UNDER-5 MORTALITY ESTIMATION IN HUMANITARIAN EMERGENCIES: A COMPARISON OF ESTIMATION METHODOLOGIES USING MICROSIMULATION

Abstract

Complex humanitarian emergencies are characterized by increases in mortality, mass migration, and collapse of infrastructure. Demographic estimation on under-5 mortality in these settings is generally conducted using household surveys. Indirect methods of estimation, collected using summary birth histories, have clear advantages over complete birth histories, as they are faster and require less training to implement. It is unclear, however, how well the analytic techniques developed for summary birth histories perform when mortality patterns fluctuate. Using the Socsim simulation program, one baseline and four emergency scenarios were developed and each was simulated 100 times. Two methods of indirect estimation for child mortality - the Brass methodology and the IHME methodology - and the direct method of under-5 mortality estimation were applied to assess how quickly each method was able to detect rapid changes in mortality, how well the method was able to estimate the underlying level of mortality, and for how long after the crisis period ended the method was affected by the increase in mortality. In general, none of the indirect methods performed well. The Brass method, though able to detect abrupt changes in mortality is inadequate because of its reliance on a reference period. The IHME methods, though able to estimate mortality for the survey year, were generally not able to accurately estimate the level of mortality change in situations with extreme changes. In situations of fluctuating mortality, all indirect methods smoothed fluctuations, eliminating the ability to estimate excess deaths due to conflict. Although more time-consuming, if under-5 mortality is of primary interest, complete birth histories and direct estimation should be used