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Causes of death in children younger than five years in China in 2015: an updated analysis Author: Peige Song Examination Number: B073207 Master of Science by Research The University of Edinburgh 2016 PLAGIARISM STATEMENT I, Peige Song, declare that all the work in this thesis was performed personally unless stated otherwise. No part of this work has not been submitted for any other degree or profession qualification. Signature: Date: 01/05/2016 i ACKNOWLEDGEMENTS It is a great pleasure to thank those who made this thesis possible. First and foremost my thanks go to my lovely supervisors, Dr Kit Yee Chan, Professor Igor Rudan and Dr Evropi Theodoratou for giving me the opportunity to work on an exciting project of which I am very proud. All of them have always been optimistic and encourageing and shown genuinely caring for me. Throughout my master work, Igor and Kit continusly encouraged me to develop critical research skills and invested a lot on me, I owe a debt of gratitude to them for giving me such an excellent experience, and it was my great honor to work under the supervision of the leading experts in the field of global health research. I would like to give my heartfelt gratitude to the China Scholarship Council (CSC) and the University of Edinburgh, for the financial support during my study. Special huge thanks to Professor Harry Campbell and Dr Evropi Theodoratou for their supports at the start of my study in the University of Edinburgh, which helped to turn over a new leaf of my life and research career. The accompany and friendship of my fellow PhD students and friends, Xue, Luciana, Martine, Anna, Trini, Tomi and Rosie and other colleagues, greatly eased the research process. I also owe my gratitude to all my friends from home country, especially Tong, Huan, Yanjin, Daidi, who lended their supports and caring during the whole stage of my life in Edinburgh. Last but not least, I would also like to say thanks to my parents and my husband, who have been telling me “to eat well” and “to be happy”. I am especially grateful to my husband, the first person who encouraged me to make my academic dream come true in the UK and assisted me both emotionally and academically whenever I need. Life would definitely go better even though we need to start from nothing in a foreign country, big thanks to you for all the support, sacrifice and for waiting, my love. ii TABLE OF CONTENTS PLAGIARISM STATEMENT ............................................................................................. i ACKNOWLEDGEMENTS................................................................................................. ii TABLE OF CONTENTS ................................................................................................... iii LIST OF TABLES .............................................................................................................. v LIST OF FIGURES ........................................................................................................... vi ABBREVIATIONS ......................................................................................................... viii ABSTRACT ....................................................................................................................... x 1 INTRODUCTION ....................................................................................................... 1 1.1 Background ......................................................................................................... 1 1.2 Civil registration and vital statistics ...................................................................... 2 1.3 Death classification .............................................................................................. 3 1.4 Main mortality data sources in China ................................................................... 3 1.4.1 Mortality data for the population of China .................................................... 4 1.4.2 Mortality data for children ............................................................................ 6 1.5 Child mortality....................................................................................................10 1.5.1 Global profile ..............................................................................................10 1.5.2 China profile ...............................................................................................13 1.6 Causes of death in children .................................................................................16 1.6.1 Global profile ..............................................................................................16 1.6.2 China profile ...............................................................................................18 1.7 Research objectives.............................................................................................20 1.8 Outline of the thesis ............................................................................................21 2 METHODS ................................................................................................................22 2.1 Data sources .......................................................................................................22 2.1.1 Child mortality data.....................................................................................22 2.1.2 Number of live births ..................................................................................24 2.2 Systematic review ...............................................................................................25 iii 2.2.1 Overview ....................................................................................................25 2.2.2 Search strategy ............................................................................................26 2.2.3 Study criteria ...............................................................................................32 2.2.4 Study selection and data extraction ..............................................................33 2.3 Statistical analysis ...............................................................................................34 2.3.1 Procedures ..................................................................................................34 2.3.2 Statistical modelling ....................................................................................35 2.4 Ethical self-assessment .......................................................................................36 3 RESULTS ..................................................................................................................37 3.1 Study characteristics ...........................................................................................37 3.2 Modelling test and selection ................................................................................40 3.3 Final modelling methods .....................................................................................46 3.4 Generating national and provincial estimates .......................................................52 3.4.1 Main causes of child deaths from 2009 to 2015 ...........................................52 3.4.2 Main causes of child deaths in 2015 ............................................................55 4 DISCUSSION ............................................................................................................64 4.1 Methods for predicting causes of child deaths .....................................................64 4.2 Summary of findings and recommendations ........................................................66 4.2.1 Neonatal diseases ........................................................................................66 4.2.2 Infectious diseases.......................................................................................68 4.2.3 Congenital abnormalities .............................................................................69 4.2.4 Accidents ....................................................................................................70 4.2.5 Sudden infant death syndrome .....................................................................71 4.3 Limitations and future direction ..........................................................................72 REFERENCES ..................................................................................................................76 APPENDICS .....................................................................................................................88 iv LIST OF TABLES Table 1.1 Number of countries according to MDG target 4.A Achievement status,