National Population Growth Rate, Its Components, and Subnational Contributions: A Research Note

A population's current growth rate is determined jointly by changes in fertility, mortality, and migration. This overall growth rate is also the average of age-specific growth rates, which can be decomposed into the result of historical changes in fertility, mortality, and migration. However, doing so requires more than 100 years of historical data, meaning that such analyses are possible only in a select few populations. In this research note, we propose an adapted version of the variable-r model to measure contributions to the population growth rate for countries with shorter demographic series. In addition, we extend this model to explore the contribution of subnational changes to the national population growth rate. Our results demonstrate that the age-specific growth rates obtained from short historical series, say 25 years, closely match those of the longer series. These abbreviated age-specific growth rates closely resemble the growth rate at birth of their respective cohorts, which is the major determinant of population growth, except at older ages where mortality becomes the main explanatory element. Exploring subnational populations, we find considerable heterogeneity in the age profile of the components of growth and find that the most populous regions tend to have an outsized impact on national-level growth.

U.S. Fertility in Life Course Context: A Research Note on Using Census-Held Linked Administrative Records for Geographic and Sociodemographic Subgroup Estimation

Fertility is a life course process that is strongly shaped by geographic and sociodemographic subgroup contexts. In the United States, scholars face a choice: they can situate fertility in a life course perspective using panel data, which is typically representative only at the national level; or they can attend to subnational contexts using rate schedules, which do not include information on life course statuses. The method and data source we introduce here, Census-Held Linked Administrative Records for Fertility Estimation (CLAR-FE), permits both. It derives fertility histories and rate schedules from U.S. Census Bureau-held data for the nation and by state, racial and ethnic subgroups, and the important life course status of parity. We generate three types of rates for 2000-2020 at the national and state levels by race and ethnicity: age-specific rates and both unconditional and conditional parity- and age-specific rates. Where possible, we compare these rates with those produced by the National Center for Health Statistics. Our new rate schedules illuminate state and racial and ethnic differences in transitions to parenthood, providing evidence of the important subgroup heterogeneity that characterizes the United States. CLAR-FE covers nearly the entire U.S. population and is available to researchers on approved projects through the Census Bureau's Federal Statistical Research Data Centers.

Mapping heterogeneity in family planning indicators in Burkina Faso, Kenya, and Nigeria, 2000-2020

BACKGROUND

Family planning is fundamental to women's reproductive health and is a basic human right. Global targets such as Sustainable Development Goal 3 (specifically, Target 3.7) have been established to promote universal access to sexual and reproductive healthcare services. Country-level estimates of contraceptive use and other family planning indicators are already available and are used for tracking progress towards these goals. However, there is likely heterogeneity in these indicators within countries, and more local estimates can provide crucial additional information about progress towards these goals in specific populations. In this analysis, we develop estimates of six family indicators at a local scale, and use these estimates to describe heterogeneity and spatial-temporal patterns in these indicators in Burkina Faso, Kenya, and Nigeria.

METHODS

We used a Bayesian geostatistical modelling framework to analyse geo-located data on contraceptive use and family planning from 61 household surveys in Burkina Faso, Kenya, and Nigeria in order to generate subnational estimates of prevalence and associated uncertainty for six indicators from 2000 to 2020: contraceptive prevalence rate (CPR), modern contraceptive prevalence rate (mCPR), traditional contraceptive prevalence rate (tCPR), unmet need for modern methods of contraception, met need for family planning with modern methods, and intention to use contraception. For each country and indicator, we generated estimates at an approximately 5 × 5-km resolution and at the first and second administrative levels (regions and provinces in Burkina Faso; counties and sub-counties in Kenya; and states and local government areas in Nigeria).

RESULTS

We found substantial variation among locations in Burkina Faso, Kenya, and Nigeria for each of the family planning indicators estimated. For example, estimated CPR in 2020 ranged from 13.2% (95% Uncertainty Interval, 8.0-20.0%) in Oudalan to 38.9% (30.1-48.6%) in Kadiogo among provinces in Burkina Faso; from 0.4% (0.0-1.9%) in Banissa to 76.3% (58.1-89.6%) in Makueni among sub-counties in Kenya; and from 0.9% (0.3-2.0%) in Yunusari to 31.8% (19.9-46.9%) in Somolu among local government areas in Nigeria. There were also considerable differences among locations in each country in the magnitude of change over time for any given indicator; however, in most cases, there was more consistency in the direction of that change: for example, CPR, mCPR, and met need for family planning with modern methods increased nationally in all three countries between 2000 and 2020, and similarly increased in all provinces of Burkina Faso, and in large majorities of sub-counties in Kenya and local government areas in Nigeria.

