Continuities and changes in spatial patterns of under-five mortality at the district level in India (1991–2011)

Background India has the largest number of under-five deaths globally, and large variations in under-five mortality persist between states and districts. Relationships between under-five mortality and numerous socioeconomic, development and environmental health factors have been explored at the national and state levels, but the possible spatial heterogeneity in these relationships has seldom been investigated at the district level. This study seeks to unravel local variation in key determinants of under-five mortality based on the 1991 and 2011 censuses. Methods Using geocoded district-level data from the last two census rounds (1991 and 2011) and ordinary least squares and geographically weighted regressions, we identify district-specific relationships between under-five mortality rate and a series of determinants for two periods separated by 20 years (1986–1987 and 2006–2007). To identify spatial groupings of coefficients, we perform a cluster analysis based on t-values of the geographically weighted regression. Results The geographically weighted regression analysis shows that relationships between the under-five mortality rate and factors for socioeconomic, development, and environmental health factors vary spatially in terms of direction, strength, and extent when considering: female literacy and labor force participation; share of scheduled castes and scheduled tribes; access to electricity; safe water and sanitation; road infrastructure; and medical facilities. This spatial heterogeneity is accompanied by significant changes over time in the roles that these factors play in under-five mortality. Important local determinants of under-five mortality in 2011 were female literacy, female labor force participation, access to sanitation facilities and electricity; while the key local determinants in 1991 were road infrastructure, safe water, and medical facilities. We identify six different clusters based on geographically weighted regression coefficients that broadly encompass the same districts in both periods; but these clusters do not follow the regional boundaries suggested by the previous studies. In particular, the high mortality states of India that are often typically classified as high focus states were classified into three different clusters based on the relationship of the factors associated with under-five mortality. Conclusion This study demonstrates the utility of combining geographically weighted regression and cluster analyses as a methodological approach to study local-level variation in public health indicators, and it could be applied in any country using aggregate-level information from census or survey data. Identifying local predictors of under-five mortality is important for designing interventions in specific districts. Additional reduction in under-five mortality will only be possible with intervention programs designed at the local level, which take into consideration local level determinants of under-five mortality

Global, regional, and national mortality trends in older children and young adolescents (5–14 years) from 1990 to 2016: an analysis of empirical data

Summary Background From 1990 to 2016, the mortality of children younger than 5 years decreased by more than half, and there are plentiful data regarding mortality in this age group through which we can track global progress in reducing the under-5 mortality rate. By contrast, little is known on how the mortality risk among older children (5–9 years) and young adolescents (10–14 years) has changed in this time. We aimed to estimate levels and trends in mortality of children aged 5–14 years in 195 countries from 1990 to 2016. Methods In this analysis of empirical data, we expanded the United Nations Inter-agency Group for Child Mortality Estimation database containing data on children younger than 5 years with 5530 data points regarding children aged 5–14 years. Mortality rates from 1990 to 2016 were obtained from nationally representative birth histories, data on household deaths reported in population censuses, and nationwide systems of civil registration and vital statistics. These data were used in a Bayesian B-spline bias-reduction model to generate smoothed trends with 90% uncertainty intervals, to determine the probability of a child aged 5 years dying before reaching age 15 years. Findings Globally, the probability of a child dying between the ages 5 years and 15 years was 7·5 deaths (90% uncertainty interval 7·2–8·3) per 1000 children in 2016, which was less than a fifth of the risk of dying between birth and age 5 years, which was 41 deaths (39–44) per 1000 children. The mortality risk in children aged 5–14 years decreased by 51% (46–54) between 1990 and 2016, despite not being specifically targeted by health interventions. The annual number of deaths in this age group decreased from 1·7 million (1·7 million–1·8 million) to 1 million (0·9 million–1·1 million) in 1990–2016. In 1990–2000, mortality rates in children aged 5–14 years decreased faster than among children aged 0–4 years. However, since 2000, mortality rates in children younger than 5 years have decreased faster than mortality rates in children aged 5–14 years. The annual rate of reduction in mortality among children younger than 5 years has been 4·0% (3·6–4·3) since 2000, versus 2·7% (2·3–3·0) in children aged 5–14 years. Older children and young adolescents in sub-Saharan Africa are disproportionately more likely to die than those in other regions; 55% (51–58) of deaths of children of this age occur in sub-Saharan Africa, despite having only 21% of the global population of children aged 5–14 years. In 2016, 98% (98–99) of all deaths of children aged 5–14 years occurred in low-income and middle-income countries, and seven countries alone accounted for more than half of the total number of deaths of these children. Interpretation Increased efforts are required to accelerate reductions in mortality among older children and to ensure that they benefit from health policies and interventions as much as younger children. Funding UN Children\u27s Fund, Bill & Melinda Gates Foundation, United States Agency for International Development

