title: Measuring progress towards achieving Millennium Development Goals in small populations: is under-five mortality in Tuvalu declining?
abstract: OBJECTIVE
  Infant mortality rates (IMR) and under-five mortality rates (U5MR) in Tuvalu (2010 population 11,149) for 1990-2011 were evaluated to determine best estimates of levels and trends.
  
  
  METHODS
  Estimates were graphed over time to identify trends/inconsistencies, and censored for reliability/plausibility. Where possible, 95% confidence intervals (CIs) and tests for linear trend were calculated.
  
  
  RESULTS
  Ministry of Health (MoH) data indicates IMR and U5MR (per 1,000 live births) declined over 1990-2008: IMR 62 (95%CI 46-81) for 1991-93 (51 deaths) to 19 (95%CI 10-33) for 2006-08 (12 deaths); U5MR 67 (95%CI 50-87) for 1991-93 (55 deaths) to 19 (95%CI 10-33) for 2006-08 (12 deaths). The 2007 Demographic and Health Survey (DHS) suggests recent trends are increasing: IMR 24 for 1998-2002 to 31 (95%CI 20-42) for 2003-07; U5MR 29 for 1998-2002 to 36 (95%CI 30-43) for 2003-07 (deaths not provided). Tests for linear trend and 95%CIs indicate MoH declines are statistically significant, but recent increased estimates from DHS are not, and could be affected by recall bias.
  
  
  CONCLUSIONS
  Small populations provide challenges in interpretation of IMR/U5MR trends. To ensure the correct interpretation of rates, CIs (95%) and tests for trend should be calculated. Tuvalu has experienced steady decline in IMR/U5MR over the past 20 years.
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales.
authors.forename: Richard
authors.initials: R
authors.lastname: Taylor
authors.forename: Christine
authors.initials: C
authors.lastname: Linhart
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Hayes
authors.forename: Steven
authors.initials: S
authors.lastname: Homasi
mesh_terms: D002675:Child, Preschool; D003710:Demography / Q000706:statistics & numerical data; D005260:Female; D006040:Goals; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008849:Micronesia / Q000453:epidemiology; D015203:Reproducibility of Results
keywords: Millennium Development Goals; Tuvalu; child mortality; infant mortality