Dwyer-Lindgren Laura, Squires Ellen R, Teeple Stephanie, Ikilezi Gloria, Allen Roberts D, Colombara Danny V, Allen Sarah Katherine, Kamande Stanley M, Graetz Nicholas, Flaxman Abraham D, El Bcheraoui Charbel, Asbjornsdottir Kristjana, Asiimwe Gilbert, Augusto Ângelo, Augusto Orvalho, Chilundo Baltazar, De Schacht Caroline, Gimbel Sarah, Kamya Carol, Namugaya Faith, Masiye Felix, Mauieia Cremildo, Miangotar Yodé, Mimche Honoré, Sabonete Acácio, Sarma Haribondhu, Sherr Kenneth, Simuyemba Moses, Sinyangwe Aaron Chisha, Uddin Jasim, Wagenaar Bradley H, Lim Stephen S
Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98103, USA.
Health Alliance International, Seattle, WA, USA.
Popul Health Metr. 2018 Aug 13;16(1):13. doi: 10.1186/s12963-018-0171-7.
The under-5 mortality rate (U5MR) is an important metric of child health and survival. Country-level estimates of U5MR are readily available, but efforts to estimate U5MR subnationally have been limited, in part, due to spatial misalignment of available data sources (e.g., use of different administrative levels, or as a result of historical boundary changes).
We analyzed all available complete and summary birth history data in surveys and censuses in six countries (Bangladesh, Cameroon, Chad, Mozambique, Uganda, and Zambia) at the finest geographic level available in each data source. We then developed small area estimation models capable of incorporating spatially misaligned data. These small area estimation models were applied to the birth history data in order to estimate trends in U5MR from 1980 to 2015 at the second administrative level in Cameroon, Chad, Mozambique, Uganda, and Zambia and at the third administrative level in Bangladesh.
We found substantial variation in U5MR in all six countries: there was more than a two-fold difference in U5MR between the area with the highest rate and the area with the lowest rate in every country. All areas in all countries experienced declines in U5MR between 1980 and 2015, but the degree varied both within and between countries. In Cameroon, Chad, Mozambique, and Zambia we found areas with U5MRs in 2015 that were higher than in other parts of the same country in 1980. Comparing subnational U5MR to country-level targets for the Millennium Development Goals (MDG), we find that 12.8% of areas in Bangladesh did not meet the country-level target, although the country as whole did. A minority of areas in Chad, Mozambique, Uganda, and Zambia met the country-level MDG targets while these countries as a whole did not.
Subnational estimates of U5MR reveal significant within-country variation. These estimates could be used for identifying high-need areas and positive deviants, tracking trends in geographic inequalities, and evaluating progress towards international development targets such as the Sustainable Development Goals.
五岁以下儿童死亡率（U5MR）是衡量儿童健康与生存状况的一项重要指标。国家层面的U5MR估算数据很容易获取，但在国家以下层面估算U5MR的工作却受到限制，部分原因是可用数据源在空间上存在不一致性（例如，使用不同的行政级别，或因历史边界变化所致）。
我们在六个国家（孟加拉国、喀麦隆、乍得、莫桑比克、乌干达和赞比亚）的调查和人口普查中，以每个数据源中可用的最精细地理级别分析了所有可用的完整和简要出生史数据。然后，我们开发了能够纳入空间不一致数据的小区域估计模型。这些小区域估计模型被应用于出生史数据，以估算喀麦隆、乍得、莫桑比克、乌干达和赞比亚第二行政级别以及孟加拉国第三行政级别在1980年至2015年期间的U5MR趋势。
我们发现所有六个国家的U5MR都存在显著差异：每个国家中U5MR最高的地区与最低的地区之间存在两倍多的差异。1980年至2015年期间，所有国家的所有地区U5MR均有所下降，但下降程度在国家内部和国家之间都有所不同。在喀麦隆、乍得、莫桑比克和赞比亚，我们发现2015年有些地区的U5MR高于该国其他地区1980年的水平。将国家以下层面的U5MR与千年发展目标（MDG）的国家层面目标进行比较，我们发现孟加拉国12.8%的地区未达到国家层面目标，尽管该国整体上达到了目标。乍得、莫桑比克、乌干达和赞比亚少数地区达到了国家层面的MDG目标，而这些国家整体上未达到。
国家以下层面的U5MR估算揭示了国家内部的显著差异。这些估算可用于确定高需求地区和正向偏差地区，跟踪地理不平等趋势，以及评估在可持续发展目标等国际发展目标方面的进展。
