Afghanistan Mortality Survey 2010 - Measure DHS

Perhaps a more sensitive indicator is the ratio of neonatal to postneonatal death. This ratio variesby level of under-5 mortality, as can be seen in Figure D.5, which charts the ratios observed in the periods0-4 and 5-9 years prior to 209 DHS surveys. The overall average ratio of neonatal to postneonatalmortality is 1.23; that of Asian countries is 1.44; and that of South Asian countries (Bangladesh, India,Nepal, and Pakistan) is 1.78. A power curve fitted to the data 4 from the 209 surveys shows the predictedNN/PNN ratio that would be expected at any given under-5 mortality level. At the level of under-5mortality found for Afghanistan excluding the South zone of 83 deaths per 1000 births, the predicted ofthe neonatal/postneonatal ratio is 1.13. The NN/PNN ratio actually observed for Afghanistan excludingthe South zone is 0.80, considerably lower than the predicted ratio.Table D.7 shows the estimated levels of neonatal, postneonatal, infant, and under-5 mortalityrates for Afghanistan excluding the South zone under varying assumptions with respect to theneonatal/postneonatal death ratio. The three columns under “Adjusted values using NN/PNN” reflect theaverage ratio of the four South Asian countries, the average ratio for all DHS surveys, and the ratiopredicted by the trend line given the under-5 mortality rate of Afghanistan excluding the South zone. Theestimated numbers of neonatal deaths and the adjusted mortality rates taking into account each of theNN/PNN ratios are shown. For example, taking into account the ratio predicted by the trend line given theunder-5 mortality rate actually reported for the region (1.13), under-5 mortality for Afghanistan excludingthe South zone would be adjusted upwards to 91 deaths per 1,000 from the measured rate of 83.Finally, the process of predicting NN/PNN ratios was repeated based on these adjusted ratios foreach estimated under-5 mortality rate. The fifth column shows the final estimate of the NN/PNN ratio(1.09), where the estimated under-5 mortality rate converges so that the adjusted ratio and the impliedratio are consistent. The infant and under-5 mortality rates given by the final adjusted ratio are 71 and 90,respectively, assuming that the estimated increase in neonatal deaths is entirely due to omission.Figure D.5 Ratio of Neonatal (NN) to Postneonatal (PNN)Mortality Rates by Level of Under-5 Mortality for Periods 0-4 and5-9 Years Prior to Survey, for 209 DHS Surveys4.003.503.00Actual data9 per. Mov. Avg. (Actual data)Power (Actual data)Ratio NN/PNN rate2.502.001.501.00y = 6.8541x -0.40820.500.000 50 100 150 200 250 300 350 400Under-5 Mortality RateAMS 20104 NN/PNN = 6.8541*U5MR (-0.408) , where NN/PNN is the neonatal to postneonatal mortality ratio and U5MR is theunder-5 mortality rate.190 | Appendix D