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Institute for International Programs


IMPROVED Estimates
© 2018 Kato James, Courtesy of Photoshare

Improved estimates of the causes and determinants of
neonatal, child, and adolescent mortality

Improved estimates of the causes and determinants of neonatal, child, and adolescent mortality

Overall Aim

There has been great progress in cause of death estimates within the neonatal and 1-59 month age groups, but for the purpose of better informing policy-makers and program implementers, there is a need to better utilize country data to inform its own estimates and understand these estimates within finer age categorizations. Additionally, the need to understand the mortality patterns of older children and adolescents has come into increasing focus. Lastly, measuring neonatal mortality using survey data also needs to be improved. The project aims to expand upon the progress made during the Maternal and Child Epidemiology Estimation project to enhance the influence of country-specific empirical data on the estimates, establish finer age categorizations in the under-five age group, provide cause of death estimates for older child and adolescent (5-19) age groups, and improve survey based neonatal mortality estimation by better understanding misclassification between neonatal deaths and stillbirths.

Focus Areas

  1. Enhanced compilation, analysis and reporting of all available information on national and global causes of neonatal and child (1-59 months) mortality and among finer age groups
  2. Improved approaches and methods for estimates of subnational causes of child death (in selected countries)
  3. Improved approaches and methods to further unpack mortality burden due to "other" causes of child death
  4. Enhanced compilation, estimation and reporting of all available information on national and global causes of adolescent (5-19 years) mortality
  5. Updated and improved estimation of child (0-4) and adolescent (5-19) etiology of mortality and morbidity of major causes of disease
  6. Improved understanding of the extent of misclassification between stillbirths and neonatal deaths and the contribution of the lack of provider-mother communication on vital status in a mixed method study


Results from the 2017-18 Tanzania Verbal/Social Autopsy (VASA) Study



Wahl, B., Knoll, M.D., Shet, A., Gupta, M., Kumar, R., Liu, L., et al. National, regional, and state-level pneumonia and severe pneumonia morbidity in India: modelled estimates for 2000 and 2015. (2020). Lancet Child Adolescent Health, 4(9);678-687,

Schumacher, A.E., McCormick, T.H., Wakefield, J., Chu, Y., Perin, J., Villavicencio, F., et al. A flexible Bayesian framework to estimate age- and cause-specific child mortality over time from sample registration data. (2020). Annals of Applied Statistics. Available at:

Liu, L., & Patton, G. Shedding light on a million annual deaths in the middle years of childhood. (2020). Editorial. Lancet. 393: 1075-6,

Kalter, H.D., Perin, J., Amouzou, A., Kwamdera, G., Adewemimo, W.A., Nguefack, F., Roubanatou, A.M., Black, R.E. Using health facility deaths to estimate population causes of neonatal and child mortality in four African countries. BMC Medicine, 18(183). doi:

Wang, X., Li, Y., O'Brien, K. L., Madhi, S. A., Widdowson, M. A., Byass, P., ... & Azziz-Baumgartner, E. (2020). Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: a systematic review and modelling study. The Lancet Global Health. doi:


Black, R., Fontaine, O., Lamberti, L., Bhan, M., Huicho, L., El Arifeen, S., ... & Young, M. (2019). Drivers of the reduction in childhood diarrhea mortality 1980-2015 and interventions to eliminate preventable diarrhea deaths by 2030. Journal of global health, 9(2). doi: 10.7189/jogh.09.020801

Wolfheim, C., Fontaine, O., & Merson, M. (2019). Evolution of the World Health Organization’s programmatic actions to control diarrheal diseases. Journal of global health, 9(2). doi: 10.7189/jogh.09.020802

Billah, S. M., Raihana, S., Ali, N. B., Iqbal, A., Rahman, M. M., Khan, A. N. S., ... & Walker, N. (2019). Bangladesh: a success case in combating childhood diarrhoea. Journal of global health, 9(2). doi: 10.7189/jogh.09.020803

