated against vital statistics from other populations. Health and Demographic Surveillance Systems (HDSSs) are alternate sources of population-based data in much of sub-Saharan Africa, which are less formally utilized in estimation.OBJECTIVEIn this study we compare the age pattern of U5M in different African data sources (HDSSs, Demographic and Health Surveys (DHS), and Multiple Indicator Cluster Surveys (MICS)), and contrast these with the historical record as summarized in the Human Mortality Database and model age patterns.METHODSWe examined the relative levels of neonatal, postneonatal, infant, and child mortality across data sources. We directly compared estimates for DHS and MICS subnational regions with HDSS, and used linear regression to identify data and contextual attributes that correlated with the disparity between estimates.RESULTSHDSS and FBH data suggests that African populations have higher levels of child mortality and lower infant mortality than the historic record. This age pattern is most explicit for Western African populations, but also characterizes data for other subregions. The comparison between HDSS and FBH data suggests that FBH estimates of child mortality are biased downward. The comparison is less conclusive for neonatal and infant mortality.CONTRIBUTIONThis study questions the practice of using model age patterns derived from largely high-income settings for inferring or correcting U5M estimates for African populations. It also highlights the considerable uncertainty around the consistency of HDSS and FBH estimates of U5M.

Newborns and Under-5 Mortality in Ethiopia: The Necessity to Revitalize Partnership in Post-COVID-19 Era to Meet the SDG Targets.

The Sustainable Development Goals (SDGs) were adopted during the United Nations meeting in 2015 to succeed Millennium Development Goals. Among the health targets, SDG 3.2 is to end preventable deaths of newborns and children under 5 years of age by 2030. These 2 targets aim to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births. Ethiopia is demonstrating a great reduction in child mortality since 2000. In the 2019 child mortality estimation which is nearly 5 years after SDGs adoption, Ethiopia’s progress toward reducing the newborns and under-5 mortality lie at 27 and 50.7 per 1000 live births, respectively. The generous financial and technical support from the global partners have helped to achieve such a significant reduction. Nevertheless, the SDG targets for newborns and under-5 mortality reduction are neither attained yet nor met the national plan to achieve by the end of 2019/2020. The partnership dynamics during COVID-19 crisis and the pandemic itself may also be taken as an opportunity to draw lessons and spur efforts to achieve SDG targets. This urges the need to reaffirm a comprehensive partnership and realignment with other interconnected development goals. Therefore, collective efforts with strong partnerships are required to improve the determinants of child health and achieving SDG target reduction until 2030.

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.

The burden of anthropometric failure and child mortality in India

The public health burden of nutritional deficiency and child mortality is the major challenge India is facing upfront. In this context, using National Family Health Survey, 2015–16 data, this study estimated rate of composite index of anthropometric failure (CIAF) among Indian children by their population characteristics, across states and examined the multilevel contextual determinants. We further investigated district level burden of infant and child mortality in terms of multiple anthropometric failure prevalence across India. The multilevel analysis confirms a significant state, district and PSU level variation in the prevalence of anthropometric failures. Factors like- place of residence, household’s economic wellbeing, mother’s educational attainment, age, immunization status and drinking water significantly determine the different forms of multiple anthropometric failures. Wealth status of the household and mother’s educational status show a clear gradient in terms of the estimated odds ratios. The district level estimation of infant and child mortality demonstrates that districts with higher burden of multiple anthropometric failures show elevated risk of infant and child mortality. Unlike previous studies, this study does not use the conventional indices, instead considered the CIAF to identify the exact and severe form of undernutrition among Indian children and the associated nexus with infant and child mortality at the district level.

Precision-weighted estimates of neonatal, post-neonatal and child mortality for 640 districts in India, National Family Health Survey 2016.

BackgroundThe conventional indicators of infant and under-five mortality are aggregate deaths occurring in the first year and the first five years, respectively. Monitoring deaths by <1 month (neonatal), 1-11 months (post-neonatal), and 12-59 months (child) can be more informative given various etiological causes that may require different interventions across these three mutually exclusive periods. For optimal resource allocation, it is also necessary to track progress in robust estimates of child survival at a smaller geographic and administrative level.MethodsData on 259 627 children came from the 2015-2016 Indian National Family Health Survey. We used a random effects model to account for the complex survey design and sampling variability, and predicted district-specific probabilities of neonatal, post-neonatal, and child mortality. The resulting precision-weighted estimates are more reliable as they pool information and borrow strength from other districts that share the same state membership. The Pearson correlation and Spearman’s rank correlation were assessed for the three mortality estimates, and the Moran’s I measure was used to detect spatial clustering of high burden districts for each outcome.ResultsThe majority of under-five deaths was disproportionately concentrated in the neonatal period. Across all districts, the predicted probability of neonatal, post-neonatal, and child mortality varied from 6.0 to 63.9 deaths, 3.8 to 47.6 deaths, and 1.7 to 11.8 deaths per 1000 live births, respectively. The overall correlation between district-wide probabilities of mortality for the three mutually exclusive periods was moderate (Pearson correlation = 0.47-0.58, Spearman’s rank correlation = 0.58-0.64). For each outcome, a relatively strong spatial clustering was detected across districts that transcended state boundaries (Moran’s I = 0.61-0.76).ConclusionsSufficiently breaking down the under-five mortality to distinct age groups and using the precision-weighted estimations to monitor performances at smaller geographic and administrative units can inform more targeted interventions and foster accountability to improve child survival.

