Design of household sample surveys to test death registration completeness

This paper studies the design effect of counting rules, for linking deaths to housing units where they are enumerated in the survey, on the sampling variance of dual system and single system estimators of death registration completeness. It investigates estimators based on conventional rules that uniquely link each death to a single housing unit as well as estimators based on multiplicity rules which permit deaths to be linked to more than one housing unit. Sampling variance formulas are derived containing parameters that reflect the efficiency of the counting rule. Estimates of these parameters for different counting rules are compared utilizing information that was collected in a mortality survey experiment. Finally, the design of a national death registration test is considered and the sample size implications of different counting rules arc compared.

     

Socioeconomic Inequalities in Infant Mortality in Egypt: Analyzing Trends Between 1995 and 2014

This paper analyses the trend of the socioeconomic inequalities in infant mortality rates in Egypt over the period 1995–2014, using repeated cross-sectional data from the National Demographic and Health Survey. A multivariate logistic regression and concentration indices are used to examine the demographic and socioeconomic correlates of infant mortality, and how the degree of socioeconomic disparities in child mortality rates has evolved over time. We find a significant drop in infant mortality rates from 63 deaths per 1000 live births in 1995 to 22 deaths per 1000 live births in 2014. However, analyzing trends over the study period reveals no corresponding progress in narrowing the socioeconomic disparities in childhood mortality. Infant mortality rates remain higher in rural areas and among low-income families than the national average. Results show an inverse association between infant mortality rates and living standard measures, with the poor bearing the largest burden of early child mortality. Though the estimated concentration indices show a decline in the degree of socioeconomic inequality in child mortality rates over time, infant mortality rate among the poor remains twice the rate of the richest wealth quintile. Nonetheless, this decline in the degree of socioeconomic inequality in child mortality is not supported by the results of the multivariate logistic regression model. Results of the logistic model show higher odds of infant mortality among rural households, children who are twins, households with risky birth intervals. We find no statistically significant association between infant mortality and child’s sex, access to safe water, mothers’ work, and mothers’ nutritional status. Infant mortality is negatively associated with household wealth and regular health care during pregnancy. Concerted effort and targeting intervention measures are still needed to reduce the degree of socioeconomic and regional inequalities in child health, including infant mortality, in Egypt.     

Neo-natal and post-neo-natal mortality in a rural area of Bangladesh

Abstract An analysis of neo-natal and post-neo-natal mortality in 132 villages (population of 117,000) of Matlab thana indicates the following: (i) Neo-natal deaths accounted for 60% of the infant mortality rate of 125. This proportion was unexpectedly high since previous research had maintained that in countries with infant mortality rates over 100, neo-natal deaths account for less than one-third of all infant deaths. Since the present findings on the proportions of neo-natal deaths correspond exactly with results from an earlier registration system in East Pakistan, it is suggested that the long-accepted proposition, 'less developed' areas are characterized by lower proportions of neo-natal deaths than 'more developed' areas, be re-examined. (2) The infant death rate accounts for 36% of all deaths in the population. If the infant death rate were reduced by half the result would be a decrease in the current crude death rate from 16 to 13. Although this reduction would appear to be small, in the context of a current high growth rate of 3% (from 1966-67 to 1968-69) it exerts a sizeable impact. For example, it would take a reduction of eight points in the crude birth rate of 46 just to achieve a growth rate 2·5% under these circumstances. Obviously, continued efforts in death control without an effective birth control programme will perpetuate high rates of growth. (3) Neo-natal and post-neo-natal mortality exhibited the -expected 'U' shaped pattern with parity, and generally varied as expected with age and family size, except in the oldest age group and largest family size where the risk was smaller than in the preceding groups. An explanation for these findings is presented, based on the effect that births to high-parity women with low child mortality have upon the total neo-natal and post-neo-natal mortality rates. It was found that these births exhibit a much lower mortality risk than births to women of comparable parities and higher child mortality, and that their numbers account for the lower risk to the births in the oldest age group and largest family size. It was concluded that women with a combination of high parity and low child mortality most probably represent a group with superior socio-economic and or health conditions which contribute to the lower risk of neo-natal and post-neo-natal death.     

