A Pseudo-likelihood Approach to Under-5 Mortality Estimation

Abstract

Accurate and precise estimates of the under-5 mortality rate (U5MR) are an important health summary for countries. However, full survival curves allow us to better understand the pattern of mortality in children under five. Modern demographic methods for estimating a full mortality schedule for children have been developed for countries with good vital registration and reliable census data, but perform poorly in many low- and middle-income countries (LMICs). In these countries, the need to utilize nationally representative surveys to estimate the U5MR requires additional care to mitigate potential biases in survey data, acknowledge the survey design, and handle the usual characteristics of survival data, for example, censoring and truncation. In this paper, we develop parametric and non-parametric pseudo-likelihood approaches to estimating child mortality across calendar time from complex survey data. We show that the parametric approach is particularly useful in scenarios where data are sparse and parsimonious models allow efficient estimation. We compare a variety of parametric models to two existing methods for obtaining a full survival curve for children under the age of 5, and argue that a parametric pseudo-likelihood approach is advantageous in LMICs. We apply our proposed approaches to survey data from four LMICs.