CONCLUSIONS

Despite substantial increases in contraceptive use, too many women still have an unmet need for modern methods of contraception. Moreover, country-level estimates of family planning indicators obscure important differences among locations within the same country. The modelling approach described here enables estimating family planning indicators at a subnational level and could be readily adapted to estimate subnational trends in family planning indicators in other countries. These estimates provide a tool for better understanding local needs and informing continued efforts to ensure universal access to sexual and reproductive healthcare services.

Mind the gap: city-level inflation synchronization

The post-pandemic rise in consumer prices across the world has renewed interest in inflation dynamics after decades of global disinflation. This paper provides a spatial investigation of inflation synchronicity at the city level in Lithuania using disaggregated monthly data during the period 2000-2021. The empirical analysis provides strong evidence that (i) the co-movement of city-level inflation rates-estimated using the instantaneous quasi-correlation approach-is significantly weaker than the extent of synchronization suggested by the simple correlation analysis; (ii) there is substantial heterogeneity in the instantaneous quasi-correlation of inflation subcomponents between city pairs; and (iii) there are significant changes in the degree of city-level synchronization over time, reflecting important economic developments in history such as the global financial crisis, the adoption of euro, and the COVID-19 pandemic.

Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens

BACKGROUND

Pregnant women in sub-Saharan Africa (SSA) experience the highest levels of maternal mortality and stillbirths due to predominantly avoidable causes. Antenatal care (ANC) can prevent, detect, alleviate, or manage these causes. While eight ANC contacts are now recommended, coverage of the previous minimum of four visits (ANC4+) remains low and inequitable in SSA.

METHODS

We modelled ANC4+ coverage and likelihood of attaining district-level target coverage of 70% across three equity stratifiers (household wealth, maternal education, and travel time to the nearest health facility) based on data from malaria indicator surveys in Kenya (2020), Uganda (2018/19) and Tanzania (2017). Geostatistical models were fitted to predict ANC4+ coverage and compute exceedance probability for target coverage. The number of pregnant women without ANC4+ were computed. Prediction was at 3 km spatial resolution and aggregated at national and district -level for sub-national planning.

RESULTS

About six in ten women reported ANC4+ visits, meaning that approximately 3 million women in the three countries had <ANC4+ visits. The majority of the 366 districts in the three countries had ANC4+ coverage of 50-70%. In Kenya, 13% of districts had < 70% coverage, compared to 10% and 27% of the districts in Uganda and mainland Tanzania, respectively. Only one district in Kenya and ten districts in mainland Tanzania were likely met the target coverage. Six percent, 38%, and 50% of the districts had at most 5000 women with <ANC4+ visits in Kenya, Uganda, and mainland Tanzania, respectively, while districts with > 20,000 women having <ANC4+ visits were 38%, 1% and 1%, respectively. In many districts, ANC4+ coverage and likelihood of attaining the target coverage was lower among the poor, uneducated and those geographically marginalized from healthcare.

CONCLUSIONS

These findings will be invaluable to policymakers for annual appropriations of resources as part of efforts to reduce maternal deaths and stillbirths.

Estimation of national and subnational all-cause mortality indicators in Nepal, 2017

BACKGROUND

Despite the civil registration and vital statistics (CRVS) system in Nepal operating for several decades, it has not been used to produce routine mortality statistics. Instead, mortality statistics rely on irregular surveys and censuses that primarily focus on child mortality. To fill this knowledge gap, this study estimates levels and subnational differentials in mortality across all ages in Nepal, primarily using CRVS data adjusted for incompleteness.

METHODS

We analyzed death registration data (offline or paper-based) and CRVS survey reported death data, estimating the true crude death rate (CDR) and number of deaths by sex and year for each province and ecological belt. The estimated true number of deaths for 2017 was used with an extension of the empirical completeness method to estimate the adult mortality (45q15) and life expectancy at birth by sex and subnational level. Plausibility of subnational mortality estimates was assessed against poverty head count rates.