Choudhary, T. S., Sinha, B., Khera, A., Bhandari, N., Chu, Y., Jackson, B., ... & Bhan, M. K. (2019). Factors associated with the decline in under-five diarrhea mortality in India: a LiST analysis. Journal of global health, 9(2). doi: 10.7189/jogh.09.020804

Huicho, L., Tavera, M., Huayanay-Espinoza, C. A., Béjar-Díaz, M., Rivera-Ch, M., Tam, Y., ... & Black, R. E. (2019). Drivers of the progress achieved by Peru in reducing childhood diarrhoea mortality: a country case study. Journal of global health, 9(2). doi: 10.7189/jogh.09.020805

Honorati, M., Pyande, M., Jitihada, B., Jackson, B., Yasinta, K., Karim, M., ... & Black, R. E. (2019). Factors associated with the decline in under five diarrhea mortality in Tanzania from 1980-2015. Journal of Global Health, 9(2). DOI: 10.7189/jogh.09.020806

Liu, L., Chu, Y., Oza, S., Hogan, D., Perin, J., Bassani, D.G., Ram, U., Fadel, S.A., Pandey, A., Dhingra, N., Sahu, D., Kumar, P., Cibulskis, R., Wahl, B., Shet, A., Mathers, C., Lawn, J., Jha, P., Kumar, R., Black, R.E., & Cousens, S. (2019). National, regional and state all-cause and cause-specific under-five mortality in India in 2000-2015: a systematic analysis with implications for the Sustainable Development Goals. The Lancet Global Health, 7(6);721-734. doi:
Data files.
Press coverage: 

Wahl, B., Sharan, A., Deloria Knoll, M., Kumar, R., Liu, L., Chu, Y., ... & Arora, NK. (2019). National, regional, and state-level burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children 1-59 months of age in India from 2000-2015. The Lancet Global Health, 7(6);735-747. doi:

Koffi, AK., Perin, J., Kalter, HD., Adewemimo, A., Black, RE. (2019). How fast did newborns die in Nigeria from 2009-2013: a time-to-death analysis using Verbal /Social Autopsy data. Journal of Global Health, 9(2). doi: 10.7189/jogh.09.020501. doi: 10.7189/jogh.09.020501.

McAllister, D. A., Liu, L., Shi, T., Chu, Y., Reed, C., Burrows, J., ... & Nair, H. (2019). Global, regional, and national estimates of pneumonia morbidity and mortality in children younger than 5 years between 2000 and 2015: a systematic analysis. The Lancet Global Health, 7(1);e47-e57.

Blencowe, H., Krasevec, J., de Onis, M., Black, RE., An, X., Stevens, GA., Borghi, E., Hayashi, C., Estevez, D., Cegalon, L., Sheikh, S., Hardy, VP., Lawn, JE., & Cousens, S. (2019). National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: A systematic analysis. Lancet Global Health, 7(7);e849-860.


Wahl, B., O'Brien, K. L., Greenbaum, A., Majumder, A., Liu, L., Chu, Y., ... & Rudan, I. (2018). Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000–15. The Lancet Global Health6(7), e744-e757, doi

Adeloye, D., Bowman, K., Chan, K. Y., Patel, S., Campbell, H., & Rudan, I. (2018). Global and regional child deaths due to injuries: an assessment of the evidence. Journal of Global Health8(2):021104. doi:10.7189/jogh.08.021104

Department of Evidence, Information and Research (WHO, Geneva) and Maternal Child Epidemiology Estimation (MCEE). Disease burden and mortality estimates. WHO-MCEE estimates for child causes of death 2000–2017. (2018, December 06). Retrieved from

Adeloye, D., Chan, K. Y., Thorley, N., Jones, C., Johnstone, D., L'Heveder, A., ... & Rudan, I. (2018). Global and regional estimates of the morbidity due to type I diabetes among children aged 0-4 years: a systematic review and analysis. Journal of Global Health, 8(2). doi: 10.7189/jogh.08.021101