Estimating the completeness of death registration

Summary Death registration statistics, even when incomplete, can provide valuable information about mortality. In particular, the age structure of deaths can be used to estimate the completeness of registration, provided that this completeness does not vary substantially with age. Two methods of estimating the completeness of death registration from the distribution of deaths by age are described. The first is derived from stable population theory and requires an estimate of the rate of natural increase of the population, as well as assuming stability. However, the technique can also be used to generate simultaneously estimates of the rate of natural increase and of death registration completeness. The second method which requires two census age distributions and intercensal deaths by age, estimates the relative enumeration completeness of the two censuses as well as the completeness of death registration and requires only that the population be closed. Results are sensitive to overstatement of age. The methods are illustrated by being applied to figures from Thailand for the period 1960-70 and are found to work satisfactorily.     

Infant mortality in the Marshall Islands

Levy and Booth present previously unpublished infant mortality rates for the Marshall Islands. They use an indirect method to estimate infant mortality from the 1973 and 1980 censuses, then apply indirect and direct methods of estimation to data from the Marshall Islands Women's Health Survey of 1985. Comparing the results with estimates of infant mortality obtained from vital registration data enables them to estimate the extent of underregistration of infant deaths. The authors conclude that 1973 census appears to be the most valid information source. Direct estimates from the Women's Health Survey data suggest that infant mortality has increased since 1970-1974, whereas the indirect estimates indicate a decreasing trend in infant mortality rates, converging with the direct estimates in more recent years. In view of increased efforts to improve maternal and child health in the mid-1970s, the decreasing trend is plausible. It is impossible to estimate accurately infant mortality in the Marshall Islands during 1980-1984 from the available data. Estimates based on registration data for 1975-1979 are at least 40% too low. The authors speculate that the estimate of 33 deaths per 1000 live births obtained from registration data for 1984 is 40-50% too low. In round figures, a value of 60 deaths per 1000 may be taken as the final estimate for 1980-1984.     

The effect of child mortality experience on subsequent fertility: in Pakistan and Bangladesh

Summary This paper presents an empirical analysis of the effects, behavioural and biological, of child mortality experience on subsequent fertility in two South Asian Islamic nations. Data for the investigation came from retrospective pregnancy histories of 2,910 currently married women interviewed in the Pakistan National Impact Survey (1968-69) and from longitudinal vital registration data (1966-2070) of 5,236 women residing in a rural area of Bangladesh collected by the Cholera Research Laboratory. The aim of this study was to assess the importance of the child-replacement motivational response to child death experience after biological effects have been controlled adequately. A common approach employed previously has been to examine cumulative fertility according to child death experience. In Pakistan and Bangladesh, a consistently positive relationship was demonstrated between the number of children ever born and the number of child deaths. This method, however, did not exclude the inverse relationship, the influence of fertility on mortality, nor did it dissect out behavioural from biological effects. Utilizing a measure of subsequent fertility, live-birth-to-live-birth intervals, the study further illustrated another common pitfall. Since the risk of infant death, which leads to shorter birth intervals, is associated with the mother's reproductive history, women with child mortality experience are more likely to experience shorter intervals because of the biological effect of subsequent infant death. Behavioural influences may, therefore, be observed by considering only those birth intervals in which the first-born child survives to the end of the interval. With these limitations controlled, very few, if any, behavioural influences were noted in the Pakistan and Bangladesh data. Median birth intervals in Pakistan varied between 35-43 and 41-42 months, increasing with parity. Within each parity group, no consistent difference was observed between women with and without previous child loss. In Bangladesh, the median birth interval for all women with a surviving infant was 37-2 months. This was shortened to 24-31 months by an infant death. When intervals with infant deaths were excluded, little or no behavioural influence was detected among women of the same parity, but with varying levels of previous child loss. Even without behavioural effects, elimination of infant mortality in Bangladesh would reduce fertility by prolonging the average period of post-partum sterility. In the Bangladesh setting, however, the size of the effect was only about four per cent. This modest effect, more-over, was counterbalanced by an overall increase of net reproduction by seven per cent due to better survivorship of infants.     

