Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom.
Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at LSHTM, Fajara, The Gambia.
PLoS One. 2019 Jul 23;14(7):e0219919. doi: 10.1371/journal.pone.0219919. eCollection 2019.
In The Gambia, national estimates of under-five mortality (U5M) were from censuses and multiple indicator cluster surveys (MICS). The country's first demographic and health survey (DHS) conducted in 2013 provided empirical disaggregated national estimates of neonatal, post-neonatal and child mortality trends.
To assess the consistency and accuracy of the estimates of U5M from the existing data sources and its age-specific components in rural Gambia and produce reliable up-to-date estimates.
Available national data on under-five mortality from 2000 onwards were extracted. Additionally, data from two DHS regions were compared to those from two health and demographic surveillance systems (HDSS) located within them. Indirect and direct estimates from the data were compared and flexible parametric survival methods used to predict mortality rates for all empirical data points up to 2015.
Internal consistency checks on data quality for indirect estimation of U5M suggest that the data were plausible at national level once information from women aged 15-19 years was excluded. The DHS and HDSS data used to make direct U5M estimates were plausible, however HDSS data were of better quality. For 2009-2013, the DHS estimates agreed well with the 2013 census and 2010 MICS reports of U5M but was less accurate about the early births of older women. The most recent estimates from the 2013 DHS, which refer to 2011-12, are an U5M rate of 54/1000 livebirths (95% CI: 43-64) and a neonatal mortality rate of 21/1000 livebirths (95% CI: 15-27), contributing almost 40% of U5M in The Gambia. The DHS showed that for the decade prior to the survey, child mortality dropped by 55% and neonatal mortality by 31%. This indicates the importance of neonatal mortality in The Gambia, and the need to focus on neonatal survival, while maintaining currently successful strategies to further reduce U5M.
在冈比亚，五岁以下儿童死亡率（U5M）的国家估计数来自人口普查和多指标类集调查（MICS）。该国于 2013 年进行的第一次人口与健康调查（DHS）提供了新生儿、新生儿后期和儿童死亡率趋势的经验性分类国家估计数。
评估现有数据源中 U5M 及其特定年龄组的估计数的一致性和准确性，并提供可靠的最新估计数。
提取了 2000 年以来国家关于五岁以下儿童死亡的现有数据。此外，还比较了来自两个 DHS 地区的数据与位于其中的两个健康和人口监测系统（HDSS）的数据。比较了数据的间接和直接估计数，并使用灵活的参数生存方法预测了截至 2015 年的所有经验数据点的死亡率。
对 U5M 间接估计数据质量的内部一致性检查表明，一旦排除了 15-19 岁妇女的数据，全国数据就具有合理性。用于进行直接 U5M 估计的数据，即 DHS 和 HDSS 数据具有合理性，但是 HDSS 数据的质量更高。对于 2009-2013 年，DHS 估计数与 2013 年人口普查和 2010 年多指标类集报告中的 U5M 估计数吻合较好，但对老年妇女的早期分娩的估计数准确性较差。2013 年 DHS 的最新估计数，指的是 2011-12 年的数据，U5M 率为 54/1000 活产（95%CI：43-64），新生儿死亡率为 21/1000 活产（95%CI：15-27），占冈比亚 U5M 的近 40%。DHS 显示，在调查前十年，儿童死亡率下降了 55%，新生儿死亡率下降了 31%。这表明新生儿死亡率在冈比亚的重要性，需要注重新生儿的生存，同时保持目前成功的战略以进一步降低 U5M。
