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NEW THIS WEEK: GLOBAL DETERMINANTS OF MORTALITY IN UNDER-FIVES

Saturday, 7th of December 2013

• GLOBAL DETERMINANTS OF MORTALITY IN UNDER 5s: 10 YEAR WORLDWIDE LONGITUDINAL STUDY

Abstract below; full text is at http://www.bmj.com/content/347/bmj.f6427

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f6427 (Published 8 November 2013)

Cite this as: BMJ 2013;347:f6427

Matthieu Hanf, research fellow12,

Mathieu Nacher, professor in epidemiology and public health34,

Chantal Guihenneuc, professor in biostatistics 15,

Pascale Tubert-Bitter, research director12,

Michel Chavance, research director12

1Biostatistics, CESP Centre for research in Epidemiology and Population Health, U1018, Inserm; Villejuif, France

2Université Paris Sud 11, UMRS 1018, Villejuif, France

3Centre d’Investigation Clinique Epidémiologie Clinique Antilles Guyane CIC-EC INSERM CIE 802, Cayenne General Hospital, Cayenne, French Guiana

4Université des Antilles et de la Guyane, EPaT EA3593, Cayenne, French Guiana

5Université Paris-Descartes, Sorbonne Paris Cité, EA 4064, Laboratoire Santé Publique et Environnement, Paris, France

Correspondence to: M Hanf INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations Equipe 1 Biostatistique, 16 avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France matthieu{at}hanf.fr

Accepted 30 September 2013

Abstract

Objective To assess at country level the association of mortality in under 5s with a large set of determinants.

Design Longitudinal study.

Setting 193 United Nations member countries, 2000-09.

Methods Yearly data between 2000 and 2009 based on 12 world development indicators were used in a multivariable general additive mixed model allowing for non-linear relations and lag effects.

Main outcome measure National rate of deaths in under 5s per 1000 live births

Results The model retained the variables: gross domestic product per capita; percentage of the population having access to improved water sources, having access to improved sanitation facilities, and living in urban areas; adolescent fertility rate; public health expenditure per capita; prevalence of HIV; perceived level of corruption and of violence; and mean number of years in school for women of reproductive age. Most of these variables exhibited non-linear behaviours and lag effects.

Conclusions By providing a unified framework for mortality in under 5s, encompassing both high and low income countries this study showed non-linear behaviours and lag effects of known or suspected determinants of mortality in this age group. Although some of the determinants presented a linear action on log mortality indicating that whatever the context, acting on them would be a pertinent strategy to effectively reduce mortality, others had a threshold based relation potentially mediated by lag effects. These findings could help designing efficient strategies to achieve maximum progress towards millennium development goal 4, which aims to reduce mortality in under 5s by two thirds between 1990 and 2015.