A modification for use in destabilized populations of brass's technique for estimating completeness of death registration

Summary Brass has developed a method of estimating completeness of death registration using only data on deaths and population by age and sex. In this paper, his method is briefly outlined and the assumptions upon which it is based are discussed. In particular, the implications of the failure of the assumption of stability of the population are investigated. It is found that in populations where mortality has been declining, use of the technique leads to underestimation of completeness. A modification of the technique based on knowledge of the duration and rate of mortality change is proposed for use in such populations. Using simulated destabilized populations, the modification is tested and found to yield more accurate estimates of completeness of death registration than the unmodified technique. The usefulness of the modified technique is further illustrated by applying it to data for Costa Rican females in 1963.     

The Middle East population puzzle

An overview is provided of Middle Eastern countries on the following topics; population change, epidemiological transition theory and 4 patterns of transition in the middle East, transition in causes of death, infant mortality declines, war mortality, fertility, family planning, age and sex composition, ethnicity, educational status, urbanization, labor force, international labor migration, refugees, Jewish immigration, families, marriage patterns, and future growth. The Middle East is geographically defined as Bahrain, Egypt, Iraq, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syria, United Arab Emirates, Yemen, Gaza and the West Bank, Iran, Turkey, and Israel. The Middle East's population grew very little until 1990 when the population was 43 million. Population was about doubled in the mid-1950s at 80 million. Rapid growth occurred after 1950 with declines in mortality due to widespread disease control and sanitation efforts. Countries are grouped in the following ways: persistent high fertility and declining mortality with low to medium socioeconomic conditions (Jordan, Oman, Syria, Yemen, and the West Bank and Gaza), declining fertility and mortality in intermediate socioeconomic development (Egypt, Lebanon, Turkey, and Iran), high fertility and declining mortality in high socioeconomic conditions (Bahrain, Iraq, Kuwait, Qatar, Saudi Arabia, and the United Arab Emirates), and low fertility and mortality in average socioeconomic conditions (Israel). As birth and death rates decline, there is an accompanying shift from communicable diseases to degenerative diseases and increases in life expectancy; this pattern is reflected in the available data from Egypt, Kuwait, and Israel. High infant and child mortality tends to remain a problem throughout the Middle East, with the exception of Israel and the Gulf States. War casualties are undetermined, yet have not impeded the fastest growing population growth rate in the world. The average fertility is 5 births/woman by the age of 45. Muslim countries tend to have larger families. Contraceptive use is low in the region, with the exception of Turkey and Egypt and among urban and educated populations. More than 40% of the population is under 15 years of age. The region is about 50% Arabic (140 million). Educational status has increased, particularly for men; the lowest literacy rates for women are in Yemen and Egypt. The largest countries are Iran, Turkey, and Egypt.     

Estimation of vital rates for Ghana

Abstract A complete and efficient registration system, of the type which would provide good data on births and deaths, does not exist in Ghana. However, registration of vital events is supposed to be compulsory in 39 towns in the country but the data collected in these areas are too inadequate and defective to provide a sound basis for the analysis of the dynamics of population growth. The results of the censuses conducted by the colonial governments are so defective and unreliable that they do not allow scientific research in the field of population analysis. Before 1960, therefore, when the national census and the post-enumeration survey (based on a 5% sample of the population) were carried out, estimates of fertility and mortality levels were little more than guesses. In this study an attempt has been made to utilize the information on the age-sex composition provided by the 1960 census and post-enumeration survey data on births and deaths to determine, as far as possible, the levels of fertility and mortality and the rates of population growth in Ghana. The fertility estimates-i.e. a crude birth rate of 50, total fertility rate of 6.9 and a gross reproduction rate of 3.4-show that Ghana's fertility is one of the highest in the world. An expectation of life at birth of 40 years, an infant mortality of 160 and a crude death rate of 23 appear to be the most plausible estimates. These estimates yield a rate of natural increase of 2.7% and a growth rate of 3.0% per annum.     

