Volume 44 - Article 18 | Pages 415–442  

Age patterns of under-5 mortality in sub-Saharan Africa during 1990‒2018: A comparison of estimates from demographic surveillance with full birth histories and the historic record

By Hallie Eilerts, Julio Romero-Prieto, Jeffrey Eaton, Georges Reniers

Abstract

Background: Estimates of under-5 mortality (U5M) for sub-Saharan African populations often rely heavily on full birth histories (FBHs) collected in surveys and model age patterns of mortality calibrated against vital statistics from other populations. Health and Demographic Surveillance Systems (HDSSs) are alternate sources of population-based data in much of sub-Saharan Africa, which are less formally utilized in estimation.

Objective: In this study we compare the age pattern of U5M in different African data sources (HDSSs, Demographic and Health Surveys (DHS), and Multiple Indicator Cluster Surveys (MICS)), and contrast these with the historical record as summarized in the Human Mortality Database and model age patterns.

Methods: We examined the relative levels of neonatal, postneonatal, infant, and child mortality across data sources. We directly compared estimates for DHS and MICS subnational regions with HDSS, and used linear regression to identify data and contextual attributes that correlated with the disparity between estimates.

Results: HDSS and FBH data suggests that African populations have higher levels of child mortality and lower infant mortality than the historic record. This age pattern is most explicit for Western African populations, but also characterizes data for other subregions. The comparison between HDSS and FBH data suggests that FBH estimates of child mortality are biased downward. The comparison is less conclusive for neonatal and infant mortality.

Contribution: This study questions the practice of using model age patterns derived from largely high-income settings for inferring or correcting U5M estimates for African populations. It also highlights the considerable uncertainty around the consistency of HDSS and FBH estimates of U5M.

Author's Affiliation

• Hallie Eilerts - London School of Hygiene and Tropical Medicine, United Kingdom EMAIL
• Julio Romero-Prieto - London School of Hygiene and Tropical Medicine, United Kingdom EMAIL
• Jeffrey Eaton - Imperial College London, United Kingdom EMAIL
• Georges Reniers - London School of Hygiene and Tropical Medicine, United Kingdom EMAIL

Other articles by the same author/authors in Demographic Research

Sample selection bias in adult mortality estimates from mobile phone surveys: Evidence from 25 low- and middle-income countries
Volume 51 - Article 37

Knowledge, risk perceptions, and behaviors related to the COVID-19 pandemic in Malawi
Volume 44 - Article 20

Sexual networks, partnership mixing, and the female-to-male ratio of HIV infections in generalized epidemics: An agent-based simulation study
Volume 33 - Article 15

Polygyny and HIV in Malawi
Volume 19 - Article 53

Divorce and Remarriage in Rural Malawi
Special Collection 1 - Article 6

An Assessment of the KDICP and MDICP Data Quality: Interviewer Effects, Question Reliability and Sample Attrition
Special Collection 1 - Article 2

Most recent similar articles in Demographic Research

Children under 5 in polygynous households in sub-Saharan Africa, 2000 to 2020
Volume 51 - Article 32    | Keywords: children, Demographic and Health Surveys (DHS), family demography, polygyny, sub-Saharan Africa

Using Respondent-Driven Sampling to measure abortion safety in restrictive contexts: Results from Kaya (Burkina Faso) and Nairobi (Kenya)
Volume 50 - Article 47    | Keywords: induced abortion, respondents-driven samples, social networks, sub-Saharan Africa

Predictive utility of key family planning indicators on dynamic contraceptive outcomes: Results from longitudinal surveys in Burkina Faso, Kenya, Uganda, and Côte d'Ivoire
Volume 50 - Article 45    | Keywords: contraception, contraceptive adoption, contraceptive discontinuation, contraceptive use, family planning, longitudinal data, methods, panel data, Performance and Monitoring for Action (PMA) surveys, sub-Saharan Africa

Decomposition analysis of disparities in infant mortality rates across 27 US states
Volume 50 - Article 40    | Keywords: decomposition, health disparities, infant mortality, United States of America

Losing the female survival advantage: Sex differentials in infant and child mortality in Pakistan
Volume 50 - Article 15    | Keywords: child mortality, family, gender discrimination, Pakistan, sex differentials, son preference, South Asia, survival analysis