Transcript Multiple Indicator Cluster Surveys Data
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
Birth
Periods for Under-5 Mortality Measurement
Under-5 Mortality (0-4 Years) 1 5 Neonatal Mortality (First month) Post-Neonatal Mortality (1-11 months) Infant Mortality (Birth to One Year) Child Mortality (1 to 4 years)
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
35.0
30.0
25.0
20.0
15.0
10.0
5.0
Linear trendline 0.0
0 2 4 6 8 10 12 14 Months 16 18 20 22 24 26
3000 2500 2000 1500 1000 500 0 1996
Age shifting: common issue in DHS
Niger: Births by year, DHS06
Questions on under-5s for all births after January 2001 1998 2000 2002 Year 2004 2006 Living Dead Total
Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year periods preceding the survey, (Total), 2010 0-4 Periods of analysis of 5 years 5-9 10-14 15-19 20-24 Mean Mean Mean Mean Mean Deaths Age in months 0 1-2 3-5 6-11
Table CM.0: Early childhood mortality rates
620.26
63.04
89.22
99.64
504.88
110.23
82.81
166.7
445.41
77.51
71.63
151.27
348.55
73.39
46.55
121.36
201.48
87.22
26.91
33.94
Exposure Age in months 12-23 24-35 36-47 48-59 0 1-2 208.61
244.79
144.69
84.05
13920.14
13237.43
242.33
209.71
133.63
74.16
11978.53
11624.09
169.82
208.98
107.73
49.9
9302.7
8735.32
175.52
164.71
69.09
34.12
6793.22
6359.38
98.35
90.18
30.93
18.01
3910.57
3549.13
Probability Age in months 3-5 6-11 12-23 24-35 36-47 48-59 0 1-2 3-5 6-11 12-23 24-35 36-47 48-59 12969.53
12610.69
12296.12
11917.43
11361.23
10698 44.56
4.76
6.88
7.9
16.97
20.54
12.73
7.86
11611.1
11262.74
10425.94
9526.55
8756.18
8153.75
42.15
9.48
7.13
14.8
23.24
22.01
15.26
9.1
8495.96
8346.37
7958.39
7284.85
6587.17
6035.32
47.88
8.87
8.43
18.12
21.34
28.69
16.35
8.27
6170.02
5903.85
5335.74
4659.14
4033.44
3489.87
51.31
11.54
7.54
20.56
32.89
35.35
17.13
9.78
3277.48
3176.58
2964.97
2480.25
1997.63
1671.45
51.52
24.58
8.21
10.69
33.17
36.36
15.48
10.77
Check denominators for: Less than 250 cases * 250-499 cases ( )
Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year periods preceding the survey, (Total), 2010 0-4 Periods of analysis of 5 years 5-9 10-14 15-19 20-24 Mean Mean Mean Mean Mean Deaths Age in months 0 1-2 3-5 6-11
Table CM.0: Early childhood mortality rates
620.26
63.04
89.22
99.64
504.88
110.23
82.81
166.7
445.41
77.51
71.63
151.27
348.55
73.39
46.55
121.36
201.48
87.22
26.91
33.94
Exposure Age in months 12-23 24-35 36-47 48-59 0 1-2 208.61
244.79
144.69
84.05
13920.14
13237.43
242.33
209.71
133.63
74.16
11978.53
11624.09
169.82
208.98
107.73
49.9
9302.7
8735.32
175.52
164.71
69.09
34.12
6793.22
6359.38
98.35
90.18
30.93
18.01
3910.57
3549.13
Probability Age in months 3-5 6-11 12-23 24-35 36-47 48-59 0 1-2 3-5 6-11 12-23 24-35 36-47 48-59 12969.53
12610.69
12296.12
11917.43
11361.23
10698 44.56
4.76
6.88
7.9
16.97
20.54
12.73
7.86
11611.1
11262.74
10425.94
9526.55
8756.18
8153.75
42.15
9.48
7.13
14.8
23.24
22.01
15.26
9.1
8495.96
8346.37
7958.39
7284.85
6587.17
6035.32
47.88
8.87
8.43
18.12
21.34
28.69
16.35
8.27
6170.02
5903.85
5335.74
4659.14
4033.44
3489.87
51.31
11.54
7.54
20.56
32.89
35.35
17.13
9.78
3277.48
3176.58
2964.97
2480.25
1997.63
1671.45
51.52
24.58
8.21
10.69
33.17
36.36
15.48
10.77
Neonatal mortality
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 0-4 Periods of analysis of 5 years 5-9 10-14 15-19 20-24 Mean Mean Mean Mean Mean Deaths Age in months 0 1-2 620.26
63.04
504.88
110.23
445.41
77.51
348.55
73.39
201.48
87.22
3-5 6-11 12-23 24-35 89.22
99.64
208.61
244.79
82.81
166.7
242.33
209.71
71.63
151.27
169.82
208.98
46.55
121.36
175.52
164.71
26.91
33.94
98.35
90.18
Exposure Age in months 36-47 48-59 0 1-2 3-5 6-11 12-23 24-35 144.69
84.05
13920.14
13237.43
12969.53
12610.69
12296.12