Mortality in China 1964-2000

This paper uses data from censuses and surveys to re-estimate mortality levels and trends in China from the 1960s to 2000. We use the General Growth Balance method to evaluate the completeness of death reporting above the youngest ages in three censuses of the People's Republic of China from 1982 to 2000, concluding that reporting quality is quite high, and revisit the completeness of death recording in the 1973-75 Cancer Epidemiology Survey. Estimates of child mortality from a variety of direct and indirect sources are reviewed, and best estimates arrived at. Our estimates show a spectacular improvement in life expectancy in China: from about 60 years in the period 1964-82 to nearly 70 years in the period 1990-2000, with a further improvement to over 71 years by 2000. We discuss why survival rates continue improving in China despite reduced government involvement in and increasing privatization of health services, with little insurance coverage.     

The cocos-keeling islands: A demographic laboratory

The Cocos Islands, which are situated in the Indian Ocean approximately halfway between Colombo and Fremantle, were first peopled early in the nineteenth century and were gradually developed as a very isolated coconut plantation with a labour force consisting partly of persons of Malay stock descended from the original group of settlers and partly of Bantamese contract labourers from Java. As the Cocos-born population increased in size, the dependence on contract labour decreased and, before the end of the century, all immigration ceased. The 1947 Malay population of the islands was about 1,800.

The islands are fascinating from a demographer's point of view because there was a virtually complete registration of live births, deaths and marriages and a partial registration of stillbirths. With these registration records it was possible to construct the life history of every individual from birth, through infancy and childhood to marriage, and thence through fatherhood or motherhood to death.

The picture revealed by an analysis of these records is that of a population with very high fertility and with mortality at a high level before the first World war and at a medium level after that war. Crude birth rates varied between 50 and 60 per thousand population during the period 1888 to 1947. Crude death rates were between 30 and 40 per thousand population until 1912 but under 2.0 per thousand population after 1918.

Most Cocos girls married before reaching the age of 20 and there were an average of between eight and nine live births per woman living through the childbearing period. There was a steady decline in the average number of live births with advancing age at marriage from age 16 onwards. A significantly high proportion of those dying in the middle of the childbearing period had never married, but the fertility of those marrying at an early age (14, 15 and 16) and dying before reaching the age of 36 was slightly higher than that of those who married at a similar age and survived. Women who survived to the age of 55 were of higher fertility than those who died between the ages of 40 and 55. An analysis of birth intervals revealed significant differences (a) between birth intervals after a stillbirth or after a live birth in which the child died in early infancy, and birth intervals after a live birth in which the offspring survived for longer than 0.4 years, and (b) between the interval from first to second birth and the subsequent birth intervals. There was a difference of almost exactly a year between the average birth interval after a stillbirth or live birth ending in a neo-natal death and the average birth interval after the birth of a child surviving to age 2; there was a similar difference of a year between corresponding median birth intervals.

From 1888 to 1912 infant mortality was well above 300 per thousand. After 1918 infant mortality averaged rather under 100 infant deaths per 1,000 live births. The reduction in infant mortality rates was accompanied by an increase in the mortality of children aged 1 to 4, and the heavy incidence of mortality at these ages after 1918 is the most striking feature of the analysis of mortality by age. Whilst mortality in infancy fell much more heavily on males than on females, early childhood mortality was much higher in Cocos for girls than for boys. The life table computed for the period 1918 to 1947 indicated a life expectancy of about 50 years for males and 47 years for females.     

