Multiple Indicator Cluster Surveys Data Dissemination - Further Analysis Workshop

Mortality

MICS4 Data Dissemination and Further Analysis Workshop

Background• Child mortality: Probabilities of dying during the first 5 years of life,

usually broken down by conventional age segments

• Infant (first one year) and under-5 mortality rates (first 5 years) are the most commonly calculated probabilities

Periods for Under-5 Mortality Measurement

Neonatal Mortality

(First month)

Post-Neonatal Mortality (1-11 months)

Child Mortality (1 to 4 years)

Infant Mortality (Birth to One Year)

Under-5 Mortality (0-4 Years)

Birth 1 5

Background• MDG 4: reduce under-5 mortality by two-thirds, between

1990 and 2015– Indicator 1.3 – Under-5 Mortality Rate– Indicator 1.4 – Infant Mortality Rate

• Both indicators are measured in MICS surveys

• Child mortality indicators are broad indicators of social development/health status

• Used to evaluate impact of interventions based on trends

Measurement of child mortality

Data Sources

• Vital registration• Population censuses• Surveillance systems, sample registration systems• Household surveys

– Direct: Data from full birth histories, as in DHS and some MICS surveys

– Indirect: Data from summary birth histories, to use “Brass methods”

– Note that surveys that include birth histories can be used both for direct and indirect estimation

Methods: Direct method

•Based on birth histories

•Required data:– Data of birth for each child (month and year)– Survival status– Date or age at death for each child who has died

•Typically, synthetic cohort life table approach used to estimate rates

Methods: Direct method

• Rely heavily on the quality of information collected – work best in populations where dates and durations are well-known

• Sources of errors:– Omission of births and deaths– Misreporting of age at death (age heaping at 12 months is

common)– Birth misplacement

Age heaping: child’s death at 12 months

Niger DHS06 - Age at death in months

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

0 2 4 6 8 10 12 14 16 18 20 22 24 26

Months

Pe

rce

nt o

f d

ea

ths

1-2

3 m

on

ths

Linear trendline

Niger: Births by year, DHS06

0

500

1000

1500

2000

2500

3000

1996 1998 2000 2002 2004 2006

Year

Nu

mb

ers

LivingDeadTotal

Questions on under-5s for all births after January 2001

Age shifting: common issue in DHS

Check denominators for:Less than 250 cases *250-499 cases ( )

0-4 5-9 10-14 15-19 20-24

Mean Mean Mean Mean Mean

0 620.26 504.88 445.41 348.55 201.48

1-2 63.04 110.23 77.51 73.39 87.22

3-5 89.22 82.81 71.63 46.55 26.91

6-11 99.64 166.7 151.27 121.36 33.94

12-23 208.61 242.33 169.82 175.52 98.35

24-35 244.79 209.71 208.98 164.71 90.18

36-47 144.69 133.63 107.73 69.09 30.93

48-59 84.05 74.16 49.9 34.12 18.01

0 13920.14 11978.53 9302.7 6793.22 3910.57

1-2 13237.43 11624.09 8735.32 6359.38 3549.13

3-5 12969.53 11611.1 8495.96 6170.02 3277.48

6-11 12610.69 11262.74 8346.37 5903.85 3176.58

12-23 12296.12 10425.94 7958.39 5335.74 2964.97

24-35 11917.43 9526.55 7284.85 4659.14 2480.25

36-47 11361.23 8756.18 6587.17 4033.44 1997.63

48-59 10698 8153.75 6035.32 3489.87 1671.45

0 44.56 42.15 47.88 51.31 51.52

1-2 4.76 9.48 8.87 11.54 24.58

3-5 6.88 7.13 8.43 7.54 8.21

6-11 7.9 14.8 18.12 20.56 10.69

12-23 16.97 23.24 21.34 32.89 33.17

24-35 20.54 22.01 28.69 35.35 36.36

36-47 12.73 15.26 16.35 17.13 15.48

48-59 7.86 9.1 8.27 9.78 10.77

Exposure Age in months

Probability Age in months

Table CM.0: Early childhood mortality rates

Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year periods preceding the survey, (Total), 2010

