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Madagascar child mortality esti

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					                   Madagascar child mortality estimates


The preliminary survey report for the Madagascar DHS 2003-2004 (DHS03) has just been
released. Comparison of the most recent U5MR data point from the DHS97, of 159 per 1000 live
births, with the most recent value from the DHS03, of 94, suggests there has been a huge decrease
in U5MR in the last few years in Madagascar.

However, when the full data set from the DHS03 is plotted on charts, together with data from
previous surveys, the conclusions are different. Focusing on the U5MR chart, it can be seen that
DHS03 data is very obviously lower than data from MICS00, DHS97 and DHS92 – a sizable 30
and more less than either of the previous DHS direct estimates (DHSd97 and DHSd92). The
most recent points from both the DHSi97 (indirect) and MICSi00 cannot be taken as support for
the DHS03 results since the DHSi97 data are highly variable, and the most recent point from
DHSi97 and MICSi00 have a high degree of uncertainty.

It is possible that the DHS03 mortality data are closer to the actual situation in Madagascar than
either of the earlier two DHS. However, there is much more consistency between the data from
the DHS92, DHS97 and MICS00 than with DHS03, and it is therefore unlikely that mortality data
from the former three surveys are all incorrect.

Hence, if the DHS03 data appear underestimate mortality levels in Madagascar, as is indicated by
the comparison with other surveys, the question remains as to what impact the DHS03 data
should have on the mortality estimates for Madagascar. A frequent option, where levels are
different, is to take the trend of the survey data as relevant, and to use this trend to project
forward from higher levels of mortality derived from earlier surveys. This has been done in the
attached charts for U5MR, using the composite trend given by the most recent three data points.
IMR has been derived from U5MR.

Nevertheless, taking such an approach leads to a considerable degree of uncertainty in the most
recent mortality estimates. For example, in the case of IMR, the older three data points from the
DHS03 show an increase in IMR when both the DHSd92 and DHSd97 show a decline in IMR
over the same period. Hence, at least for IMR, the trend from DHS03 does not appear indicative
of the actual trend.

Clearly, further analysis of the DHS 2003 would be useful in order to assess why the mortality
data from the survey are considerably lower than that from earlier surveys.


                                                                                     GJ. 2004.7.8
                                                           MADAGASCAR - UNDER-FIVE
                                                                 MORTALITY

                                                 250
   Under-five mortality rate (per 1000 births)




                                                 200




                                                 150




                                                 100




                                                 50




                                                  0
                                                  1960    1965   1970   1975   1980   1985   1990   1995   2000   2005
                                                                                  Year

                                                       MDSi66      DHSd92        DHSi92        MICSi95       DHSd97


                                                       DHSi97      MICSi00       DHSd03        EST


CMRMAD047.XLS                                                                                                     2004.7.8
                                                   MADAGASCAR - INFANT MORTALITY

                                             140



                                             120
   Infant mortality rate (per 1000 births)




                                             100



                                             80



                                             60



                                             40



                                             20



                                              0
                                              1960    1965   1970   1975   1980   1985   1990   1995   2000      2005
                                                                              Year

                                                   MDSi66      DHSd92        DHSi92       MICSi95       DHSd97


                                                   DHSi97      MICSi00       DHSd03       EST


CMRMAD047.XLS                                                                                                 2004.7.8
                                                                               Data




CHILD MORTALITY - MADAGASCAR


         North (see model lifetable chart)
         MDSi66        DHSd92          DHSi92        MICSi95     DHSd97     DHSi97              MICSi00     DHSd03     KHest               EST
  Year   U5MR      IMR U5MR        IMR U5MR      IMR U5MR    IMR U5MR   IMR U5MR            IMR U5MR    IMR U5MR   IMR U5MR            IMR U5MR       IMR
1951.1     135      84
1953.9     122      77
1956.8     130      81
1959.5     135      84
1961.9     132      83
1964.0     164     100
1970.5                    171      104
1975.5                    169       91
1980.5                    181      104
1985.5                    195      113
1990.3                    163       93
1978.4                                     159    97
1981.2                                     169   103
1983.8                                     167   101
1986.1                                     182   110
1988.2                                     194   116
1990.1                                     188   113
1992.5                                                 153     94
1975.4                                                               177      95
1980.4                                                               179     103
1985.4                                                               204     116
1990.4                                                               170     103
1995.4                                                               159      96
1983.3                                                                                172   104
1986.1                                                                                155    95
1988.6                                                                                192   115
1991.0                                                                                165   101
1993.1                                                                                145    90
1995.0                                                                                148    91
1989.0                                                                                             174    105
1992.0                                                                                             168    102
1994.0                                                                                             155     95
1996.0                                                                                             148     91
1998.0                                                                                             136     85
1986.6                                                                                                           141      75
1991.6                                                                                                           129      77
1996.6                                                                                                           130      82
2001.6                                                                                                            94      58
 1960                                                                                                                           186    112
 1965                                                                                                                           183    110
 1970                                                                                                                           180    109
 1975                                                                                                                           178    107
 1980                                                                                                                           175    106
 1985                                                                                                                           173    105
 1990                                                                                                                           170    103
 1995                                                                                                                           168    102                  Ratio
 1960                                                                                                                                           186   112   1.66
 1965                                                                                                                                           183   110   1.66
 1970                                                                                                                                           180   109   1.65
 1975                                                                                                                                           178   107   1.66
 1980                                                                                                                                           175   106   1.65
 1985                                                                                                                                           173   105   1.65
 1990                                                                                                                                           168   103   1.63
 1995                                                                                                                                           156    95   1.64
 2000                                                                                                                                           137    84   1.63
 2005                                                                                                                                           119    74   1.61


                                                       Note: DHS97 on evernborn etc only given to one decimal place in DHS final report. This
                                                       will likely result in highly variable estimates of child mortality




   CMRMAD047.XLS                                                                                                                                       2004.7.8
                                            AllLtab1t




                            Coale-Demeny model life tables
          240

          220

          200

          180

          160

          140
Q5*1000




          120

          100

          80

          60

          40

          20

           0
                0           20   40    60           80   100   120    140    160
                                               Q1*1000
                    North               South                  East
                    West                Madagascar DHS92       Madagascar DHS97
                    Madagascar DHS03

				
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