Afghanistan Mortality Survey 2010 - Measure DHS

estimate of infant and under-5 mortality can be produced with these data using a method developed byWilliam Brass. The Brass, or indirect, method is based on the number of children ever-born and thenumber surviving, tabulated by the age of the mother. The method uses model fertility and mortalityschedules to adjust the proportions surviving by the age group of the mother to the standard rates.The indirect methodology has several problems and thus is most appropriate in situations wherethere are no other sources of data. The counts of births and surviving children may be subject to omission,although less so if a full pregnancy/birth history is asked to probe for each birth and the interval betweenbirths. Occasionally, stillbirths may be included in the total birth counts, leading to upwardly biasedmortality estimates. Another problem in some countries is inaccuracy in the reported age of the women,especially where the level of education is low.Also, the indirect methodology depends on model life tables, which may or may not hold for thearea and time in question. The age pattern of mortality in some countries has been found to be outside thelimits of all the families of available tables, which are based mainly on developed and advanceddeveloping countries. In addition, the estimates produced cover a wide time period, averaging values overthat period. If there have been swings in mortality level due to wars, famine, epidemics, etc. or recentimprovements in health care, then the estimates from data on children ever-born and surviving will notrepresent those swings and current mortality may be over underestimated.Another problem with the method arises from the fact that it is usual to use the proportion ofchildren surviving of women in the 20-24 and 25-29 age groups to produce the infant and under-5mortality estimates. These age groups have central ages of 22.5 and 27.5 years, respectively, and theaverage ages are actually less than the central ages. The average time since birth of children born towomen 20-24 and 25-29 is two years and three years, respectively. Thus, the average age at childbirth forwomen 20-24 and 25-29 is about 20 years and 24 years, respectively. Therefore, the estimates producedfrom these age groups are somewhat biased, in that they consist of more first births and births at youngerages than is true for the whole population of women of reproductive age. Moreover, if a woman reportsmore than one birth, the birth interval necessarily is short, especially for women 20-24. In general, it hasbeen found that using the age group 25-29 years overestimates mortality by about 10 percent.Finally, if rates are estimated using indirect techniques, dating of the estimate is possible only ifeither no trend or a linear trend in the estimated rates is assumed.D.2 AMS 2010 CHILD MORTALITY ESTIMATESEstimates of child mortality levels were prepared using each of the three methods describedabove. In each case the results are presented for all Afghanistan, Afghanistan excluding the South zone,and the South zone. In considering the national results and the results for the South zone, one should notethat a substantial proportion of the rural population, particularly in the South zone, was not intervieweddue to the security situation. This exclusion gives the national estimates and especially the estimates forthe South zone a bias toward urban and the more secure rural areas.D.2.1 Estimates from the Pregnancy History DataAs described above, the AMS 2010 pregnancy history data provide the most comprehensive bodyof information on child mortality and, thus, are the primary source of information used for exploringlevels, trends, and differentials in child mortality in this report. Table D.1 presents the child mortalityestimates for the ages 0-4 years by sex.Appendix D | 181