The epidemiological transition in Antananarivo, Madagascar: an assessment based on death registers (1900–2012)

Background: Madagascar today has one of the highest life expectancies in sub-Saharan Africa, despite being among the poorest countries in the continent. There are relatively few detailed accounts of the epidemiological transition in this country due to the lack of a comprehensive death registration system at the national level. However, in Madagascar's capital city, death registration was established around the start of the 20th century and is now considered virtually complete. Objective: We provide an overview of trends in all-cause and cause-specific mortality in Antananarivo to document the timing and pace of the mortality decline and the changes in the cause-of-death structure. Design: Death registers covering the period 1976–2012 were digitized and the population at risk of dying was estimated from available censuses and surveys. Trends for the period 1900–1976 were partly reconstructed from published sources. Results: The crude death rate stagnated around 30‰ until the 1940s in Antananarivo. Mortality declined rapidly after the World War II and then resurged again in the 1980s as a result of the re-emergence of malaria and the collapse of Madagascar's economy. Over the past 30 years, impressive gains in life expectancy have been registered thanks to the unabated decline in child mortality, despite political instability, a lasting economic crisis and the persistence of high rates of chronic malnutrition. Progress in adult survival has been more modest because reductions in infectious diseases and diseases of the respiratory system have been partly offset by increases in cardiovascular diseases, neoplasms, and other diseases, particularly at age 50 years and over. Conclusions: The transition in Antananarivo has been protracted and largely dependent on anti-microbial and anti-parasitic medicine. The capital city now faces a double burden of communicable and non-communicable diseases. The ongoing registration of deaths in the capital generates a unique database to evaluate the performance of the health system and measure intervention impacts

Adult Mortality from Sibling Survival Data : Does the Corrected Method Perform Better?

Due to the lack of complete registration of deaths in most countries of sub-Saharan Africa, adult mortality is still measured through unconventional techniques. Estimates based on sibling survival have long been deemed implausibly low, but they have received increasing acceptance in recent years. They can provide valuable counterpoints to model-based estimates, which are typically derived from childhood mortality and standard age patterns of mortality. This more optimistic view in the literature is partly due to the work of Gakidou and King (2006). The weighting scheme they suggest to correct for selection biases in sibling histories has been applied to DHS surveys, and it yields much higher estimates than previous calculations based on the same data. After reviewing the main features of this procedure, this paper offers a methodological critique of its application to DHS data. Microsimulations are used to demonstrate that the "Corrected Sibling Survival" method may substantially overestimate mortality rates, especially among males

Sibship Sizes and Family Sizes in Survey Data Used to Estimate Mortality

Survey data on sibling survival provide a crucial source of information for estimating adult mortality in countries where vital records are incomplete. This article assesses the quality of these data by comparing sibship sizes reported in Demographic and Health Surveys with women’s mean number of children ever born in the previous generation. This comparison, conducted at aggregate level, suggests that a high proportion of siblings are omitted, since the sibship sizes are 15% lower, on average, than would be expected on the basis of number of children ever born. Such omissions are more frequent in sub-Saharan Africa than in other developing regions, and their extent increases slightly with the respondents’ age. Adult mortality deduced from these data is not necessarily underestimated, however, since omissions appear to mainly concern siblings who died in childhood