11917.43
133.63
74.16
11978.53
11624.09
11611.1
11262.74
10425.94
9526.55
107.73
49.9
9302.7
8735.32
8495.96
8346.37
7958.39
7284.85
69.09
34.12
6793.22
6359.38
6170.02
5903.85
5335.74
4659.14
30.93
18.01
3910.57
3549.13
3277.48
3176.58
2964.97
2480.25
Probability Age in months 36-47 48-59 0 1-2 3-5 6-11 12-23 24-35 36-47 48-59 11361.23
10698 44.56
4.76
6.88
7.9
16.97
20.54
12.73
7.86
8756.18
8153.75
42.15
9.48
7.13
14.8
23.24
22.01
15.26
9.1
6587.17
6035.32
47.88
8.87
8.43
18.12
21.34
28.69
16.35
8.27
4033.44
3489.87
51.31
11.54
7.54
20.56
32.89
35.35
17.13
9.78
1997.63
1671.45
51.52
24.58
8.21
10.69
33.17
36.36
15.48
10.77
Post-neonatal mortality Infant mortality
Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year periods preceding the survey, (Total), 2010 0-4 Periods of analysis of 5 years 5-9 10-14 15-19 20-24 Mean Mean Mean Mean Mean Deaths Age in months 0 1-2 3-5 6-11
Table CM.0: Early childhood mortality rates
620.26
63.04
89.22
99.64
504.88
110.23
82.81
166.7
445.41
77.51
71.63
151.27
348.55
73.39
46.55
121.36
201.48
87.22
26.91
33.94
Exposure Age in months 12-23 24-35 36-47 48-59 0 1-2 208.61
244.79
144.69
84.05
13920.14
13237.43
242.33
209.71
133.63
74.16
11978.53
11624.09
169.82
208.98
107.73
49.9
9302.7
8735.32
175.52
164.71
69.09
34.12
6793.22
6359.38
98.35
90.18
30.93
18.01
3910.57
3549.13
Probability Age in months 3-5 6-11 12-23 24-35 36-47 48-59 0 1-2 3-5 6-11 12-23 24-35 36-47 48-59 12969.53
12610.69
12296.12
11917.43
11361.23
10698 44.56
4.76
6.88
7.9
16.97
20.54
12.73
7.86
11611.1
11262.74
10425.94
9526.55
8756.18
8153.75
42.15
9.48
7.13
14.8
23.24
22.01
15.26
9.1
8495.96
8346.37
7958.39
7284.85
6587.17
6035.32
47.88
8.87
8.43
18.12
21.34
28.69
16.35
8.27
6170.02
5903.85
5335.74
4659.14
4033.44
3489.87
51.31
11.54
7.54
20.56
32.89
35.35
17.13
9.78
3277.48
3176.58
2964.97
2480.25
1997.63
1671.45
51.52
24.58
8.21
10.69
33.17
36.36
15.48
10.77
Child mortality
Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year periods preceding the survey, (Total), 2010 0-4 Periods of analysis of 5 years 5-9 10-14 15-19 20-24 Mean Mean Mean Mean Mean Deaths Age in months 0 1-2 3-5 6-11
Table CM.0: Early childhood mortality rates
620.26
63.04
89.22
99.64
504.88
110.23
82.81
166.7
445.41
77.51
71.63
151.27
348.55
73.39
46.55
121.36
201.48
87.22
26.91
33.94
Exposure Age in months 12-23 24-35 36-47 48-59 0 1-2 208.61
244.79
144.69
84.05
13920.14
13237.43
242.33
209.71
133.63
74.16
11978.53
11624.09
169.82
208.98
107.73
49.9
9302.7
8735.32
175.52
164.71
69.09
34.12
6793.22
6359.38
98.35
90.18
30.93
18.01
3910.57
3549.13
Probability Age in months 3-5 6-11 12-23 24-35 36-47 48-59 0 1-2 3-5 6-11 12-23 24-35 36-47 48-59 12969.53
12610.69
12296.12
11917.43
11361.23
10698 44.56
4.76
6.88
7.9
16.97
20.54
12.73
7.86
11611.1
11262.74
10425.94
9526.55
8756.18
8153.75
42.15
9.48
7.13
14.8
23.24
22.01
15.26
9.1
8495.96
8346.37
7958.39
7284.85
6587.17
6035.32
47.88
8.87
8.43
18.12
21.34
28.69
16.35
8.27
6170.02
5903.85
5335.74
4659.14
4033.44
3489.87
51.31
11.54
7.54
20.56
32.89
35.35
17.13
9.78
3277.48
3176.58
2964.97
2480.25
1997.63
1671.45
51.52
24.58
8.21
10.69
33.17
36.36
15.48
10.77
Under-5 mortality
Estimates from direct method
Table 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 5-9 10-14 15-19 20-24 44.56
42.15
47.88
51.31
51.52
18.55
29.79
33.36
37.15
40.71
63.11
71.94
81.24
88.46
92.23
56.89
67.88
72.69
92.03
92.63
116.41
134.94
148.03
172.35
176.32
C1 MICS Survey
Direct estimates of U5MR
250 200 150 100 50 0 1985,00 1990,00 1995,00 2000,00 2005,00 2010,00
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 method
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 Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Mean number of Total number of children ever born .286
