Maternal and Child Epidemiology Estimation (MCEE)

Estimation of deaths by cause for women, newborns and children under five (global, by country)

JHU led this effort to provide timely estimates of the causes and determinants of neonatal and child mortality reflecting the effects of accelerated child survival interventions, and to improve knowledge of the causes of maternal mortality. 

The team produced cause of death estimates with time trends since 2000 at multiple levels – global, regional, national level for over 190 countries, as well as subnational level estimates for selected countries (e.g. China and India). 

LSHTM, through a subgrant from JHU/IIP, advanced the neonatal cause of death distribution previously conducted under the auspices of CHERG by improving the statistical models used to develop these estimates.  The team produced neonatal cause of death estimates for high mortality countries at the country-level every other year, with time trends and at the regional level every year, and including more detailed causes, such as congenital subgroups and infections in the cause of death estimation.

WHO, through a subgrant from JHU/IIP, provided the leadership in estimating global, regional, and country –level causes of maternal deaths.  This effort is focused on improving the methods and underlying data necessary for making these estimates. The team will liaised with the WHO maternal morbidity working group on defining areas of focus and establish sub-groups for focus areas, including systematic reviews on maternal morbidity due to infectious diseases and sepsis.

Etiology-specific morbidity and mortality estimates for conditions such as pneumonia, meningitis, and neonatal infections

The objective of this activity was to provide pathogen-specific estimates of mortality and morbidity for significant childhood conditions. Expanding on the work of the CHERG over the past decade to provide estimates of important child syndromes, this activity sought to improve understanding of the contribution of specific pathogens to morbidity and mortality from childhood pneumonia, meningitis, and neonatal infections. Substantial new information on pathogen-specific morbidity and mortality has become available in recent years, particularly from low- and middle-income countries. This new information was incorporated into national, regional, and global estimates disease burden estimates.

Partners at the International Vaccine Access Center (IVAC) at JHU worked to estimate the burden of Streptococcus pneumoniae and Haemophilus influenzae type b (Hib), two major causes of pneumonia and meningitis for which safe and effective vaccines are now available. In 2015, the team expanded their estimation work to estimates the burden of meningitis caused by Neisseria meningitidis (meningococcus). In 2016, subnational etiology estimates were also produced for India.

Through a subgrant from JHU/IIP, the University of Edinburgh (UoE) conducted comprehensive systematic reviews on 1) morbidity of post-neonatal childhood pneumonia; 2) etiology-specific morbidity of post-neonatal childhood pneumonia, specifically Respiratory Syncytial Virus (RSV), Metapnuemovirus (hMPV), and parainfluenza; and 3) etiology-specific morbidity of neonatal infections. UoE also developed improved methods to estimate country specific estimates of childhood pneumonia (with uncertainty ranges) using information on risk factors and their population attributable fractions, including HIV-attributable burden.

Estimation of the Pathogen-Specific Causes of Diarrhea Among Children Under 5 Years of Age and Updated Estimation of the Effectiveness and Herd Effect of the Rotavirus Vaccine (global)

This activity built off the previous CHERG-led estimates of pathogen specific diarrhea mortality (Lanata et al. Plos One 2013) and estimates by region and by age of diarrhea incidence (Fischer Walker et al. BMC Public Health 2012).  JHU/IIP faculty, in collaboration with faculty at Instituto de Investigacion Nutricional, Peru estimated the proportion of diarrhea episodes in children under 5 years of age attributable to each of the main diarrhea pathogens.  Those pathogens include; rotavirus, norovirus, adenovirus, astrovirus, EPEC, ETEC, Shigella spp., Campylobacter spp., Cryptosporidium spp., Salmonella spp, Vibrio cholerae O1, and Entamoeba hystolytica.  If sufficient data are found, regional estimates will be made in addition to global estimates.  Through systematic review of the literature, the team is also updated the current estimate of the effectiveness of rotavirus vaccine against rotavirus mortality.

Estimates of National Low Birth Weight (LBW) Rates and Trends Since 1995 (global, by country)

The primary underlying causes of low birthweight are intra-uterine growth restriction, preterm birth, or a combination of the two. At a population level both of these conditions are strongly associated with maternal factors such as maternal age, nutritional status, physical health, infection and lifestyle factors.  As such LBW is a critical indicator for both the health of the mother and future risk for the baby.  While LBW is an important marker of risk for neonatal and child mortality, there is no recognized time series of national level estimates. LSHTM, through a subgrant with JHU/IIP, worked in close coordination with WHO, UNICEF, JHU, and Brigham and Women’s Hospital to systematically review the LBW rate data sources, assess data availability and quality, and refine the analytical methodologies and processes to adjust survey based LBW data. National time trends will be estimated and published for LBW rates from 1995, or 2000 to the present, with uncertainty ranges.