Periods of analysis of 5 years

Deaths Age in months

Neonatal mortality

0-4 5-9 10-14 15-19 20-24

Mean Mean Mean Mean Mean

0 620.26 504.88 445.41 348.55 201.48

1-2 63.04 110.23 77.51 73.39 87.22

3-5 89.22 82.81 71.63 46.55 26.91

6-11 99.64 166.7 151.27 121.36 33.94

12-23 208.61 242.33 169.82 175.52 98.35

24-35 244.79 209.71 208.98 164.71 90.18

36-47 144.69 133.63 107.73 69.09 30.93

48-59 84.05 74.16 49.9 34.12 18.01

0 13920.14 11978.53 9302.7 6793.22 3910.57

1-2 13237.43 11624.09 8735.32 6359.38 3549.13

3-5 12969.53 11611.1 8495.96 6170.02 3277.48

6-11 12610.69 11262.74 8346.37 5903.85 3176.58

12-23 12296.12 10425.94 7958.39 5335.74 2964.97

24-35 11917.43 9526.55 7284.85 4659.14 2480.25

36-47 11361.23 8756.18 6587.17 4033.44 1997.63

48-59 10698 8153.75 6035.32 3489.87 1671.45

0 44.56 42.15 47.88 51.31 51.52

1-2 4.76 9.48 8.87 11.54 24.58

3-5 6.88 7.13 8.43 7.54 8.21

6-11 7.9 14.8 18.12 20.56 10.69

12-23 16.97 23.24 21.34 32.89 33.17

24-35 20.54 22.01 28.69 35.35 36.36

36-47 12.73 15.26 16.35 17.13 15.48

48-59 7.86 9.1 8.27 9.78 10.77

Exposure Age in months

Probability Age in months

Table CM.0: Early childhood mortality rates

Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year periods preceding the survey, (Total), 2010

Periods of analysis of 5 years

Deaths Age in months

0-4 5-9 10-14 15-19 20-24

Mean Mean Mean Mean Mean

0 620.26 504.88 445.41 348.55 201.48

1-2 63.04 110.23 77.51 73.39 87.22

3-5 89.22 82.81 71.63 46.55 26.91

6-11 99.64 166.7 151.27 121.36 33.94

12-23 208.61 242.33 169.82 175.52 98.35

24-35 244.79 209.71 208.98 164.71 90.18

36-47 144.69 133.63 107.73 69.09 30.93

48-59 84.05 74.16 49.9 34.12 18.01

0 13920.14 11978.53 9302.7 6793.22 3910.57

1-2 13237.43 11624.09 8735.32 6359.38 3549.13

3-5 12969.53 11611.1 8495.96 6170.02 3277.48

6-11 12610.69 11262.74 8346.37 5903.85 3176.58

12-23 12296.12 10425.94 7958.39 5335.74 2964.97

24-35 11917.43 9526.55 7284.85 4659.14 2480.25

36-47 11361.23 8756.18 6587.17 4033.44 1997.63

48-59 10698 8153.75 6035.32 3489.87 1671.45

0 44.56 42.15 47.88 51.31 51.52

1-2 4.76 9.48 8.87 11.54 24.58

3-5 6.88 7.13 8.43 7.54 8.21

6-11 7.9 14.8 18.12 20.56 10.69

12-23 16.97 23.24 21.34 32.89 33.17

24-35 20.54 22.01 28.69 35.35 36.36

36-47 12.73 15.26 16.35 17.13 15.48

48-59 7.86 9.1 8.27 9.78 10.77

Exposure Age in months

Probability Age in months

Table CM.0: Early childhood mortality rates

Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year periods preceding the survey, (Total), 2010

