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S V Subramanian - One of the best experts on this subject based on the ideXlab platform.
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association does not imply prediction the accuracy of birthweight in predicting Child Mortality and anthropometric failure
2020Co-Authors: Akshay Swaminathan, Rockli Kim, S V SubramanianAbstract:Abstract Purpose Epidemiologic studies often conflate the strength of association with predictive accuracy and build classification models based on arbitrarily selected probability cutoffs without considering the cost of misclassification. We illustrated these common pitfalls by building association, prediction, and classification models using birthweight as an exposure and Child Mortality and Child anthropometric failure as outcomes. Methods Nationally representative samples of 188,819 and 164,113 Children aged less than 5 years across India were used for our analysis of Mortality and anthropometric failure, respectively. We assessed outcomes of neonatal, postneonatal, and Child Mortality as well as stunting, wasting, and underweight. Birthweight was the main exposure. We used adjusted and unadjusted logistic regression models to evaluate association strength, univariable and multivariable logistic regression models trained on 80% of the data using 10-fold cross-validation to evaluate predictive power, and classification models across a series of possible misclassification cost scenarios to evaluate classification accuracy. Results Birthweight was strongly associated with five of six outcomes (P Conclusions Although birthweight is strongly associated with Mortality and anthropometric failure, it is a poor predictor of Child health outcomes, highlighting that strong associations do not imply predictive power. We recommend that (1) future research focus on building predictive models for anthropometric failure given their clinical relevance in diagnosing individual cases, and that (2) studies that build classifiers report performance metrics across a range of cutoffs to account for variation in the cost of FPs and FNs.
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socioeconomic and gender inequalities in neonatal postneonatal and Child Mortality in india a repeated cross sectional study 2005 2016
2019Co-Authors: Omar Karlsson, Rockli Kim, William Joe, S V SubramanianAbstract:Background In India, excess female under-5 Mortality is well documented. Under-5 Mortality is also known to be patterned by socioeconomic factors. This study examines sex differentials and sex-specific wealth gradients in neonatal, postneonatal and Child Mortality in India. Methods Repeated cross-sectional study of nationally representative samples of 298 955 Children 0–60 months old from the National Family Health Surveys conducted in 2005–2006 and 2015–2016. The study used logistic regression models as well as Cox proportional hazards models. Results Overall, boys had greater neonatal Mortality than girls and the difference increased between 2005–2006 and 2015–2016. Girls had greater postneonatal and Child Mortality, but the difference decreased between the surveys and was not statistically significant for Child Mortality in 2015–2016. A negative wealth gradient was found for all Mortality outcomes. Neonatal Mortality was persistently greater for boys. Girls had higher Child Mortality than boys at low levels of wealth and greater postneonatal Mortality over much of the wealth distribution. The wealth gradient in neonatal Mortality increased between surveys. Females had a stronger wealth gradient than boys for Child Mortality. Conclusion Not distinguishing between neonatal, postneonatal and Child Mortality masks important gender-specific and wealth-specific disparities in under-5 Mortality in India. Substantial gains towards the Sustainable Development Goals can be made by combating neonatal Mortality, especially at low levels of wealth. Although impressive improvements have been made in reducing the female disadvantage in postneonatal and Child Mortality, concerted engagements are necessary to eliminate the gender gap—especially in poor households and in north India.
Kenneth Hill - One of the best experts on this subject based on the ideXlab platform.
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data on survival of recent births as a source of Child Mortality estimates in the developing world an assessment of census data
2016Co-Authors: Leena Merdad, Kenneth Hill, Michael LevinAbstract:In many less developed countries, household surveys collect full and summary birth histories to provide estimates of Child Mortality. However, full birth histories are expensive to collect and cannot provide precise estimates for small areas, and summary birth histories only provide past Child Mortality trends. A simple method that provides estimates for the most recent past uses questions about the survival of recent births in censuses or large household surveys. This study examines such data collected by 45 censuses and shows that on average they tend to underestimate under-5 Mortality in comparison with alternative estimates, albeit with wide variations. In addition, the high non-sampling uncertainty in this approach precludes its use in providing robust estimates of Child Mortality at the country level. Given these findings, we suggest that questions about the survival of recent births to collect data on Child Mortality not be included in census questionnaires.