Waters, D., Adeloye, D., Woolham, D., Wastnedge, E., Patel, S., & Rudan, I. (2018). Global birth prevalence and mortality from inborn errors of metabolism: a systematic analysis of the evidence. Journal of Global Health, 8(2). doi: 10.7189/jogh.08.021102

Wastnedge, E., Waters, D., Patel, S., Morrison, K., Goh, M. Y., Adeloye, D., & Rudan, I. (2018). The global burden of sickle cell disease in children under five years of age: a systematic review and meta-analysis. Journal of Global Health, 8(2). doi: 10.7189/jogh.08.021103

Balsells, E., Dagan, R., Yildirim, I., Gounder, P. P., Steens, A., Muñoz-Almagro, C., ... & van der Ende, A. (2018). The relative invasive disease potential of Streptococcus pneumoniae among children after PCV introduction: A systematic review and meta-analysis. Journal of Infection, 77(5);368-378. doi: 10.1016/j.jinf.2018.06.004

Li, Y., Peterson, M. E., Campbell, H., & Nair, H. (2018). Association of seasonal viral acute respiratory infection with pneumococcal disease: a systematic review of population-based studies. BMJ Open, 8(4);e019743. doi:10.1136/ bmjopen-2017-019743

Mas, V., Nair, H., Campbell, H., Melero, J. A., & Williams, T. C. (2018). Antigenic and sequence variability of the human respiratory syncytial virus F glycoprotein compared to related viruses in a comprehensive dataset. Vaccine, 36(45);6660-6673. doi: 10.1016/j.vaccine.2018.09.056

Obando-Pacheco, P., Justicia-Grande, A. J., Rivero-Calle, I., Rodríguez-Tenreiro, C., Sly, P., Ramilo, O., ... & Nunes, M. C. (2018). Respiratory syncytial virus seasonality: a global overview. The Journal of Infectious Diseases, 217(9);1356-1364. doi: 10.1093/infdis/jiy056

Adanu, R.M. (Ed). “Thinking beyond maternal mortality: re-conceptualizing and measuring maternal morbidity” published in International Journal of Gynecology and Obstetrics 2018; 141(S1): 1-68. (2018, May 23) Retrieved from

WHO, UNFPA, UNICEF, ICM, ICN, FIGO & IPA. (2018). Definition of skilled health personnel providing care during childbirth. Geneva: The 2018 joint statement by WHO. Retrieved from



Fadel, S. A., Rasaily, R., Awasthi, S., Begum, R., Black, R. E., Gelband, H., ... & Morris, S. K. (2017). Changes in cause-specific neonatal and 1–59-month child mortality in India from 2000 to 2015: a nationally representative survey. The Lancet390(10106), 1972-1980.

Scheltema, N. M., Gentile, A., Lucion, F., Nokes, D. J., Munywoki, P. K., Madhi, S. A., ... & Thamthitiwat, S. (2017). Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): a retrospective case series. The Lancet Global Health, 5(10);e984-e991.

Hobbs, A. J., Moller, A. B., Carvajal-Aguirre, L., Amouzou, A., Chou, D., & Say, L. (2017). Protocol for a scoping review to identify and map the global health personnel considered skilled attendants at birth in low and middle-income countries between 2000 and 2015. BMJ Open7(10);e017229. doi: 10.1136/bmjopen-2017-017229

Kozuki, N., Katz, J., Clermon,t A., & Walker, N., and the Child Health Epidemiology Reference Group SGA-Preterm Birth Working Group (2017). New option in the Lives Saved Tool (LiST) allows for the conversion of prevalence of small-for-gestational-age and preterm births to prevalence of low birth weight. The Journal of Nutrition, 147(11);2141S-2146S.


The Improve Project is funded by the Bill & Melinda Gates Foundation, Investment ID: OPP1172551