RESULTS

Adult mortality in Nepal for 2017 is estimated to be 159 per 1000 for males and 116 for females, while life expectancy was estimated as 69.7 years for males and 73.9 years for females. Subnationally, male adult mortality ranges from 129 per 1000 in Madhesh to 224 in Karnali and female adult mortality from 89 per 1000 in Province 1 to 159 in Sudurpashchim. Similarly, male life expectancy is between 64.9 years in Karnali and 71.8 years in Madhesh and female male life expectancy between 69.6 years in Sudurpashchim and 77.0 years in Province 1. Mountain ecological belt and Sudurpashchim and Karnali provinces have high mortality and high poverty levels, whereas Terai and Hill ecological belts and Province 1, Madhesh, and Bagmati and Gandaki provinces have low mortality and poverty levels.

CONCLUSIONS

This is the first use of CRVS system data in Nepal to estimate national and subnational mortality levels and differentials. The national results are plausible when compared with Global Burden of Disease and United Nations World Population Prospects estimates. Understanding of the reasons for inequalities in mortality in Nepal should focus on improving cause of death data and further strengthening CRVS data.

The economic efficiency of aid targeting

How efficient is the targeting of foreign aid to populations in need? A long literature has focused on the impacts of foreign aid, but much rarer are studies that examine how such aid is allocated within countries. We examine the extent to which donors efficiently respond to exogenous budget shocks by shifting resources toward needier districts within a given country, as predicted by theory. We use recently geocoded data on the World Bank's aid in 23 countries that crossed the lower-middle income threshold between 1995 and 2010 and thus experienced sharp aid reductions. We measure locations' need along a number of dimensions, including nighttime lights emissions, population density, conflict exposure, and child mortality. We find little evidence that aid project siting is increasingly concentrated in worse-off areas as budgets shrink; the only exception appears to be a growing share of funding in more conflict-affected areas. We further analyze the relationship of health aid to child mortality measures in six key countries, again finding little evidence of efficient responses to budget shocks. Taken together, these results suggest that large efficiency gains may be possible in the distribution of aid from the World Bank and other donors.

Heterogeneity in subnational mortality in the context of the COVID-19 pandemic: the case of Belgian districts in 2020

BACKGROUND

The COVID-19 pandemic has led to major shocks in mortality trends in many countries. Yet few studies have evaluated the heterogeneity of the mortality shocks at the sub-national level, rigorously accounting for the different sources of uncertainty.

METHODS

Using death registration data from Belgium, we first assess change in the heterogeneity of districts' standardized mortality ratios in 2020, when compared to previous years. We then measure the shock effect of the pandemic using district-level values of life expectancy, comparing districts' observed and projected life expectancy, accounting for all sources of uncertainty (stemming from life-table construction at district level and from projection methods at country and district levels). Bayesian modelling makes it easy to combine the different sources of uncertainty in the assessment of the shock. This is of particular interest at a finer geographical scale characterized by high stochastic variation in annual death counts.

RESULTS

The heterogeneity in the impact of the pandemic on all-cause mortality across districts is substantial: while some districts barely show any impact, the Bruxelles-Capitale and Mons districts experienced a decrease in life expectancy at birth of 2.24 (95% CI:1.33-3.05) and 2.10 (95% CI:0.86-3.30) years, respectively. The year 2020 was associated with an increase in the heterogeneity of mortality levels at a subnational scale in comparison to past years, measured in terms of both standardized mortality ratios and life expectancies at birth. Decisions on uncertainty thresholds have a large bearing on the interpretation of the results.

CONCLUSION

Developing sub-national mortality estimates taking careful account of uncertainty is key to identifying which areas have been disproportionately affected.

Assessment of the national and subnational completeness of death registration in Nepal

Background

Reliable and timely mortality data from a civil registration and vital statistics (CRVS) system are of crucial importance for generating evidence for policy and monitoring the progress towards national and global development goals. In Nepal, however, the death registration system is not used to produce mortality statistics, because it does not providing data on age at death and only reporting deaths by year of registration. This study assesses the completeness of death registration in Nepal – both the existing offline system and the newer online system – as well as the completeness of death reporting from a CRVS Survey, and assesses differences by year, sex, ecological belt, and province.

Methods

The empirical completeness method is used to estimate completeness at all ages from the offline (paper-based) registration system (2013-17), the online registration system (2017-19) and the CRVS Survey (2014-15).

