title: Estimation of district-level under-5 mortality in Zambia using birth history data, 1980-2010.
abstract: Birth history data-the primary source of data on under-5 mortality in developing countries-are infrequently used for subnational estimates due to concerns over small sample sizes. In this study we consider different methods for analyzing birth history data in combination with various small area models. We construct a simulation environment to assess the performance of different combinations of birth history methods and small area models in terms of bias, efficiency, and coverage. We find that performance is highly dependent on the birth history method applied and how temporal trends are accounted for. We estimated trends in district-level under-5 mortality in Zambia from 1980 to 2010 using the best-performing model. We find that under-5 mortality is highly variable within Zambia: there was a 1.8-fold difference between the lowest and highest levels in 2010, and declines over the period 1980 to 2010 ranged from less than 5% to more than 50%.
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: ladwyer@uw.edu.
authors.forename: Laura
authors.initials: L
authors.lastname: Dwyer-Lindgren
authors.affiliation: Central Statistical Office of Zambia, Lusaka, Zambia. Electronic address: FKakungu@zamstats.gov.zm.
authors.forename: Frank
authors.initials: F
authors.lastname: Kakungu
authors.affiliation: Department of Economics, University of Zambia, Lusaka, Zambia. Electronic address: peterhangoma555@yahoo.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Hangoma
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: marieng@uw.edu.
authors.forename: Marie
authors.initials: M
authors.lastname: Ng
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: haidong@uw.edu.
authors.forename: Haidong
authors.initials: H
authors.lastname: Wang
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: abie@uw.edu.
authors.forename: Abraham D
authors.initials: AD
authors.lastname: Flaxman
authors.affiliation: Department of Economics, University of Zambia, Lusaka, Zambia. Electronic address: fmasiye@yahoo.com.
authors.forename: Felix
authors.initials: F
authors.lastname: Masiye
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: gakidou@uw.edu.
authors.forename: Emmanuela
authors.initials: E
authors.lastname: Gakidou
mesh_terms: D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D006306:Health Surveys / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors; D062206:Spatial Analysis; D015024:Zambia / Q000453:epidemiology
keywords: Birth history methods; Child mortality; Geospatial analysis; Small area estimation; Spatial–temporal smoothing; Under-5 mortality