Health workforce and health-related sustainable development goals from 1990 to 2018 in China: a retrospective study based on national statistical data

BackgroundThe health workforce has vital roles in protecting and promoting the health of the population, given that it is a prerequisite of health care. Reducing maternal mortality, neonatal mortality, and under-5 mortality are three important health-related sustainable development goals (SDGs). To my knowledge, no study has yet analysed the importance of the health workforce for health-related SDGs in China on the basis of multiple-year national statistical data. I aimed to achieve this with the present study. MethodsUnivariate linear regression analyses were done with maternal mortality ratios, neonatal mortality, and under-five mortality as dependent variables. Aggregate density of health technicians was an independent variable in one set of regressions. Doctor and nurse densities were separately used in two other sets. All variables were transformed into natural logarithms. Statistical data for these variables covered 1990–2018 and were extracted from the China Health Statistics Yearbook 2019, WHO, and the UN Inter-agency Group for Child Mortality Estimation. The study was approved by the ethics committee of the School of Medicine of Xi’an Jiaotong University (number 2014189). FindingsDensity of health technicians was significant in accounting for maternal mortality ratio, neonatal mortality, and under-5 mortality (with elasticities ranging from –1·219 to –2·400, all p-values <0·0001). The elasticities of the three types of mortality with respect to doctor and nurse densities ranged from –1·643 to –3·227 (p=0·00012 for maternal mortality ratio, p<0·0001 for neonatal mortality, and p<0·0001 for under-5 mortality) and from –0·766 to –1·471 (all p-values <0·0001). InterpretationThe density of the health workforce is important in accounting for variation in maternal mortality ratio, neonatal mortality, and under-5 mortality in China. The effect of this density in reducing child mortality is greater than it is in reducing maternal mortality in China, possibly because qualified health technicians can better address the illnesses that put children at risk. Doctor density has a greater effect than nurse density in reducing all the three mortality types, possibly because of a greater of specialisation of doctors. Investment in the health workforce should always be part of a strategy to achieve health-related SDGs in China. FundingMajor Programme of National Social Science Fund of China: Research on Disease Prevention and Healthy China Construction (17ZDA079).

Leveraging the COVID-19 response to end preventable child deaths from pneumonia

Leveraging the COVID-19 response to end preventable child deaths from pneumonia

Indirect estimation of child mortality using 2011 census data in the Islamic Republic of Iran.

Child mortality rates are considered to be one of the key indicators of child health. The main objective of this research was to calculate child mortality rates (CMRs) indirectly, using census data, and to investigate using spatial pattern analysis the presence of any clustering patterns among provincial regions. The Trussell version of the Brass method and Coale-Demeny West model were used to estimate CMRs and life expectancy (LE) at birth. The analyses were performed using the QFive program of MORTPAK 4 software. For cluster analysis, local and global Moran's I indexes were measured. Infant mortality rate, under-5 mortality rate, 1-4 mortality rate and LE at birth were estimated as 21.9, 26, 4.1 (deaths per 1000 live births) and 72.1 years, respectively. Global Moran's I index was calculated as 0.09, 0.09, 0.08 and 0.12, respectively. Special attention must be paid in provinces with high clusters regarding the evaluation of public health programmes, and the cause of failure of these programmes in reduction of childhood mortality indices.

Child Mortality Transition in the Arabian Gulf: Wealth, Health System Reforms, and Development Goals.

Background: Child mortality is the most crucial indicator of national progress and a reflection of not only the health system performance but also the wealth (budget) utilization and goal achievements. Many developing nations have recorded progress in this dimension but those of the Arabian Gulf (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates) show remarkable progress and achievements.Methods: Using the latest update of United Nations Inter-agency Group for Child Mortality Estimation 2017, an attempt is made here to review and appraise their achievements in child mortality reduction since 1950s taking into account Under 5 mortality, infant mortality, and neonatal mortality.Results: This review finds a rapid decline in child mortality in the Arabian Gulf in a short span of 50 years, which is in line with the achievement of Sustainable Development Goals.Conclusions: There is a remarkable budget allocation and investment in health system building, improving the other contributing sectors like water, sanitation, hygiene, nutrition, and life style modifications apart from the usual health care interventions.

Indirect estimation of infant mortality in small areas

The Brass-type indirect methods of early-age mortality estimation have been used for more than four decades, providing very robust estimates for countries without reliable vital registration systems. However, when estimation areas become smaller, the number of dead children could be very small, especially among those born to young women, who provide essential information to estimate recent mortality. In these cases, estimates could be affected by random errors and unexpected annual fluctuations. At the same time, although it is very unlikely that demographic trends in a small area would follow patterns very different from those prevailing in the broader environment they belong to, it is possible that some local events may become relevant to small areas, causing some deviations from the assumptions that may hold true to the larger area. The objective of this paper is to propose an adaptation of the indirect estimation approach, which would allow obtaining infant and child mortality estimates for small areas. As such, this proposal belongs to the realm of indirect estimation methods, sharing the limitations and advantages that characterize this type of estimation procedures. The method is illustrated with data from the 2014 Population and Housing Census of Myanmar. The results indicate that the method proposed here provides reliable and consistent infant mortality estimates, compared to the original Brass’ method, even in very small areas.