Maternal mortality in South Africa: lessons from a case study in the use of deaths reported by households in censuses and surveys

South Africa is unique in being a developing country which has asked questions on pregnancy-related deaths in both its 2001 census and 2007 household survey, and monitors maternal and pregnancy-related mortality through vital registration and a confidential enquiry into maternal deaths. These sources of data provide a wide range of estimates of maternal mortality for the country. This paper examines these estimates to assess to what extent the differences between them are due to data deficiencies, methodological deficiencies or definitional differences. The results show that since maternal deaths are relatively rare it is fairly difficult to establish the maternal mortality rate with a great degree of accuracy in a setting where data are less than perfect. They also show that to some extent the differences are due to differences and errors in processing of data but that pregnancy-related mortality should not be treated as synonymous with maternal mortality. However, after adjustment, pregnancy-related mortality from vital registration was comparable with the level that may be expected using several alternative approaches, while the rate reported by households in census and surveys was about double that from vital registration. Nonetheless, all the data indicate an upward trend in maternal mortality that is in keeping with the impact of the HIV/AIDS epidemic, which is likely to have contributed to the discrepancies.     

The Level and Age Pattern of Mortality in Bandafassi (Eastern Senegal): Results From a Small-Scale and Intensive Multi-Round Survey

The data collected in the Bandafassi demographic study in Eastern Senegal, a small-scale intensive and experimental follow-up survey of a population of about 7,000 in 1983, were analysed to derive an estimated life table. The use of multi-round surveys, combined with anthropological methods to estimate ages and collect genealogies, has resulted in unusually reliable data. Taking into account the uncertainty of the estimates due to the small size of the population, mortality was high, with life-expectancy at birth close to 31 years; a pattern of infant and child mortality close to that observed in other rural areas of Senegal, with a very high level or mortality between ages six months and three years; a seasonal pattern in child mortality with two high-risk periods, the rainy season and the end of the dry season; an adult mortality pattern similar to that described in model life tables for developed countries; no significant difference by sex or ethnic group. The Bandafassi population study and a few similar studies suggest that one possible way to improve demographic estimates in countries where vital registration systems are defective would be to set up a sample of population laboratories where intensive methods of data collection would continue for extended periods.     

Household income and child survival in Egypt

This article uses household-level economic and fertility survey data to examine the relationship between household income and child survival in Egypt. Income has little effect on infant mortality but is inversely related to mortality in early childhood. The relationship persists with other associated socioeconomic variables controlled. The mechanisms underlying the income effects are not evident from this analysis: income differentials in sources of household drinking water, type of toilet facilities, and maternal demographic characteristics do not explain the net impact of income on child mortality. The absence of effects on child survival of the size of the place of residence and the relatively weak effects of maternal schooling are also notable.     

Estimates of vital rates for the Canadian Indians, 1960–1970

The present paper is an attempt to evaluate the registered data on Canadian Indians collected by the Department of Indian Affairs and Northern Development and to prepare vital rates for 1960–1970 using the adjusted data. A cursory examination of registered data for the purpose of developing various demographic indices and for making future estimates of population indicates certain anomalies that call for a careful appraisal of the data. The main problem is the inconsistency in the reporting of births, due largely to the late registration of births. One plausible reason for late registration may be the increased outward movement of Indians from their reserves. Indirect methods are used to adjust the number of births and infant deaths reported annually since 1960. On the basis of the adjusted data, vital rates for the Canadian Indians are calculated for the period 1960–1970. The crude death rate decreased from 10.9 in 1960 to 7.5 in 1970. The infant mortality rate registered a drastic decline, from 81.5 deaths per 1,000 births in 1960 to 34.9 in 1970. During this same time period the birth rate also declined, from 46.5 to 37.2.     

The effects of infant mortality on fertility revisited: new evidence from latin america

In this paper, we examine empirical evidence for a relation between infant and child mortality and fertility in Latin American countries from 1920 to 1990. We investigate the relation at several levels of aggregation and evaluate the extent to which evidence at one level is consistent with evidence at other levels. We first examine aggregate cross-country information over several decades, a type of data typically used in past research on the topic. We also examine yearly series of births, deaths, infant deaths, and socioeconomic indicators for selected countries to track the association between short-term fluctuations in fertility and infant mortality. Finally, we use micro-level data from the Demographic and Health Surveys (DHS) to assess the relation between fertility and child mortality from individual reproductive histories. The evidence we assemble from these different data sets is remarkably consistent and suggests small positive effects of infant mortality on fertility. These effects, however, may be too small to support the hypothesis that changes in child mortality are of more than modest importance in the process of fertility decline in Latin America in the late twentieth century.     

