A Model of Child Morbidity, Mortality and Health Interventions

A macro model of morbidity and mortality in children under five years of age is presented. Monthly disease-specific incidence and case fatality rates form the basis of the model and the efficacy and coverage of disease-specific interventions alter these values. In addition, frailty is modeled via relative risks of mortality based on five groups, determined in the first month by the birthweight distribution and at later ages by the proportion of children surviving a given illness who become more frail and the proportion not ill and with adequate nutrition who become less frail. A validation of the model was carried out using data from the comparison and treatment areas of the Demographic Surveillance System in Matlab, Bangladesh. The model very closely predicts the observed mortality level. Scenarios for improvements in coverage of specific interventions in settings in South Asia, West Africa and Andean South America are modeled and their effects on mortality gauged. The model provides a useful tool for those wishing to know the mortality impact of specified mixes of interventions in a given setting. Limitations of the model are considered and possible extensions to address these are discussed.