Orphelins et VIH-sida en Afrique subsaharienne : l'intérêt des microsimulations

Plus de trois décennies après les premiers moments de la diffusion du VIH-sida, de nombreux pays africains font face à des épidémies matures, et voient leur prévalence baisser ou se stabiliser. Par contre, en raison de la longue période d'incubation du VIH, la diminution du nombre d'infections ne se traduit pas directement par une baisse des risques de mortalité aux âges adultes. Ce maintien sur une longue durée de niveaux de mortalités élevées et fortement concentrés aux premiers âges adultes a profondément modifié les structures par âge des populations, la composition des ménages, ou encore les mouvements entre communautés rurales et urbaines. Par ce biais, le VIH-sida a redistribué les cartes des échanges intergénérationaux. Cette communication est axée sur les orphelins et leurs grands parents, à partir d’un modèle de microsimulation calibré sur les projections démographiques des Nations Unies et des estimations de l’ONUSIDA. L'objectif consiste à documenter les effets de l'épidémie sur le nombre et la structure par âge des orphelins, ainsi que sur les soutiens dont ils peuvent disposer dans leur famille proche

Estimation de la mortalité adulte en Afrique subsaharienne à partir de la survie des proches : apports de la microsimulation

Adult mortality in Sub-Saharan Africa remains a neglected issue in the realm of population studies. Due to the lack of civil registration systems, risks of dying in adulthood still need to be estimated from defective and deficient data. Among these data, the survival of parents and siblings, as collected in censuses and surveys, can be used to reconstruct past trends in mortality. This PhD dissertation combines reports on kin survival with microsimulations to revisit methodological aspects of the estimation of adult mortality. The main selection biases of kin survivorship statistics are discussed, alongside problems of data quality. Recent estimates of the probability of dying between ages 15 and 60 are also presented. Overall, this dissertation highlights the considerable heterogeneity of mortality in Sub-Saharan Africa, where adult mortality rates vary up to threefold from one country to another, mainly because of the differential impact of the HIV/AIDS epidemic.(DEMO 3) -- UCL, 201

Mortality between ages 5 and 15

Across the world, around one million children aged between 5 and 15 years died in 2017. For a child on its fifth birthday, the risk of dying before reaching its fifteenth birthday is 7.2 per 1,000. This is five times lower than the risk for a newborn of dying before age 5 (39 per 1,000). Mortality between ages 5 and 15 halved between 1990 and 2017, and most deaths in this age group now occur in low- and middle-income countries. In 2017, one-third of all deaths were concentrated in West and Central Africa, where the probability of dying at these ages is more than 20 times higher than in Western Europe

Estimating mortality based on maternal orphanhood in populations with HIV: a simulation study

In countries lacking comprehensive systems of death registration, adult mortality rates are regularly estimated from parental survival through the orphanhood method. The HIV epidemic has introduced breaches in assumptions underpinning this method, for example due to increased correlation between maternal and child survival. This study evaluates the magnitude of HIV-related bias in orphanhood-based estimates and introduces new adjustments. A set of 576 populations with substantial mortality from AIDS are generated with microsimulations. Orphanhood estimates are compared to the underlying mortality levels. Revised coefficients to convert proportions of respondents with surviving parents into survivorship probabilities are calculated and applied to survey and census data from 16 African countries facing severe HIV epidemics. Without adjustment for HIV-related biases, the orphanhood method produces downward-biased mortality levels, with mean percentage errors reaching 37% in reports from young children aged 5-14 in simulations. Unbiased mortality rates can be obtained by combining two sets of proportions of parents surviving, and using revised coefficients accounting for trends in seroprevalence and coverage of antiretroviral therapy. In most countries with large HIV epidemics, this new approach provides estimates that are in agreement with those of the United Nations. Orphanhood-based estimates can fill data gaps on adult mortality in low- and middle-income countries, including those with high HIV prevalence. Further research is needed to correct for biases in male mortality inferred from paternal orphanhood