Leontine Alkema and Danzhen You compare and summarize differences in underlying data and modelling approaches used by two key groups who publish data on global under-5 mortality rates
Millennium Development Goal 4 calls for a reduction in the under-five mortality rate (U5MR) by two-thirds between 1990 and 2015. In 2011, estimates were published by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) and the Institute for Health Metrics and Evaluation (IHME). The difference in the U5MR estimates produced by the two research groups was more than 10% and corresponded to more than ten deaths per 1,000 live births for 10% of all countries in 1990 and 20% of all countries in 2010, which can lead to conflicting conclusions with respect to countries' progress. To understand what caused the differences in estimates, we summarised differences in underlying data and modelling approaches used by the two groups, and analysed their effects.
Methods and Findings
UN IGME and IHME estimation approaches differ with respect to the construction of databases and the pre-processing of data, trend fitting procedures, inclusion and exclusion of data series, and additional adjustment procedures. Large differences in U5MR estimates between the UN IGME and the IHME exist in countries with conflicts or civil unrest, countries with high HIV prevalence, and countries where the underlying data used to derive the estimates were different, especially if the exclusion of data series differed between the two research groups. A decomposition of the differences showed that differences in estimates due to using different data (inclusion of data series and pre-processing of data) are on average larger than the differences due to using different trend fitting methods.
Substantial country-specific differences between UN IGME and IHME estimates for U5MR and the number of under-five deaths exist because of various differences in data and modelling assumptions used. Often differences are illustrative of the lack of reliable data and likely to decrease as more data become available. Improved transparency on methods and data used will help to improve understanding about the drivers of the differences.
Please see later in the article for the Editors' Summary.
In 2010, more than seven million children died before they reached their fifth birthday, and the global under-five mortality rate (also denoted in the literature as U5MR and 5q0) was 57 deaths per 1,000 live births. Most deaths before the age of five years occur in developing countries (about half occur in just five countries—India, Nigeria, the Democratic Republic of the Congo, Pakistan, and China), and most are caused by preventable or treatable diseases such as pneumonia, diarrhea, and malaria. Faced with this largely avoidable loss of young lives, in 1990, the United Nations (UN) World Summit for Children pledged to improve the survival of children. Later, in 2000, world leaders set a target of reducing under-five mortality to one-third of its 1990 level (12 million) by 2015, as Millennium Development Goal 4 (MDG 4). This goal, together with seven others, is designed to improve the social, economic, and health conditions in the world's poorest countries.
Why Was This Study Done?
Although progress towards MDG 4 is accelerating, MDG 4 is unlikely to be reached. It is important, therefore, to know which countries are making poor progress towards MDG 4 so that extra resources can be concentrated in these areas. To monitor both national and global progress, accurate, up-to-date estimates of U5MR are essential. The first step in estimating U5MR is the collection of data on child deaths, usually through vital registration systems (which record all births and deaths) in developed countries and through surveys that ask women about their living and dead children in developing countries. Country-specific U5MR estimates that are comparable over time and across countries are obtained from these data using a statistical process called trend fitting. Two groups—the UN Inter-agency Group for Child Mortality Estimation (UN IGME) and the Institute for Health Metrics and Evaluation (IHME)—recently published new estimates of the levels and trends in U5MR and under-five deaths across the world. However, their estimates differ somewhat and, for some countries, disagree on the progress being made towards MDG 4. Here, the researchers examine the differences in the underlying data and the trend fitting approaches used by the UN IGME and the IHME to try to understand why their estimates are different.
What Did the Researchers Do and Find?
The researchers first compared the estimates produced by the two groups. From 1990 to 2010, the UN IGME's global estimates of U5MR and under-five deaths were consistently slightly higher than those of the IHME. For example, in 2010, the UN IGME and IMHE estimates of U5MR were 56.7 and 53.9 deaths per 1,000 births, respectively. However, although the global estimates from the two groups were broadly similar, there were important differences between the two sets of estimates at the country level, particularly in countries where there was conflict or civil unrest (for example, Somalia) or high HIV prevalence. The researchers then examined the data used by the two groups to estimate under-five deaths and U5MR, the method used for U5MR trend fitting, and additional adjustment procedures (for example, the UN IGME incorporates feedback from experts and country consultations in its estimates). The UN IGME and IHME estimation approaches included differences in all of these areas, but differences in the data used caused on average larger differences in the estimates than the use of different trend fitting methods did.
What Do These Findings Mean?
These findings show that the substantial country-specific differences between UN IGME and IHME estimates for U5MR and the number of under-five deaths are the result of several differences between the data and trend fitting methods used by the two groups. In particular, the findings indicate that the lack of reliable data in many developing countries, especially those where there is civil unrest or ongoing conflicts, is often responsible for differences in estimates. These differences should, therefore, decrease as more reliable data become available. For now, though, the differences between the UN IGME and IHME national estimates of child mortality may cause confusion about the true extent of progress towards MDG 4 and could foster policy inactivity if the reasons for the discrepancies are not made clear. The researchers call, therefore, for more transparency on the methods and data used in the estimation of U5MR and for a concerted effort by governments, UN agencies, and non-governmental organizations to improve the collection of reliable data on child deaths.
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001288.
This paper is part of a collection of papers on Child Mortality Estimation Methods published in PLOS Medicine
The United Nations Childrens Fund (UNICEF) works for children's rights, survival, development, and protection around the world; it provides information on Millennium Development Goal 4, and its Childinfo website provides detailed statistics about child survival and health, including a description of the UN Inter-agency Group for Child Mortality Estimation and a link to its database; the 2011 UN IGME report on Levels and Trends in Child Mortality is available
The Institute for Health Metrics and Evaluation website includes a summary of their 2011 analysis of U5MR and under-five deaths
The World Health Organization also has information about Millennium Development Goal 4 and provides estimates of child mortality rates (some information in several languages)
Further information about the Millennium Development Goals is available