children ever born 1316 Mean number children surviving .267
1.255
4732 1.107
Total number of children Proportion Number of surviving 1229 dead .082
women 4601 4175 .123
3770 2.522
3.743
5.026
5.772
6.407
2.663
8287 8339 10654 8421 8138 49887 2.160
3.202
4.105
4.669
5.016
2.216
7100 7132 8703 6812 6372 41523 .149
.145
.185
.192
.217
.170
3286 2228 2120 1459 1270 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
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 Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Mean number of Total number of children ever born .286
children ever born 1316 Mean number children surviving .267
1.255
2.522
3.743
5.026
5.772
6.407
2.663
4732 8287 8339 10654 8421 8138 49887 1.107
2.160
3.202
4.105
4.669
5.016
2.216
Total number of children Proportion Number of surviving 1229 dead .082
women 4601 4175 7100 7132 8703 6812 6372 41523 .123
.149
.145
.185
.192
.217
.170
3770 3286 2228 2120 1459 1270 18734 Check denominators
Indirect method
Age group 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Coale-Demeny Models (Trussel equations) Mean children ever born .286
Proportion children dead of born .082
Age i 1 1.255
2.522
3.743
5.026
5.772
6.407
.123
.149
.145
.185
.192
.217
2 3 5 10 15 20 Q(i) North .071
.116
.140
.144
.196
.201
.223
t(i) North 1.4
2.7
4.4
6.4
8.5
10.9
13.7
Q(i) South .068
.122
.150
.149
.194
.197
.220
t(i) South 1.3
2.7
4.5
6.6
8.9
11.5
14.5
Indirect method
Age group 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Under-five Mortality Rate (Male) Reference 2009.0
Under-five Mortality date North Rate North .111
Reference 2009.0
Under-five Mortality date South Rate South .087
Reference date East 2009.0
Under-five Mortality Rate East .097
Reference date West 2009.0
2007.7
2006.0
2004.0
2001.8
1999.4
1996.6
.150
.161
.144
.169
.162
.166
2007.7
2005.9
2003.8
2001.5
1998.9
1995.9
.142
.161
.149
.181
.178
.187
2007.6
2005.8
2003.6
2001.3
1998.7
1995.5
.140
.158
.147
.178
.175
.186
2007.7
2005.8
2003.7
2001.5
1999.0
1996.1
MICS Survey
Indirect estimates
180 160 140 120 100 80 60 40 20 0 1985,00 1990,00 1995,00 2000,00 2005,00 2010,00
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
Sexo Region Area de residência Quintil de riqueza Masculino Feminino SAB Leste Northe Sul Urbano Rural Mais rico Segundo Meio Quarto Mais pobre Total Infant Mortality Rate [1] 111 98 87 130 104 83 93 110 114 116 104 102 69 105 Under-five Mortality Rate [2] 162 146 119 207 153 112 131 167 174 179 154 149 89 155
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
5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age in 2000 Mean Number of Children Ever Born 2000 2006 2010 0.2860
0.5028
1.7158
3.3431
0.6542
1.7176
3.3253
4.6799
1.2551
2.5216
3.7432
5.0258
4.9895
6.1893
6.9033
7.2666
5.8593
6.4765
6.7208
5.7723
6.4072
Mean Number of Children Surviving 2000 2006 2010 0.2671
0.4255
1.4058
2.6323
0.5396
1.4191
2.6190
3.6527
1.1073
2.1605
3.2016
4.1055
3.8199
4.5381
4.9685
5.1520
4.3312
4.7859
4.6518
4.6691
5.0164
Mean Number of Children Deceased 2000 2006 2010 0.0189
0.0773
0.3100
0.7108
0.1145
0.2985
0.7063
1.0272
0.1478
0.3612
0.5416
0.9203
1.1696
1.6512
1.9349
2.1146
1.5281
1.6906
2.0690
1.1032
1.3907
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 4 of child mortality worldwide for reporting on progress towards MDG – Enhance the capacity of countries workshops and country visits to produce timely estimates of child mortality: regional
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
300 250 200 150 100 50 0 1985,00
Direct and indirect estimates
1990,00 MICS 2000 (Indirect) 1995,00 MICS 2006 (Indirect) 2000,00 RHS/MICS 2010 (Direct) RHS/MICS 2010 (Indirect) 2005,00 2010,00