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monitoring Child Mortality through community health worker reporting of births and deaths in malawi validation against a household Mortality survey
2014Co-Authors: Agbessi Amouzou, Kenneth Hill, Benjamin Banda, Willie Kachaka, Olga Joos, Mercy Kanyuka, Jennifer BryceAbstract:BACKGROUND: The rate of decline in Child Mortality is too slow in most African countries to achieve the Millennium Development Goal of reducing under-five Mortality by two-thirds between 1990 and 2015. Effective strategies to monitor Child Mortality are needed where accurate vital registration data are lacking to help governments assess and report on progress in Child survival. We present results from a test of a Mortality monitoring approach based on recording of births and deaths by specially trained community health workers (CHWs) in Malawi. METHODS AND FINDINGS: Government-employed community health workers in Malawi are responsible for maintaining a Village Health Register in which they record births and deaths that occur in their catchment area. We expanded on this system to provide additional training supervision and incentives. We tested the equivalence between Child Mortality rates obtained from data on births and deaths collected by 160 randomly-selected and trained CHWs over twenty months in two districts to those computed through a standard household Mortality survey. CHW reports produced an under-five Mortality rate that was 84% (95%CI: [0.711.00]) of the household survey Mortality rate and statistically equivalent to it. However CHW data consistently underestimated under-five Mortality with levels of under-estimation increasing over time. Under-five deaths were more likely to be missed than births. Neonatal and infant deaths were more likely to be missed than older deaths. CONCLUSION: This first test of the accuracy and completeness of vital events data reported by CHWs in Malawi as a strategy for monitoring Child Mortality shows promising results but underestimated Child Mortality and was not stable over the four periods assessed. Given the Malawi governments commitment to strengthen its vital registration system we are working with the Ministry of Health to implement a revised version of the approach that provides increased support to CHWs.
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Child Mortality estimation accelerated progress in reducing global Child Mortality 1990 2010
2012Co-Authors: Kenneth Hill, Danzhen You, Mie Inoue, Mikkel Z OestergaardAbstract:Monitoring development indicators has become a central interest of international agencies and countries for tracking progress towards the Millennium Development Goals. In this review, which also provides an introduction to a collection of articles, we describe the methodology used by the United Nations Inter-agency Group for Child Mortality Estimation to track country-specific changes in the key indicator for Millennium Development Goal 4 (MDG 4), the decline of the under-five Mortality rate (the probability of dying between birth and age five, also denoted in the literature as U5MR and 5q0). We review how relevant data from civil registration, sample registration, population censuses, and household surveys are compiled and assessed for United Nations member states, and how time series regression models are fitted to all points of acceptable quality to establish the trends in U5MR from which infant and neonatal Mortality rates are generally derived. The application of this methodology indicates that, between 1990 and 2010, the global U5MR fell from 88 to 57 deaths per 1,000 live births, and the annual number of under-five deaths fell from 12.0 to 7.6 million. Although the annual rate of reduction in the U5MR accelerated from 1.9% for the period 1990–2000 to 2.5% for the period 2000–2010, it remains well below the 4.4% annual rate of reduction required to achieve the MDG 4 goal of a two-thirds reduction in U5MR from its 1990 value by 2015. Thus, despite progress in reducing Child Mortality worldwide, and an encouraging increase in the pace of decline over the last two decades, MDG 4 will not be met without greatly increasing efforts to reduce Child deaths.
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Child Mortality estimation methods used to adjust for bias due to aids in estimating trends in under five Mortality
2012Co-Authors: Neff Walker, Kenneth Hill, Fengmin ZhaoAbstract:In most low- and middle-income countries, Child Mortality is estimated from data provided by mothers concerning the survival of their Children using methods that assume no correlation between the Mortality risks of the mothers and those of their Children. This assumption is not valid for populations with generalized HIV epidemics, however, and in this review, we show how the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) uses a cohort component projection model to correct for AIDS-related biases in the data used to estimate trends in under-five Mortality. In this model, births in a given year are identified as occurring to HIV-positive or HIV-negative mothers, the lives of the infants and mothers are projected forward using survivorship probabilities to estimate survivors at the time of a given survey, and the extent to which excess Mortality of Children goes unreported because of the deaths of HIV-infected mothers prior to the survey is calculated. Estimates from the survey for past periods can then be adjusted for the estimated bias. The extent of the AIDS-related bias depends crucially on the dynamics of the HIV epidemic, on the length of time before the survey that the estimates are made for, and on the underlying non-AIDS Child Mortality. This simple methodology (which does not take into account the use of effective antiretroviral interventions) gives results qualitatively similar to those of other studies.
