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MCEE-WHO Methods and Data Sources for Child Causes of Death 2000-2017 MCEE-WHO methods and data sources for child causes of death 2000-2017 Department of Evidence, Information and Research (WHO, Geneva) and Maternal Child Epidemiology Estimation (MCEE) December 2018 Global Health Estimates Technical Paper WHO/HMM/IER/GHE/2018.4 Acknowledgments This Technical Paper was prepared by Colin Mathers, with inputs from Dan Hogan, Diana Yeung, Li Liu, and Shefali Oza. Country estimates of child deaths by cause for years 2000-2017 were primarily prepared by Diana Yeung, Yue Chu, Li Liu, Jamie Perin, and Bob Black (Johns Hopkins University) and Shefali Oza, Simon Cousens, and Joy Lawn (London School of Hygiene and Tropical Medicine) of the Maternal and Child Epidemiology Estimation (MCEE) group, and Daniel Hogan, Doris Ma Fat, Jessica Ho and Colin Mathers, of the Mortality and Health Analysis unit in the WHO Department of Information, Evidence and Research, with advice and inputs from other members of MCEE, WHO Departments, collaborating UN Agencies, and other WHO expert advisory groups and academic collaborators. The Maternal and Child Health Estimation group has been supported by a grant from the Bill & Melinda Gates Foundation. These estimates make considerable use of the all-cause mortality estimates developed by the Interagency Group on Child Mortality Estimation (UN-IGME), and births estimates from the UN Population Division, as well as inputs for certain vaccine-preventable diseases developed under the oversight of the WHO Quantitative Immunization and Vaccines Related Research (QUIVER) Advisory Group. While it is not possible to name all those who provided advice, assistance or data, both inside and outside WHO, we would particularly like to note the assistance and inputs for this update provided by John Aponte, Marta Gacic-Dodo, Lucia Hug, Mary Mahy, Kim Marsh, Abdisalan Noor, Minal Patel, and Danzhen You. Estimates and analysis are available at: http://www.who.int/healthinfo/global_burden_disease/en/ For further information about the estimates and methods, please contact: [email protected]. i Table of Contents Acknowledgments .......................................................................................................................................... i Table of Contents .......................................................................................................................................... ii 1 Introduction ........................................................................................................................................... 1 2 All-cause mortality and population estimates for years 2000-2017 ....................................................... 1 2.1 Estimation of neonatal and under-5 mortality rates ....................................................................... 1 2.2 Population size and births estimates ............................................................................................... 2 2.3 Mortality shocks – epidemics, conflicts and disasters ..................................................................... 2 3 Child mortality by cause .......................................................................................................................... 2 3.1 Death registration data .................................................................................................................... 3 3.2 Modeling causes of neonatal death (ages 0-27 days) ..................................................................... 4 3.3 Modeling causes of postneonatal deaths (ages 1-59 months) ........................................................ 5 3.5 Causes of child death for China and India ....................................................................................... 6 4 Methods for cause-specific revisions and updates.................................................................................. 7 4.1 HIV/AIDS........................................................................................................................................... 7 4.2 Malaria ............................................................................................................................................. 7 4.3 Measles ............................................................................................................................................ 8 4.4 Conflict and natural disasters .......................................................................................................... 9 5 Uncertainty of estimates ......................................................................................................................... 9 References ........................................................................................................................................... 9 Annex Table A. Methods used for estimation of child causes of death, by country, 2000-2017 .............. 12 Annex Table B.1. First-level categories for analysis of neonatal child causes of death.............................. 17 Annex Table B.2. First-level categories for analysis of postneonatal child causes of death ...................... 18 ii 1 Introduction This document, Global Health Estimates Technical Paper WHO/HMM/IER/GHE/2018.4, is an update to the previous WHO/HMM/IER/GHE/2018.1, which described estimation methodology for child causes of death (COD) for 2000-2016. This updated version is edited to reflect an update in which child causes of death are estimated for years 2000-2017. The underlying methodological approaches are similar to those used to derive child COD estimates for years 2000-2012, which were published in May 2014, child COD estimates for 2000-2013, which were published in September 2014, and child COD estimates for 2000-2015, which were published in February 2016. Cause-specific estimates of deaths for children under age 5 were estimated for 14 cause categories for years 2000-2017 using methods similar to those described elsewhere by Liu et al. (1,2) and on the WHO website (http://www.who.int/healthinfo/global_burden_disease/en/). These estimates were prepared by the WHO Department of Information, Evidence and Research and the Maternal and Child Epidemiology Estimation (MCEE) group, with inputs and assistance from other WHO Departments and UN Agencies. These child cause of death estimates for years 2000-2017 supersede previously published estimates for child causes of death for years 2000-2010, 2000-2012, 2000-2013, 2000-2015 and 2000- 2016. The estimation framework is similar to that used for the previous estimates (3), although some methodological components have been improved along with updated inputs for child mortality levels (4) as well as cause-specific estimates for HIV, malaria, and measles deaths (as described in Section 4). Deaths due to pertussis were not prepared for this estimation round. Inputs to the multivariate cause composition models were also updated as described below in Section 3. These estimates of child deaths by cause represent the best estimates of WHO and MCEE, based on the evidence available to them up until November 2018, rather than representing the official estimates of Member States, and have not necessarily been endorsed by Member States. They have been computed using standard categories, definitions and methods to ensure cross-national comparability and may not be the same as official national estimates produced using alternate, potentially equally rigorous methods. The following sections of this document provide explanatory notes about data sources and methods for preparing child mortality estimates by cause. Data files and statistical code that allow interested readers to replicate the child cause of death estimates can be found at http://www.who.int/healthinfo/global_burden_disease/en/. 2 All-cause mortality and population estimates for years 2000-2017 2.1 Estimation of neonatal and under-5 mortality rates Methods for estimating time series of neonatal (0-27 days), infant (0-365 days) and under-5 mortality rates have been developed and agreed upon within the Inter-agency Group for Child Mortality Estimation (UN-IGME) which is made up of WHO, UNICEF, UN Population Division, World Bank and academic groups. UN-IGME annually assesses and adjusts all available surveys, censuses and vital registration data to estimate country-specific trends in under-five mortality per 1000 live births (U5MR) over the past few decades (4). All data sources and estimates are documented on the UN-IGME website.1 For countries with complete recording of child deaths in death registration systems, these are 1 www.childmortality.org World Health Organization Page 1 used as the source of data for the estimation of trends in neonatal, infant and child mortality. For countries with incomplete death registration, all available census and survey data sources that meet quality criteria are used. UN-IGME methods are documented in a series of papers published in a collection in 2012 (5). Under-five and infant mortality rates are estimated from data inputs using a multi-level penalized spline regression model that accommodates sources of bias across input data sources. Neonatal mortality rates (NMR) are then estimated in a second estimation process which models NMR as a function of U5MR, with splines used to capture country-specific data trends (6). For countries where child mortality is strongly affected by HIV, U5MR and NMR are estimated initially using neonatal and child mortality observations for non-AIDS deaths, calculated by subtracting from total death rates the estimated
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