Deribew Amare, Ojal John, Karia Boniface, Bauni Evasius, Oteinde Mark
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
BMC Public Health. 2016 Oct 24;16(1):1118. doi: 10.1186/s12889-016-3786-2.
Several low and middle-income countries (LMIC) use Demographic and Health Surveys (DHS) and/or Health and Demographic Surveillance System (HDSS) to monitor the health of their population. The level and trends of under-five mortality rates could be different in the HDSS sites compared to the DHS reports. In this study, we investigated the change in under-five mortality rates overtime in the HDSS sites and the corresponding DHS reports in eight countries and 13 sites.
Under-five mortality rates in the HDSS sites were determined using number of under-five deaths (numerator) and live births (denominator). The trends and annualized rate of change (ARC) of under-five mortality rates in the HDSS sites and the DHS reports were compared by fitting exponential function.
Under-five mortality rates declined substantially in most of the sites during the last 10-15 years. Ten out of 13 (77 %) HDSS sites have consistently lower under-five mortality rates than the DHS under-five mortality rates. In the Kilifi HDSS in Kenya, under-five mortality rate declined by 65.6 % between 2003 and 2014 with ARC of 12.2 % (95 % CI: 9.4-15.0). In the same period, the DHS under-five mortality rate in the Coastal region of Kenya declined by 50.8 % with ARC of 6 % (95 % CI: 2.0-9.0). The under-five mortality rate reduction in the Mlomp (78.1 %) and Niakhar (80.8 %) HDSS sites in Senegal during 1993-2012 was significantly higher than the mortality decline observed in the DHS report during the same period. On the other hand, the Kisumu HDSS in Kenya had lower under-five mortality reduction (15.8 %) compared to the mortality reduction observed in the DHS report (27.7 %) during 2003-2008. Under-five mortality rate rose by 27 % in the Agincourt HDSS in South Africa between 1998 to 2003 that was contrary to the 18 % under-five mortality reduction in the DHS report during the same period.
The inconsistency between HDSS and DHS approaches could have global implication on the estimation of child mortality and ethical issues on mortality inequalities. Further studies should be conducted to investigate the reasons of child mortality variation between the HDSS and the DHS approaches.
几个低收入和中等收入国家（LMIC）利用人口与健康调查（DHS）和/或健康与人口监测系统（HDSS）来监测其人口健康状况。与DHS报告相比，HDSS监测点五岁以下儿童死亡率的水平和趋势可能有所不同。在本研究中，我们调查了八个国家13个监测点的HDSS监测点以及相应DHS报告中五岁以下儿童死亡率随时间的变化情况。
HDSS监测点的五岁以下儿童死亡率通过五岁以下儿童死亡数（分子）和活产数（分母）来确定。通过拟合指数函数比较HDSS监测点和DHS报告中五岁以下儿童死亡率的趋势和年化变化率（ARC）。
在过去10至15年中，大多数监测点的五岁以下儿童死亡率大幅下降。13个HDSS监测点中有10个（77%）的五岁以下儿童死亡率一直低于DHS报告中的五岁以下儿童死亡率。在肯尼亚的基利菲HDSS监测点，2003年至2014年间五岁以下儿童死亡率下降了65.6%，年化变化率为12.2%（95%置信区间：9.4 - 15.0）。同期，肯尼亚沿海地区DHS报告中的五岁以下儿童死亡率下降了50.8%，年化变化率为6%（95%置信区间：2.0 - 9.0）。1993年至2012年期间，塞内加尔的姆隆普（78.1%）和尼亚哈（80.8%）HDSS监测点五岁以下儿童死亡率的下降幅度明显高于同期DHS报告中观察到的死亡率下降幅度。另一方面，2003年至2008年期间，肯尼亚基苏木HDSS监测点五岁以下儿童死亡率的下降幅度（15.8%）低于DHS报告中观察到的死亡率下降幅度（27.7%）。1998年至2003年期间，南非阿金库尔HDSS监测点的五岁以下儿童死亡率上升了27%，这与同期DHS报告中五岁以下儿童死亡率下降18%的情况相反。
HDSS和DHS方法之间的不一致可能对儿童死亡率估计产生全球影响，并引发关于死亡率不平等的伦理问题。应进一步开展研究，以调查HDSS和DHS方法之间儿童死亡率差异的原因。
