Quality of vital event data for infant mortality estimation in prospective, population-based studies: an analysis of secondary data from Asia, Africa, and Latin America

Daniel J. Erchick, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. derchick@jhu.edu.
Seema Subedi, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
Andrea Verhulst, Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA.
Michel Guillot, Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA.
Linda S. Adair, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Aluísio J. Barros, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
Bernard Chasekwa, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
Parul Christian, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
Bruna Gonçalves da Silva, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
Mariângela F. Silveira, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
Pedro C. Hallal, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
Jean H. Humphrey, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
Lieven Huybregts, Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA.
Simon Kariuki, Kenya Medical Research Institute/Centre for Global Health Research, Kisumu, Kenya.
Subarna K. Khatry, Nepal Nutrition Intervention Project - Sarlahi, Kathmandu, Nepal.
Carl Lachat, Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.
Alicia Matijasevich, Department of Preventive Medicine, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil.
Peter D. McElroy, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Ana Maria Menezes, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
Luke C. Mullany, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
Tita Lorna Perez, USC-Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines.
Penelope A. Phillips-Howard, Faculty of Medicine, Namur University, Namur, Belgium.
Dominique Roberfroid, Faculty of Medicine, Namur University, Namur, Belgium.
Iná S. Santos, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
Feiko O. Ter Kuile, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.
Thulasiraj D. Ravilla, Aravind Eye Care System, Madurai, India.
James M. Tielsch, Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Lee S. Wu, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
Joanne Katz, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.

Document Type

Journal Article

Publication Date

7-28-2023

Journal

Population health metrics

Volume

21

Issue

1

DOI

10.1186/s12963-023-00309-7

Abstract

INTRODUCTION: Infant and neonatal mortality estimates are typically derived from retrospective birth histories collected through surveys in countries with unreliable civil registration and vital statistics systems. Yet such data are subject to biases, including under-reporting of deaths and age misreporting, which impact mortality estimates. Prospective population-based cohort studies are an underutilized data source for mortality estimation that may offer strengths that avoid biases. METHODS: We conducted a secondary analysis of data from the Child Health Epidemiology Reference Group, including 11 population-based pregnancy or birth cohort studies, to evaluate the appropriateness of vital event data for mortality estimation. Analyses were descriptive, summarizing study designs, populations, protocols, and internal checks to assess their impact on data quality. We calculated infant and neonatal morality rates and compared patterns with Demographic and Health Survey (DHS) data. RESULTS: Studies yielded 71,760 pregnant women and 85,095 live births. Specific field protocols, especially pregnancy enrollment, limited exclusion criteria, and frequent follow-up visits after delivery, led to higher birth outcome ascertainment and fewer missing deaths. Most studies had low follow-up loss in pregnancy and the first month with little evidence of date heaping. Among studies in Asia and Latin America, neonatal mortality rates (NMR) were similar to DHS, while several studies in Sub-Saharan Africa had lower NMRs than DHS. Infant mortality varied by study and region between sources. CONCLUSIONS: Prospective, population-based cohort studies following rigorous protocols can yield high-quality vital event data to improve characterization of detailed mortality patterns of infants in low- and middle-income countries, especially in the early neonatal period where mortality risk is highest and changes rapidly.

Department

Global Health

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