Periods of analysis of 5 years

Deaths Age in months

Post-neonatal mortalityInfant mortality

0-4 5-9 10-14 15-19 20-24

Mean Mean Mean Mean Mean

0 620.26 504.88 445.41 348.55 201.48

1-2 63.04 110.23 77.51 73.39 87.22

3-5 89.22 82.81 71.63 46.55 26.91

6-11 99.64 166.7 151.27 121.36 33.94

12-23 208.61 242.33 169.82 175.52 98.35

24-35 244.79 209.71 208.98 164.71 90.18

36-47 144.69 133.63 107.73 69.09 30.93

48-59 84.05 74.16 49.9 34.12 18.01

0 13920.14 11978.53 9302.7 6793.22 3910.57

1-2 13237.43 11624.09 8735.32 6359.38 3549.13

3-5 12969.53 11611.1 8495.96 6170.02 3277.48

6-11 12610.69 11262.74 8346.37 5903.85 3176.58

12-23 12296.12 10425.94 7958.39 5335.74 2964.97

24-35 11917.43 9526.55 7284.85 4659.14 2480.25

36-47 11361.23 8756.18 6587.17 4033.44 1997.63

48-59 10698 8153.75 6035.32 3489.87 1671.45

0 44.56 42.15 47.88 51.31 51.52

1-2 4.76 9.48 8.87 11.54 24.58

3-5 6.88 7.13 8.43 7.54 8.21

6-11 7.9 14.8 18.12 20.56 10.69

12-23 16.97 23.24 21.34 32.89 33.17

24-35 20.54 22.01 28.69 35.35 36.36

36-47 12.73 15.26 16.35 17.13 15.48

48-59 7.86 9.1 8.27 9.78 10.77

Exposure Age in months

Probability Age in months

Table CM.0: Early childhood mortality rates

Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year periods preceding the survey, (Total), 2010

Periods of analysis of 5 years

Deaths Age in months

Child mortality

0-4 5-9 10-14 15-19 20-24

Mean Mean Mean Mean Mean

0 620.26 504.88 445.41 348.55 201.48

1-2 63.04 110.23 77.51 73.39 87.22

3-5 89.22 82.81 71.63 46.55 26.91

6-11 99.64 166.7 151.27 121.36 33.94

12-23 208.61 242.33 169.82 175.52 98.35

24-35 244.79 209.71 208.98 164.71 90.18

36-47 144.69 133.63 107.73 69.09 30.93

48-59 84.05 74.16 49.9 34.12 18.01

0 13920.14 11978.53 9302.7 6793.22 3910.57

1-2 13237.43 11624.09 8735.32 6359.38 3549.13

3-5 12969.53 11611.1 8495.96 6170.02 3277.48

6-11 12610.69 11262.74 8346.37 5903.85 3176.58

12-23 12296.12 10425.94 7958.39 5335.74 2964.97

24-35 11917.43 9526.55 7284.85 4659.14 2480.25

36-47 11361.23 8756.18 6587.17 4033.44 1997.63

48-59 10698 8153.75 6035.32 3489.87 1671.45

0 44.56 42.15 47.88 51.31 51.52

1-2 4.76 9.48 8.87 11.54 24.58

3-5 6.88 7.13 8.43 7.54 8.21

6-11 7.9 14.8 18.12 20.56 10.69

12-23 16.97 23.24 21.34 32.89 33.17

24-35 20.54 22.01 28.69 35.35 36.36

36-47 12.73 15.26 16.35 17.13 15.48

48-59 7.86 9.1 8.27 9.78 10.77

Exposure Age in months

Probability Age in months

Table CM.0: Early childhood mortality rates

Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year periods preceding the survey, (Total), 2010

Periods of analysis of 5 years

Deaths Age in months

Under-5 mortality

Estimates from direct methodTable CM.1: Early childhood mortality rates

Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year periods preceding the survey, (Total)

Neonatal mortality rate [1]

Post-neonatal mortality rate [2]

Infant mortality rate [3]

Child mortality rate [4]

Under five mortality rate [5]

Periods of analysis of 5 years

0-4 44.56 18.55 63.11 56.89 116.41

5-9 42.15 29.79 71.94 67.88 134.94

10-14 47.88 33.36 81.24 72.69 148.03

15-19 51.31 37.15 88.46 92.03 172.35

20-24 51.52 40.71 92.23 92.63 176.32

C1 MICS Survey

1985.00 1990.00 1995.00 2000.00 2005.00 2010.000

50

100

150

200

250

Direct estimates of U5MR

Methods: Indirect method•Required data

– Age of women– The total number of children she has ever borne, and– The number of those children who have died (or, the

number who are still alive)

•Require relatively fewer information than direct method

Indirect methodTable CM.1: Children ever born, children surviving and proportion dead

Mean and total numbers of children ever born, children surviving and proportion dead by age of women, Country, 2010