Results

Completeness of the offline death registration system was 69% in 2017, not increasing since 2013 and being higher for males (73%) than females (65%). Completeness of online registration was only 32% in 2019, but almost double the 2017 figure. Completeness of death reporting in the CRVS Survey was 75% in 2015. The largest subnational differentials in completeness exist for the offline registration system, ranging from 90% in Gandaki to just 39% in Karnali.

Conclusions

Improvement in the utility of the Nepalese death registration system for mortality statistics is dependent on continued roll-out of the online death registration system (which reports age at death and deaths by year of occurrence) throughout the country, focusing on areas with low registration, building a strong coordination mechanism among CRVS stakeholders and implementing public awareness programs about death registration.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12767-z.

The distributional effects of tobacco tax increases across regions in Mexico: an extended cost-effectiveness analysis

BACKGROUND

Several studies have shown the beneficial effects of tobacco fiscal policy, but distributional effects have been less examined, especially at the subnational level. The objective of this study is to analyse the distributional effects of a one-peso tobacco tax increase (roughly equivalent to tripling the current excise tax) on health, poverty, and financial outcomes at the subnational level in Mexico.

METHODS

We employ an extended cost-effectiveness analysis that estimates life-years gained, smoking attributable deaths averted, treatment costs averted, number of persons avoiding poverty and catastrophic health expenditures, and additional tax revenues by income group across five regions.

RESULTS

With the one-peso tax increase (or 44% price increase), about 1.5 million smokers would quit smoking across the five regions, resulting in nearly 630 thousand premature deaths averted and 12.6 million life years gained. The bottom income quintile would gain three times more life years gains than the top quintile (ratio 3:1), and the largest gain for the most deprived would occur in the South (ratio 19:1), the region with the highest poverty incidence. Costs averted and additional tax revenues would reach 44.6 and 16.2 billion pesos, respectively. Moreover, 251 thousand individuals would avoid falling into poverty, including 53.2 in the lowest income quintile, and 563.9 thousand would avoid catastrophic health expenditures. Overall, the bottom income group would obtain 26% of the life years gained and 24% of the cost averted, while only paying 3% of the additional tax revenue.

CONCLUSIONS

The most significant gains from a substantial cigarette price increase would be for the poorest 20%, especially in the South, the most impoverished region of Mexico. Therefore, tobacco taxes are an opportunity for governments to advance in equity and towards the achievement of sustainable development goals on non-communicable diseases.

Bayesian evidence synthesis to estimate subnational TB incidence: An application in Brazil

Background:

Evidence on local disease burden and the completeness of case detection represent important information for TB control programs. We present a new method for estimating subnational TB incidence and the fraction of individuals with incident TB who are diagnosed and treated in Brazil.

Methods:

We compiled data on TB notifications and TB-related mortality in Brazil and specified an analytic model approximating incidence as the number of individuals exiting untreated active disease (sum of treatment initiation, death before treatment, and self-cure). We employed a Bayesian inference approach to synthesize data and adjust for known sources of bias. We estimated TB incidence and the fraction of cases treated, for each Brazilian state and the Federal District over 2008–2017.

Findings:

For 2017, TB incidence was estimated as 41.5 (95 % interval: 40.7, 42.5) per 100 000 nationally, and ranged from 11.7–88.3 per 100 000 across states. The fraction of cases treated was estimated as 91.9 % (89.6 %, 93.7 %) nationally and ranged 86.0 %–94.8 % across states, with an estimated 6.9 (5.3, 9.2) thousand cases going untreated in 2017. Over 2008–2017, incidence declined at an average annual rate of 1.4 % (1.1 %, 1.9 %) nationally, and −1.1%–4.2 % across states. Over this period there was a 0.5 % (0.2 %, 0.9 %) average annual increase in the fraction of incident TB cases treated.

Interpretation:

Time-series estimates of TB burden and the fraction of cases treated can be derived from routinely-collected data and used to understand variation in TB outcomes and trends.

Trends in national and subnational wealth related inequalities in use of maternal health care services in Nepal: an analysis using demographic and health surveys (2001-2016)

Background

Maternal health affects the lives of many women and children globally every year and it is one of the high priority programs of the Government of Nepal (GoN). Different evidence articulate that the equity gap in accessing and using maternal health services at national level is decreasing over 2001–2016. This study aimed to assess whether the equity gap in using maternal health services is also decreasing at subnational level over this period given the geography of Nepal has already been identified as one of the predictors of accessibility and utilization of maternal health services.