Multidimensional Almost Dominance: Child Wellbeing in Egypt

A major drawback of First Order Stochastic Dominance approach is dominance indetermination. Levy and Leshno in 2002 suggested Almost Stochastic Dominance as a remedy in the uni-dimensional case. We introduce a Generalization of Almost First and second Order Dominance (MAFOD and MASOD) to the multidimensional case with application on child wellbeing in Egypt. We perform a multidimensional (FOD) analysis on seven deprivation indicators for three age-groups of children from Egypt 2014 Demographic and Health Survey (EDHS14). This methodology allows the ordinal ranking of regions and governorates of Egypt in terms of their children wellbeing based on their probability of domination. To solve the dominance indetermination we apply MAFOD and MASOD.     

Purposive concealment of death in household surveys in Misamis Oriental Province

Summary The randomized response technique was used in a household survey of approximately 2,000 rural and 2,000 urban households in Misamis Oriental Province in the southern Philippines in order to determine the extent of purposive concealment of death. The estimated number of deaths deliberately not revealed to the interviewers was 50 per cent or higher. Adjusted crude death rates of 11.5 and 13.4 per 1,000 population were computed for urban and rural areas, respectively, by adding estimated concealed deaths to deaths reported to the interviewers. Application of stable population techniques and of model life tables suitable to the Philippine setting, while not permitting definite conclusions, provided reasons for believing that these adjusted death rates are close to the true mortality situation in the study areas. Randomized response data further indicate that approximately 75 per cent of urban deaths and 47 per cent of rural deaths of the population studied were not registered with municipal authorities. The authors postulate that failure to register deaths with municipal authorities, together with fear of legal involvement if this failure becomes known outside the immediate neighbourhood, is a major reason for the purposive concealment of death in household surveys.     

Estimating census and death registration completeness

This article presents a new method for estimating the relative completeness of 2 census enumerations and of intercensal registered deaths. The Growth Balance Equation was developed by Brass (1975) to estimate the completeness of death registration relative to the completeness of census enumeration. The method presented here can be seen either as an extension of Martin's formulation to allow explicitly for changes in census coverage or as a modification of Brass's method to use deaths by age group rather than deaths by cohort, preferable on the grounds that age group comparisons will be less distorted by age misreporting than cohort comparisons if the patterns of age misreporting are similar for 2 successive censuses. This simple method estimates simultaneously the relative coverage of the 2 censuses and the completeness of registration of intercensal deaths. The key assumptions of the method are that the population is closed to migration and that all the coverage factors involved are invariant with age, at least for the age range studied. Analysis of the sensitivity of the estimates to the assumptions and further work on extending the method to open populations would be useful.     

Revising Infant Mortality Rates for the Early Twentieth Century United States

Accurate vital statistics are required to understand the evolution of racial disparities in infant health and the causes of rapid secular decline in infant mortality during the early twentieth century. Unfortunately, U.S. infant mortality rates prior to 1950 suffer from an upward bias stemming from a severe underregistration of births. At one extreme, African American births in southern states went unregistered at the rate of 15 % to 25 %. In this study, we construct improved estimates of births and infant mortality in the United States for 1915–1940 using recently released complete count decennial census microdata combined with the counts of infant deaths from published sources. We check the veracity of our estimates with a major birth registration study completed in conjunction with the 1940 decennial census and find that the largest adjustments occur in states with less-complete birth registration systems. An additional advantage of our census-based estimation method is the extension backward of the birth and infant mortality series for years prior to published estimates of registered births, enabling previously impossible comparisons and estimations. Finally, we show that underregistration can bias effect estimates even in a panel setting with specifications that include location fixed effects and place-specific linear time trends.