Mean number

of children

ever born

Total number

of children

ever born

Mean number children surviving

Total number

of children surviving

Proportion dead

Number of

womenAge 15-19 .286 1316 .267 1229 .082 4601

20-24 1.255 4732 1.107 4175 .123 3770

25-29 2.522 8287 2.160 7100 .149 3286

30-34 3.743 8339 3.202 7132 .145 2228

35-39 5.026 10654 4.105 8703 .185 2120

40-44 5.772 8421 4.669 6812 .192 1459

45-49 6.407 8138 5.016 6372 .217 1270

Total 2.663 49887 2.216 41523 .170 18734

Methods: Indirect method

• Distributes children ever born to women retrospectively over time using models

• Assumes– Little or no change in fertility levels and age patterns– No change or a linear decline in mortality– A pattern of mortality by age that conforms to known model life table

“families” which basically derived from European experience

Methods: Indirect method (3)

Converts proportion dead of children ever born (D(i)) reported by women in age groups 15-19, 20-24, etc. into estimates of probability of dying before attaining certain exact childhood ages, q(x):

q(x) = K(i)*D(i)

where the multiplier K(i) is meant to adjust for non mortality factors determining the value of D(i)

MICS4 Workshop

Methods: Indirect method•The age pattern of child mortality --- select the right model life table

– Coale-Demeny patterns by region: • East, North, South, and West

– United Nations patterns by region: • Latin America, Chilean, South Asian, Far Eastern, and General

Select the right model life table: India

Indirect method

Check denominators

Table CM.1: Children ever born, children surviving and proportion dead Mean and total numbers of children ever born, children surviving and

proportion dead by age of women, Country, 2010

Mean number

of children

ever born

Total number

of children

ever born

Mean number children surviving

Total number

of children surviving

Proportion dead

Number of

womenAge 15-19 .286 1316 .267 1229 .082 4601

20-24 1.255 4732 1.107 4175 .123 3770

25-29 2.522 8287 2.160 7100 .149 3286

30-34 3.743 8339 3.202 7132 .145 2228

35-39 5.026 10654 4.105 8703 .185 2120

40-44 5.772 8421 4.669 6812 .192 1459

45-49 6.407 8138 5.016 6372 .217 1270

Total 2.663 49887 2.216 41523 .170 18734

Indirect method

Coale-Demeny Models (Trussel equations)

Mean children

ever born

Proportion children dead of

born Age iQ(i)

Northt(i)

NorthQ(i)

Southt(i)

SouthAge group

15-19 .286 .082 1 .071 1.4 .068 1.3

20-24 1.255 .123 2 .116 2.7 .122 2.7

25-29 2.522 .149 3 .140 4.4 .150 4.5

30-34 3.743 .145 5 .144 6.4 .149 6.6

35-39 5.026 .185 10 .196 8.5 .194 8.9

40-44 5.772 .192 15 .201 10.9 .197 11.5

45-49 6.407 .217 20 .223 13.7 .220 14.5

Indirect method

Under-five Mortality Rate(Male)

Reference date North

Under-five

Mortality Rate North

Reference date South

Under-five

Mortality Rate South

Reference date East

Under-five

Mortality Rate East

Reference date West

Age group

15-19 2009.0 .111 2009.0 .087 2009.0 .097 2009.0

20-24 2007.7 .150 2007.7 .142 2007.6 .140 2007.7

25-29 2006.0 .161 2005.9 .161 2005.8 .158 2005.8

30-34 2004.0 .144 2003.8 .149 2003.6 .147 2003.7

35-39 2001.8 .169 2001.5 .181 2001.3 .178 2001.5

40-44 1999.4 .162 1998.9 .178 1998.7 .175 1999.0

45-49 1996.6 .166 1995.9 .187 1995.5 .186 1996.1

MICS Survey

1985.00 1990.00 1995.00 2000.00 2005.00 2010.000

20

40

60

80

100

120

140

160

180

Indirect estimates

Final estimates

• As the “final” or “most recent” estimate, we use an average of estimates based on women age 25-29 and 30-34

• Ignore estimates based on women age 15-19 and 20-24: selection bias

C1: “Final” estimates

Infant

Mortality Rate [1]

Under-five Mortality Rate

[2]Sexo Masculin

o111 162

Feminino

98 146

Region SAB 87 119Leste 130 207Northe 104 153Sul 83 112

Area de residência

Urbano 93 131Rural 110 167

Quintil de riqueza

Mais rico 114 174Segundo 116 179Meio 104 154Quarto 102 149Mais pobre

69 89

Total 105 155

Data quality issues• Main errors in data on children ever born and children

dead/surviving– Omission of deaths– Misreporting of women’s age

• Other drawbacks– Violation of assumptions– Use model life tables to adjust the data for the age pattern of

mortality in the general population --- Inappropriate model life table may results in mis-estimation of trends.

