Lei Liu

Bio: Lei Liu is an academic researcher from Johns Hopkins University. The author has contributed to research in topics: Poison control & Child mortality. The author has an hindex of 5, co-authored 5 publications receiving 2352 citations.

Causes of death in children younger than five years in China in 2015: an updated analysis.

Abstract: Background Substantial progress in reducing the child mortality rate has been made globally in the last two decades. However, for China, the number of children dying from preventable diseases is still very large. It is important to have regularly updated information on the distribution of causes of death (COD) in children to inform policy and research. In this study, we aim to estimate the COD spectrum in children younger than five years old from 2009 to 2015 with a focus on the year 2015 and to provide an updated COD prediction model for China. Methods Updated data of under-five mortality rates (U5MRs) and the number of live births at national and provincial levels were obtained from United Nation's Inter-agency Group for Child Mortality Estimation (UN IGME), Institute for Health Metrics and Evaluation (IHME), and United Nations Population Division (UNPD). Then, we conducted a systematic review across four Chinese and English bibliographic databases and identified high-quality community-based longitudinal studies of COD in children younger than five years in China. We developed a number of single-cause models to predict the number of child death for main COD in different age groups at both national and provincial levels. The jackknife procedure was applied to construct the 95% Uncertainty Ranges (URs). Results From 2009 to 2015, the under-five mortality rates have declined by 37.1%. The leading causes of death in 2015 were preterm birth complications (17.4%), birth asphyxia (15.2%), congenital abnormalities (14.1%), accidents (13.5%) and pneumonia (12.4%) for children under five years old. The COD spectrum varied substantially across Chinese provinces with different development levels. The leading cause in children under five years in the wealthier provinces (with lower U5MRs) was congenital abnormalities (up to 18.9%), while in the poorer provinces (with higher U5MRs), pneumonia was the dominant COD (up to 23.4%). Conclusions This study updates and validates the accuracy of the findings of our previous COD study and proposes a new modelling method to predict proportions for the most common causes of child death in China. These updated COD estimates suggest that current strategies to reduce child mortality should prioritise action on neonatal deaths and target interventions against the top COD according to the local COD spectrum. Special attention should also be given to reducing differences between Chinese provinces and regions with differing development levels.

Estimating the distribution of causes of death among children age 1–59 months in high-mortality countries with incomplete death certification

Abstract: BACKGROUND: Our objective was to develop a methodology to estimate causes of death among children age 1-59 months in high child mortality countries without adequate vital registration (VR) systems. METHODS: We systematically reviewed community-based studies reporting at least two causes of death among children 1-59 months of age identified from published and unpublished sources. We included (i) studies conducted after 1979 (ii) for duration of 12 months or an exact multiple (iii) with > or =25 deaths in children <5 years (iv) each death represented once and (v) <25% of deaths due to unknown causes. A study-based multinomial logistic regression model was applied to country-level data to estimate causes of child death. RESULTS: Of the 216 studies reviewed 81 were included in the analysis comprising 79 067 under-5 deaths from 25 countries. After adjusting for risk factors and intervention coverage the estimated distribution of causes of deaths in children 1-59 months of age in sub-Saharan Africa and Southeast Asia was: pneumonia (21 and 31%) diarrhoea (25 and 31%) malaria (26 and 2%) injury (3 and 4%) meningitis (3 and 4%) measles (3 and 2%) and other causes (20 and 27%) respectively. CONCLUSION: From studies reporting as few as two different causes of death statistical modelling can be used to estimate the causes of child mortality for settings with incomplete VR. Pneumonia and diarrhoea remain the leading causes of death among children 1-59 months of age in sub-Saharan Africa and Southeast Asia.

Trends in causes of death among children under 5 in Bangladesh, 1993-2004: an exercise applying a standardized computer algorithm to assign causes of death using verbal autopsy data

Abstract: Background Trends in the causes of child mortality serve as important global health information to guide efforts to improve child survival. With child mortality declining in Bangladesh, the distribution of causes of death also changes. The three verbal autopsy (VA) studies conducted with the Bangladesh Demographic and Health Surveys provide a unique opportunity to study these changes in child causes of death.

Deriving causes of child mortality by re–analyzing national verbal autopsy data applying a standardized computer algorithm in Uganda, Rwanda and Ghana

Abstract: BACKGROUND: To accelerate progress toward the Millennium Development Goal 4, reliable information on causes of child mortality is critical. With more national verbal autopsy (VA) studies becoming available, how to improve consistency of national VA derived child causes of death should be considered for the purpose of global comparison. We aimed to adapt a standardized computer algorithm to re-analyze national child VA studies conducted in Uganda, Rwanda and Ghana recently, and compare our results with those derived from physician review to explore issues surrounding the application of the standardized algorithm in place of physician review. METHODS AND FINDINGS: We adapted the standardized computer algorithm considering the disease profile in Uganda, Rwanda and Ghana. We then derived cause-specific mortality fractions applying the adapted algorithm and compared the results with those ascertained by physician review by examining the individual- and population-level agreement. Our results showed that the leading causes of child mortality in Uganda, Rwanda and Ghana were pneumonia (16.5-21.1%) and malaria (16.8-25.6%) among children below five years and intrapartum-related complications (6.4-10.7%) and preterm birth complications (4.5-6.3%) among neonates. The individual level agreement was poor to substantial across causes (kappa statistics: -0.03 to 0.83), with moderate to substantial agreement observed for injury, congenital malformation, preterm birth complications, malaria and measles. At the population level, despite fairly different cause-specific mortality fractions, the ranking of the leading causes was largely similar. CONCLUSIONS: The standardized computer algorithm produced internally consistent distribution of causes of child mortality. The results were also qualitatively comparable to those based on physician review from the perspective of public health policy. The standardized computer algorithm has the advantage of requiring minimal resources from the health care system and represents a promising way to re-analyze national or sub-national VA studies in place of physician review for the purpose of global comparison. Language: en