Monitoring Change in Child Mortality through Household Surveys

Abstract

BackgroundMost low- and middle-income countries lack fully functional civil registration systems. Measures of under-five mortality are typically derived from periodic household surveys collecting detailed information from women on births and child deaths. However, such surveys are expensive and are not appropriate for monitoring short-term changes in child mortality. We explored and tested the validity of two new analysis methods for less-expensive summary histories of births and child deaths for such monitoring in five African countries.Methods and FindingsThe first method we explored uses individual-level survey data on births and child deaths to impute full birth histories from an earlier survey onto summary histories from a more recent survey. The second method uses cohort changes between two surveys in the average number of children born and the number of children dead by single year of age to estimate under-five mortality for the inter-survey period. The first method produces acceptable annual estimates of under-five mortality for two out of six applications to available data sets; the second method produced an acceptable estimate in only one of five applications, though none of the applications used ideal data sets.ConclusionsThe methods we tested were not able to produce consistently good quality estimates of annual under-five mortality from summary birth history data. The key problem we identified was not with the methods themselves, but with the underlying quality of the summary birth histories. If summary birth histories are to be included in general household surveys, considerable emphasis must be placed on quality control.

Testing survey-based methods for rapid monitoring of child mortality, with implications for summary birth history data

“…These results show no improvement from the previous applications of this method [5]. The previous 5 applications to true SBH data across 4 countries, excluding Niger, resulted in estimates with country MAREs ranging from 10% to 24% and an aggregate MARE of 15%, very similar to the values obtained in this expanded analysis.…”

“…This addresses some of the questions raised by the initial tests of the methods detailed in Hill et al [5]. If successful, these methods would allow the rapid estimation of U5MR more cheaply and quickly than current methods, which use large, expensive and infrequent FBH surveys.…”

“…Where the consistency was better, as with the Malawi application of RMM [5] and to a lesser extent the Cameroon and Kenya MICS 2000, the results were notably better, illustrating that the method can work if CEB and CD data of sufficient quality are available.…”

“…An earlier paper [5] describes the methods, and illustrates their application to data collected by or available to the RMM project. In this analysis we apply both methods to new data to assess the performance of the methods under conditions more consistent with the underlying theory.…”

“Real-Time” Monitoring of Under-Five Mortality: Lessons for Strengthened Vital Statistics Systems

“…We assessed accuracy of mortality measures by comparison to household survey data from full birth histories, described in this paper as current best practice. Only three of these applications—reporting of vital events by community-based workers (CBWs) in Mali [ 8 ], and birth history imputation methods in Niger and Malawi [ 9 ]–produced estimates of under-five mortality rates for recent one-year periods that we consider sufficiently accurate and stable to support sound public health decision-making.…”