Methods

The study used wealth index scores for each household and calculated the concentration curves and indexes in their relative formulation, with no corrections. Concentration curve was used to identify whether socioeconomic inequality in maternity services exists and whether it was more pronounced at one point in time than another or in one province than another. The changes between 2001 and 2016 were also disaggregated across the provinces. Test of significance of changes in Concentration Index was performed by calculating pooled standard errors. We used R software for statistical analysis.

Results

The study observed a progressive and statistically significant decrease in concentration index for at least four antenatal care (ANC) visit and institutional delivery at national level over 2001–2016. The changes were not statistically significant for Cesarean Section delivery. Regarding inequality in four-ANC all provinces except Karnali showed significant decreases at least between 2011 and 2016. Similarly, all provinces, except Karnali, showed a statistically significant decrease in concentration index for institutional delivery between 2011 and 2016.

Conclusion

Despite appreciable progress at national level, the study found that the progress in reducing equity gap in use of maternal health services is not uniform across seven provinces. Tailored investment to address barriers in utilization of maternal health services across provinces is urgent to make further progress in achieving equitable distribution in use of maternal health services. There is an opportunity now that the country is federalized, and provincial governments can make a need-based improvement by addressing specific barriers.

National and sub national prevalence of Amblyopia and its trends from 1990 to 2018 in Iran

PURPOSE

To determine the national and subnational prevalence of amblyopia and the respective provincial distribution and trend during 1990-2018 in Iran.

METHODS

Amblyopia data retrieved from 26 original studies, systematic reviews, Data has been cleaned by STATA and a linear mixed effect spatio-temporal model was used to calculate Gaussian process regression mean functions. Using a Bayesian approach, by pooling empirical data based on the assumed prior, a posterior distribution obtained for age and sex specific prevalence prediction nationally during the study time and provincially.

RESULTS

The overall age-adjusted prevalence of Amblyopia was 0.03 (95% CI, 0.022-0.035). The prevalence was comparable in boys and girls (p = 0.85), highest prevalence was in >30 years old (p = 0.038). Our extrapolation revealed a stable trend of prevalence of Amblyopia in Iran during 1990-2018 (national screening program has been active from 1990 onwards). While Amblyopia prevalence suggested a declining trend in three provinces of Hormozgan, Qom and Tehran and it went up in 13 other provinces.

CONCLUSION

Amblyopia prevalence seems unchanged despite the concurrent screening program. It is noteworthy that the coverage of the program has been improved and has reached more than 85% in 2018. Our finding mandates a formal evaluation on the program.

Obtaining district-level health estimates using geographically masked location from Demographic and Health Survey data

Background

Demographic and Health Survey (DHS) data are an important source of maternal, newborn, and child health as well as nutrition information for low- and middle-income countries. However, DHSs are often unavailable at the administrative unit that is most interesting or useful for program planning. In addition, the location of DHS survey clusters are geomasked within 10 km, and prior to 2009, may have crossed district boundaries. We aim to use DHS surveyed information with these geomasked coordinates to estimate district assignments for use in health program planning and evaluation.

Methods

We developed three methods to assign a district to a geomasked survey cluster in two DHS surveys from Malawi: 2000 and 2004. Method A assigns districts of origin in proportion to the likelihood that results from repeated simulated geomasking, allowing more than one possible district of origin. Method B assigns a single district of origin which contains the greatest proportion of simulated geomasked survey clusters. Method C maps the geomasked survey cluster’s location to a district polygon. We used these method assignments to estimate a selection of commonly used coverage indicators for each district. We compared the district coverage estimates, confidence intervals, and concordance correlation coefficients, by each of the methods, to those which used validated district assignments in 2004, and we looked at coverage change from 2000 to 2004.

Results

The methods we tested each approximated the validated estimates in 2004 by confidence interval comparison and concordance correlation coefficient. Estimated agreement for method A was between .14 and .98, for method B the estimated agreement was between .97 and .99, and for method C the agreement ranged from .93 to .99 when compared with the validated district assignments. Therefore, we recommend the protocol which is the simplest to implement—method C—overlaying geomasked survey cluster within district polygon.

