IJE Advance Access originally published online on August 19, 2004
International Journal of Epidemiology 2004 33(6):1293-1301; doi:10.1093/ije/dyh182
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IJE vol.33 no.6 © International Epidemiological Association 2004; all rights reserved.
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Monitoring trends in under-5 mortality rates through national birth history surveys
1 World Health Organization, Roll Back Malaria Dept., Avenue Appia 20, CH 1211—Geneva 27, Switzerland
2 ORC Macro, 11785 Beltsville Drive, Calverton, MD 20705 USA
3 World Health Organization, StopTB Department, Avenue Appia 20, CH 1211—Geneva 27, Switzerland
4 World Health Organization, Roll Back Malaria Department, Avenue Appia 20, CH 1211—Geneva 27, Switzerland
5 KEMRI Wellcome Trust Collaborative Programme, 00100 GPO, P.O. Box 43640, Nairobi, Kenya and Centre for Tropical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
Correspondence: Dr EL Korenromp, World Health Organization, Roll Back Malaria Department, Avenue Appia 20, CH 1211—Geneva 27, Switzerland. E-mail: korenrompe{at}who.int..
Background We assessed whether Demographic and Health Surveys (DHS), a large and high-quality source of under-5 mortality estimates in developing countries, would be able to detect reductions in under-5 mortality as established in global child health goals.
Methods and Results Mortality estimates from 41 DHS conducted in African countries between 1986 and 2002, for the interval of 0–4 years preceding each survey (with a mean time lag of 2.5 years), were reviewed. The median relative error on national mortality rates was 4.4%. In multivariate regression, the relative error decreased with increasing sample size, increasing fertility rates, and increasing mortality rates. The error increased with the magnitude of the survey design effect, which resulted from cluster sampling. With levels of precision observed in previous surveys, reductions in all-cause under-5 mortality rates between two subsequent surveys of 15% or more would be detectable. The detection of smaller mortality reductions would require increases in sample size, from a current median of 7060 to over 20 000 women. Across the actual surveys conducted between 1986 and 2002, varying mortality trends were apparent at a national scale, but only around half of these were statistically significant.
Conclusions The interpretation of changes in under-5 mortality rates between subsequent surveys needs to take into account statistical significance. DHS birth history surveys with their present sampling design would be able to statistically confirm under-5 mortality reductions in African countries if true reductions were 15% or larger, and are highly relevant to tracking progress towards existing international child health targets.
Keywords Child mortality/*trends, infant mortality/*trends, time factors; Africa/epidemiology; programme monitoring, demographic and health surveys, developing countries/*statistics & numerical data
Accepted 23 February 2004
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