A FLEXIBLE BAYESIAN FRAMEWORK TO ESTIMATE AGE- AND CAUSE-SPECIFIC CHILD MORTALITY OVER TIME FROM SAMPLE REGISTRATION DATA.

In order to implement disease-specific interventions in young age groups, policy makers in low- and middle-income countries require timely and accurate estimates of age- and cause-specific child mortality. High-quality data is not available in settings where these interventions are most needed, but there is a push to create sample registration systems that collect detailed mortality information. current methods that estimate mortality from this data employ multistage frameworks without rigorous statistical justification that separately estimate all-cause and cause-specific mortality and are not sufficiently adaptable to capture important features of the data. We propose a flexible Bayesian modeling framework to estimate age- and cause-specific child mortality from sample registration data. We provide a theoretical justification for the framework, explore its properties via simulation, and use it to estimate mortality trends using data from the Maternal and Child Health Surveillance System in China.

Nationwide Mortality Studies To Quantify Causes Of Death: Relevant Lessons From India's Million Death Study.

Progress toward the United Nations 2030 Sustainable Development Goals requires improved information on mortality and causes of death. However, causes of many of the fifty million annual deaths in low- and middle-income countries remain unknown, as most of the deaths occur at home without medical attention. In 2001 India began the Million Death Study in 1.3 million nationally representative households. Nonmedical staff conduct verbal autopsies, which are structured interviews including a half-page narrative in local language of the family's story of the symptoms and events leading to death. Two physicians independently assess each death to arrive at an underlying cause of death. The study has thus far yielded information that substantially altered previous estimates of cause-specific mortality and risk factors in India. Similar robust studies are feasible at low cost in other low- and middle-income countries, particularly if they adopt electronic data management and ensure high quality of fieldwork and physician coding. Nationwide mortality studies enable the quantification of avoidable premature mortality and key risk factors for disease, and provide a practicable method to monitor progress toward the Sustainable Development Goals.

Trends in inequality in length of life in India: a decomposition analysis by age and causes of death.

BACKGROUND: Studies dealing with trends in inequality in length of life in India are rare. Studies documenting the contribution of age and causes of death to the inequality in length of life are more limited. OBJECTIVE: The study aims to examine the trends in inequality in length of life in India and 15 major states of India and to decompose the inequality in length of life into the contributions of age and causes of death. METHOD: We use life table Gini coefficient (G0) to measure the inequality in length of life. We use the formulae developed by Shkolnikov, Andreev, and Begun (DR 8(11):305-358, 2003) to decompose the differences between Gini coefficients by age and cause of death. RESULT: The G0 for men has declined from 0.32 in 1981 to 0.19 in 2011. For women, G0 has decreased from 0.31 in 1981 to 0.22 in 2011. Mortality decline in the age group 0-1 year has contributed most to the decrease in G0. In contrast, mortality decline in 60+ has tended to increase the G0. The state-wide variations in the age-specific contributions to decrease in G0 were stark. The contribution of noncommunicable diseases to the male-female gap in G0 has increased between 1990 and 2010. Injuries at ages from 20 to 39 years also contributed to the male-female difference in G0 in 2010. CONCLUSION: Future studies must analyze inequality in life expectancy for assessing the performance of societies regarding length of life. CONTRIBUTION: This is the first study that provides compelling evidence on inequality in length of life in India and its major states.

Addressing the sluggish progress in reducing maternal mortality in India.

Although some progress has been made in India, achievement of the Fifth Millennium Development Goal (MDG5; ie, 75% reduction in maternal mortality ratio [MMR] from 1990 by 2015) target seems to be unattainable by 2015. Failure of the National Population Policy, 2000, and the National Health Policy, 2002, to reduce the MMR demanded a new direction, leading to the establishment of a National Rural Health Mission in 2005. This commentary addresses both the real achievements and the hurdles faced in India's stagnating progress in maternal health. Promotion of maternal nutrition and health education, with greater attention to emergency obstetrical care at the district subcenter and primary health care center levels, must be prioritized. These changes of focus are vital to make prenatal, delivery, and postnatal care safer with increased resources allotted to adolescents, the poor, and women living in rural areas in order to enhance maternal health and achieve the MDG target.