Conclusions

Using geomasked survey clusters from DHSs to assign districts provided district level coverage rates similar to those using the validated surveyed locations. This method may be applied to data sources where survey cluster centroids are available and where district level estimates are needed for program implementation and evaluation in low- and middle-income settings. This method is of special interest to those using DHSs to study spatiotemporal trends as it allows for the utilization of historic DHS data where geomasking hinders the generation of reliable subnational estimates of health in areas smaller than the first-order administrative unit (ADM1).

Heterogeneity in potential impact and cost-effectiveness of ETEC and Shigella vaccination in four sub-Saharan African countries

Diarrheal disease burden has become more heterogenous in low- and lower middle-income countries as access to clean water, sanitation and health care has increased in wealthier urban populations. Enterotoxigenic Escherichia coli (ETEC) and Shigella are among the top five causes of diarrheal mortality in children living in sub-Saharan Africa. Here, we explored how accounting for subnational and economic heterogeneity in ETEC and Shigella disease burden affects projected vaccine impact and cost-effectiveness of standalone ETEC and Shigella vaccines during the first decade after introduction in four sub-Saharan African countries. We developed dynamic models for provincial areas and socioeconomic subpopulations of children in the Democratic Republic of Congo (DRC), Kenya, Zambia, and Zimbabwe. We estimated deaths and morbidity due to ETEC and Shigella diarrhea plus additional deaths from other infectious diseases attributable to ETEC- and Shigella-induced stunting. We analyzed cost-effectiveness using Incremental Cost-Effectiveness Ratios (ICERs) with Disability-Adjusted Life Years (DALYs) and Moderate-and-Severe Diarrheal episodes (MSD) averted as denominators. Other infectious disease deaths due to induced stunting accounted for 9-28% and 9-32% of the total provincial level ETEC and Shigella disease burden, respectively, across these four countries from years 2025 to 2034. Our results indicated that the lowest and most cost-effective provincial DALYs averted ICERs were below $600 and $500/DALY averted for ETEC and Shigella vaccination, respectively in Zimbabwe. ICERs were the highest in Zambia and Kenya, where all provincial ICERs where above $2000/DALY. The highest national and provincial MSD averted ICERs were in DRC, while the lowest were in Kenya and Zimbabwe. Vaccinations were most cost-effective in averting DALYs in lower wealth subpopulations living in the highest burden provincial areas. Our approach focused on subnational heterogeneity in ETEC and Shigella burden and vaccination access found that impact and cost-effectiveness were more favorable if vaccinations reach the most vulnerable children in underserved provinces.

Small area estimation of under-5 mortality in Bangladesh, Cameroon, Chad, Mozambique, Uganda, and Zambia using spatially misaligned data

Background

The under-5 mortality rate (U5MR) is an important metric of child health and survival. Country-level estimates of U5MR are readily available, but efforts to estimate U5MR subnationally have been limited, in part, due to spatial misalignment of available data sources (e.g., use of different administrative levels, or as a result of historical boundary changes).

Methods

We analyzed all available complete and summary birth history data in surveys and censuses in six countries (Bangladesh, Cameroon, Chad, Mozambique, Uganda, and Zambia) at the finest geographic level available in each data source. We then developed small area estimation models capable of incorporating spatially misaligned data. These small area estimation models were applied to the birth history data in order to estimate trends in U5MR from 1980 to 2015 at the second administrative level in Cameroon, Chad, Mozambique, Uganda, and Zambia and at the third administrative level in Bangladesh.

Results

We found substantial variation in U5MR in all six countries: there was more than a two-fold difference in U5MR between the area with the highest rate and the area with the lowest rate in every country. All areas in all countries experienced declines in U5MR between 1980 and 2015, but the degree varied both within and between countries. In Cameroon, Chad, Mozambique, and Zambia we found areas with U5MRs in 2015 that were higher than in other parts of the same country in 1980. Comparing subnational U5MR to country-level targets for the Millennium Development Goals (MDG), we find that 12.8% of areas in Bangladesh did not meet the country-level target, although the country as whole did. A minority of areas in Chad, Mozambique, Uganda, and Zambia met the country-level MDG targets while these countries as a whole did not.

Conclusions

Subnational estimates of U5MR reveal significant within-country variation. These estimates could be used for identifying high-need areas and positive deviants, tracking trends in geographic inequalities, and evaluating progress towards international development targets such as the Sustainable Development Goals.

Electronic supplementary material

The online version of this article (10.1186/s12963-018-0171-7) contains supplementary material, which is available to authorized users.