UN Interagency Child Mortality Estimation Prepared by Danzhen You

Outline The UN Inter-agency Group for Child Mortality Estimation (IGME) Definition of child mortality indicators Data and methods to estimate child mortality Key results from the latest estimates CME Info

The UN Inter-agency Group for Child Mortality Estimation (IGME) Formed in 2004, led by UNICEF, WHO, and includes members of UN Population Division and The World Bank 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 Technical Advisory Group (TAG) – 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

Capacity building Five regional workshops since 2008 – Asia, 2008 (23 countries/71 participants) – Latin America, 2009 (14 /30) – West and Central Africa, 2009 (21 /49) – Eastern and Southern Africa, 2010 (20/56) – Middle East and North Africa, 2010 (16/60) These workshops provided: Strengthen capacity in child mortality estimation, feedback on missing data and feedback on plausibility of estimates Individual country visits to discuss child mortality estimates and provide technical support, including: Rwanda (2008), Mexico (2008), Brazil (2008), Nigeria (2009), Suriname (2010), Mongolia (2010)

Data Collection Collect all available data – census, household surveys (DHS, MICS, etc.), vital registration, and so on UNICEF’s main data collection process – Country Report on Indicators for the Goals (CRING) WHO routine data collection process - vital registration data

Estimates consultation Workshops and country visits UNICEF country consultation ongoing work before release WHO country consultation

Definition of child mortality indicators

Child mortality indicators: definition Mortality among young children can be subdivided by age group CategoryIncludes deaths that occur: Neonatal mortalityDuring the first 28 days of life Post-neonatal mortalityAt ages 1 to 11 months Infant mortalityBetween birth and exact age 1 Child mortalityAt ages 1 to 4 years Under-five mortalityBetween birth and exact age 5

Child mortality indicators: definition Mortality rates such as U5MR and IMR are not strictly rates but are the probability of dying within a specific period IndicatorDefinition Under-five mortality rate Probability of dying between birth and exact age 5 years expressed as per 1000 live births. Infant mortality rate Probability of dying between birth and exact age 1 year expressed as per 1000 live births.

Data and methods to estimate child mortality

Data Data source – vital registration systems – population censuses – household surveys – sample registration systems – Demographic surveillance sites direct estimates and indirect estimates, trend line often used by country as official estimates Data errors and data quality assessment – sampling errors (surveys) – omission of deaths – misreporting of child’s age at death or date of birth (direct only) – selection bias – violation of assumptions (indirect only)

Methods Compile all nationally representative data for each country Fit a regression line (Spline or Loess) 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 Estimates generated in different rounds may not be comparable IGME Estimates are based on data from surveys, census, vital registrations, etc, but may differ from these data Used by UN as official estimates for monitoring MDG 4

Data rich and consistent country Mali The available data sources cluster over a narrow band and show considerable consistency The estimate line is fitted to all the data Other countries have similar patterns: Bangladesh, Benin, Indonesia, Peru, Venezuela, etc.

Data rich country but with wide variations in mortality levels 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. Other countries with wide range: Azerbaijan, Guyana, Mauritania, Tajikistan, etc.

Data rich country but with wide variations in mortality levels from different sources Tajikistan

Data rich country with wide variations in the past, and no data available for the most recent years Cambodia

country with lower estimates from vital registration Ukraine

Data poor country with wide variations Angola

Data poor country with messy data Djibouti

Why not use data from data sources as official estimates? Lack of a single source of high quality data covering the last several decades – Lack of civil registration systems that accurately record all births and deaths Data quality is an issue in some surveys Discrepancies may exist between estimates from different surveys Survey data are usually not timely for child mortality indicators – Direct estimates: refer to a five year period prior to the survey – Indirect estimates: from women aged 25-29, refer to about 2-3 years before the survey Consistent trend line from 1990 is needed for monitoring MDG 4

The release of the Latest Estimates

Key results U nder-five mortality rate has fallen by a third globally The global under-five mortality rate has fallen by a third since 1990—from 89 deaths per 1,000 live births in 1990 to 60 in Under-five mortality declined in all regions Substantial differences across regions

Key results 8.1 million children under five died in 2009 Globally, the number of deaths among children under age five has fallen from 12.4 million in 1990 to 8.1 million in This means that more than 22,000 children under five die each day—12,000 fewer than in 1990.

Key results Under-five death is increasingly concentrated in a few countries About half of global under- five deaths in 2009 occurred in only five countries: India, Nigeria, DR Congo, Pakistan and China. India, with 21 percent, and Nigeria, with 10 percent, together account for nearly a third of under-five deaths worldwide.

Causes of deaths Some 40 percent of under-five deaths occur within the first month of life (neonatal period). The two biggest killers of children under age five are pneumonia (18 percent of deaths) and diarrhoeal diseases (15 percent).

Key results The progress towards MDG 4 is insufficient globally Sub-Saharan Africa, Southern Asia and Oceania are not on track

Key results Estimates of U5MR for selected countries in 1990 and 2009

Key results Proportional decline of U5MR for selected countries,

CME Info The IGME’s Child Mortality Database:

CME Info

CME Info plan Develop CME Info 3.0 – Incorporate the planned changes in methods – Make the system more user friendly Develop a desktop version of CME Info

To summarize Data on child mortality have sampling or non-sampling errors. Under- reporting is more common than over-reporting. Data quality assessment is important Survey data are usually not timely for child mortality indicators The importance of uncertainty range around estimates UN uses IGME estimates for monitoring MDG 4 Discrepancies exist between interagency estimates and official estimates used by country government

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