Checking quality of mortality estimates

• Compare child mortality across sub-groups• Expected patterns by sex, background characteristics

• Check estimates from successive data sources

Compare CEB, CS, CD data

Age in 2000

Mean Number of Children Ever Born

Mean Number of Children Surviving

Mean Number of Children Deceased

2000 2006 2010 2000 2006 2010 2000 2006 20105-9 0.2860 0.2671 0.0189

10-14 0.6542 1.2551 0.5396 1.1073 0.1145 0.1478

15-19 0.5028 1.7176 2.5216 0.4255 1.4191 2.1605 0.0773 0.2985 0.3612

20-24 1.7158 3.3253 3.7432 1.4058 2.6190 3.2016 0.3100 0.7063 0.5416

25-29 3.3431 4.6799 5.0258 2.6323 3.6527 4.1055 0.7108 1.0272 0.9203

30-34 4.9895 5.8593 5.7723 3.8199 4.3312 4.6691 1.1696 1.5281 1.1032

35-39 6.1893 6.4765 6.4072 4.5381 4.7859 5.0164 1.6512 1.6906 1.3907

40-44 6.9033 6.7208 4.9685 4.6518 1.9349 2.0690

45-49 7.2666 5.1520 2.1146

Quality check: sample size

• Sample size needs to be sufficiently large to produce statistically reliable estimates of infant and under-five mortality

• Mortality data may carry wide confidence intervals

• Number of births and deaths for children of women aged 15-19 is often very small, thus have effects on the parity ratio and on the regression used to derive estimation equations, therefore may bias the indirect estimates

For further analysis

• Compare estimates from different sources• Analyze mortality by coverage indicators• Check age patterns of mortality (from direct

method), compare with model patterns• Multivariate analyses

The IGME Work

Members of the IGME

• UN Inter-agency Group for Child Mortality Estimation (IGME) was formed in 2004, led by UNICEF, WHO, and includes members of UN Population Division and The World Bank

• Technical Advisory Group (TAG) of the IGME– Independent– Composed of leading experts in demography and

biostatistics– Provide technical guidance on estimation methods,

technical issues and strategies for data analysis and data quality assessment

Objectives of the IGME

• Objectives of the IGME– Harmonize estimates within the UN system– Improve methods for child mortality estimation– Produce consistent estimates of child mortality

worldwide for reporting on progress towards MDG 4

– Enhance the capacity of countries to produce timely estimates of child mortality: regional workshops and country visits

The IGME method to estimate child mortality

• Update estimates annually– Compile all nationally representative data for each country– Check data quality– Fit a regression line to all data points that meet data quality standards

established by the IGME and extrapolate to a common reference year– Additional adjustment applied to countries with high HIV/AIDS

prevalence

• The IGME Estimates are based on national data from surveys, census, vital registrations, etc, but may differ from these data

Why is it necessary to produce interagency child mortality estimates

• No single, high quality source in most countries• Multiple data sources often inconsistent• Project estimates• Important to estimate since 1990• Consistent methodology

Example: Data rich and consistency countries

Mali

The available data sources cluster over a narrow band

and show considerable consistency

The estimate line is fitted to all the data

Example: Data rich countries with wide variations in mortality level from different sources

Nigeria

Has one of the widest spreads of source data,

with a range from 120 to 240 deaths per 1,000 live

birth

In driving the estimate line, all sources with

dotted lines are rated of lower quality and are

not used.

Discrepancies between national and interagency estimates

• National estimates: often use data directly from censuses, surveys, or vital registration systems

• IGME estimates: use national data from censuses, surveys, or vital registration systems as underlying data to generate estimates by fitting a tend line to these data

• For countries with consistent data, national estimates and interagency estimates are similar.

• For countries with inconsistent or messy data, differences might be large

Direct and indirect estimates

1985.00 1990.00 1995.00 2000.00 2005.00 2010.000

50

100

150

200

250

300

MICS2000 (Indirect)

MICS2006 (Indirect)

RHS/MICS2010 (Direct)

RHS/MICS2010 (Indirect)

CMEInfoThe IGME’s Child Mortality Database:

www.childmortality.org