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levels and trends in Child Mortality 1990 2009
2010Co-Authors: Danzhen You, Tessa Wardlaw, Kenneth Hill, Gareth Edward Jones, Mickey ChopraAbstract:This article looks at the levels and trends in Child Mortality from 1990-2009. It tracks the progress that has been made in this area and states that removing financial and social barriers to accessing welfare services innovations to make supply of critical services more available to the poor and increasing local accountability of the health systems are examples of policy interventions that have allowed health systems to improve equity.
Wafaie W Fawzi - One of the best experts on this subject based on the ideXlab platform.
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Child Mortality in relation to hiv infection nutritional status and socio economic background
2004Co-Authors: Eduardo Villamor, Lara Misegades, Maulidi Fataki, Roger Mbise, Wafaie W FawziAbstract:Background The aims of this study were to examine the impact of Child HIV infection on Mortality and to identify nutritional and sociodemographic factors that increase the risk of Child Mortality independent of human immunodeficiency virus (HIV) infection. Methods We conducted a prospective study in Dar es Salaam, Tanzania, among 687 Children 6‐60 months of age who were admitted to hospital with pneumonia. After discharge, Children were followed up every 2 weeks during the first year and every 4 months thereafter. Sociodemographic characteristics were determined at baseline, and HIV status, haemoglobin, and malaria infection were assessed from a blood sample. During the first year of follow-up, we measured height, weight, and mid-upper arm circumference (MUAC) monthly. We estimated the risk of Mortality according to HIV status and socio-economic characteristics using Cox proportional hazards models. Nutritional status variables (wasting and stunting) were examined as time-varying risk factors. Results Mean age at enrolment was 18 months. A total of 90 Children died during an average 24.7 months of follow-up. HIV infection was associated with an adjusted 4-fold higher risk of Mortality [relative risk (RR) = 3.92, 95% confidence interval (CI) 2.34‐6.55, P � 0.0001]. Other risk factors included Child’s age � 24 months, stunting, low MUAC, anaemia, and lack of water supply in the household. In models with time-varying covariates, stunting and wasting during the previous month were both significant and independently related to increased risk of death. HIV infection appeared to be a stronger predictor of Mortality among Children who were wasted than among those who were not (P for interaction = 0.05). Conclusions HIV infection is a strong predictor of death among Children who have been hospitalized with pneumonia. Preventable conditions including inadequate water supply, Child undernutrition, and anaemia contribute significantly to infant and Child Mortality independent of HIV infection.
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vitamin a supplementation and Child Mortality a meta analysis
1993Co-Authors: Wafaie W Fawzi, Thomas Chalmers, M G Herrera, Frederick MostellerAbstract:Objective. —A two-part meta-analysis of studies examining the relationship of vitamin A supplementation and Child Mortality. Data Sources. —We identified studies by searching the MEDLARS database from 1966 through 1992 and by scanning Current Contents and bibliographies of pertinent articles. Study Selection. —All 12 vitamin A controlled trials with data on Mortality identified in the search were used in the analysis. Data Extraction. —Data were independently extracted by two investigators who also assessed the quality of each study using a previously described method. Data Synthesis. —We formally tested for heterogeneity across studies. We pooled studies using the Mantel-Haenszel and the DerSimonian and Laird methods and adjusted for the effect of cluster assignment of treatment groups in community-based studies. Vitamin A supplementation to hospitalized measles patients was highly protective against Mortality (DerSimonian and Laird odds ratio, 0.39; 95% confidence interval, 0.22 to 0.66; P =.0004) (part 1 of the meta-analysis). Supplementation was also protective against overall Mortality in community-based studies (DerSimonian and Laird odds ratio, 0.70; clustering-adjusted 95% confidence interval, 0.56 to 0.87; P =.001) (part 2 of the meta-analysis). Conclusions. —Vitamin A supplements are associated with a significant reduction in Mortality when given periodically to Children at the community level. Factors that affect the bioavailability of large doses of vitamin A need to be studied further. Vitamin A supplements should be given to all measles patients in developing countries whether or not they have symptoms of vitamin A deficiency. ( JAMA . 1993;269:898-903)
Gianluca Esposito - One of the best experts on this subject based on the ideXlab platform.
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predictors of contemporary under 5 Child Mortality in low and middle income countries a machine learning approach
2020Co-Authors: Andrea Bizzego, Giulio Gabrieli, Marc H Bornstein, Kirby Deaterdeckard, Jennifer E Lansford, Robert H Bradley, Megan Costa, Gianluca EspositoAbstract:Using a novel machine learning approach, we identify and prioritize in terms of predictive potency the top 10 distal causes of under-5 Child Mortality from almost 40 potential distal causes in more than a quarter of a million households in more than 25 low- and middle-income countries. Notably, all 10 distal causes are preventable and treatable through social, educational, and physical intervention. Thus, a unique contribution of our machine learning approach is to identify lesser-known preventable and treatable distal causes of under-5 Child Mortality that likely account for better-known proximal causes. Funding Statement: A.B. was supported by a Post-doctoral Fellowship within MIUR programme framework ”Dipartimenti di Eccellenza” (DiPSCO, University of Trento). G.E. was supported by NAP SUG 2015, Singapore Ministry of Education ACR Tier 1 (RG149/16 and RT10/19). M.H.B. was supported by the Intramural Research Program of the NIH/NICHD, USA, and an International Research Fellowship at the Institute for Fiscal Studies (IFS), London, UK, funded by the European Research Council (ERC) under the Horizon 2020 research and innovation programme (grant agreement No 695300- HKADeC-ERC-2015-AdG). Computational resources were provided by the National Super Computing Center of Singapore (Project ID: 12001609; Computational study of Child Development in Low Resource Contexts). Declaration of Interests: The Authors declare no conflict of interest. Ethics Approval Statement: Ethics approvals were handled in each site in which data were collected.
Mie Inoue - One of the best experts on this subject based on the ideXlab platform.
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Child Mortality estimation accelerated progress in reducing global Child Mortality 1990 2010
2012Co-Authors: Kenneth Hill, Danzhen You, Mie Inoue, Mikkel Z OestergaardAbstract:Monitoring development indicators has become a central interest of international agencies and countries for tracking progress towards the Millennium Development Goals. In this review, which also provides an introduction to a collection of articles, we describe the methodology used by the United Nations Inter-agency Group for Child Mortality Estimation to track country-specific changes in the key indicator for Millennium Development Goal 4 (MDG 4), the decline of the under-five Mortality rate (the probability of dying between birth and age five, also denoted in the literature as U5MR and 5q0). We review how relevant data from civil registration, sample registration, population censuses, and household surveys are compiled and assessed for United Nations member states, and how time series regression models are fitted to all points of acceptable quality to establish the trends in U5MR from which infant and neonatal Mortality rates are generally derived. The application of this methodology indicates that, between 1990 and 2010, the global U5MR fell from 88 to 57 deaths per 1,000 live births, and the annual number of under-five deaths fell from 12.0 to 7.6 million. Although the annual rate of reduction in the U5MR accelerated from 1.9% for the period 1990–2000 to 2.5% for the period 2000–2010, it remains well below the 4.4% annual rate of reduction required to achieve the MDG 4 goal of a two-thirds reduction in U5MR from its 1990 value by 2015. Thus, despite progress in reducing Child Mortality worldwide, and an encouraging increase in the pace of decline over the last two decades, MDG 4 will not be met without greatly increasing efforts to reduce Child deaths.
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the decline in Child Mortality a reappraisal
2000Co-Authors: Omar Ahmad, Alan D Lopez, Mie InoueAbstract:The present paper examines, describes and documents country-specific trends in under-five Mortality rates (i.e., Mortality among Children under five years of age) in the 1990s. Our analysis updates previous studies by UNICEF, the World Bank and the United Nations. It identifies countries and WHO regions where sustained improvement has occurred and those where setbacks are evident. A consistent series of estimates of under-five Mortality rate is provided and an indication is given of historical trends during the period 1950-2000 for both developed and developing countries. It is estimated that 10.5 million Children aged 0-4 years died in 1999, about 2.2 million or 17.5% fewer than a decade earlier. On average about 15% of newborn Children in Africa are expected to die before reaching their fifth birthday. The corresponding figures for many other parts of the developing world are in the range 3-8% and that for Europe is under 2%. During the 1990s the decline in Child Mortality decelerated in all the WHO regions except the Western Pacific but there is no widespread evidence of rising Child Mortality rates. At the country level there are exceptions in southern Africa where the prevalence of HIV is extremely high and in Asia where a few countries are beset by economic difficulties. The slowdown in the rate of decline is of particular concern in Africa and South-East Asia because it is occurring at relatively high levels of Mortality, and in countries experiencing severe economic dislocation. As the HIV/AIDS epidemic continues in Africa, particularly southern Africa, and in parts of Asia, further reductions in Child Mortality become increasingly unlikely until substantial progress in controlling the spread of HIV is achieved.