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Abstract
Undernutrition, resulting in restricted growth, and quantified here using height-for-age z-scores, is an important contributor to childhood morbidity and mortality. Since all levels of mild, moderate, and severe undernutrition are of clinical and public health importance, it is of interest to estimate the shape of the z-scores’ distributions. We present a finite normal mixture model that uses data on 4.3 million children to make annual country-specific estimates of these distributions for under-5-year-old children in the world’s 141 low- and middle-income countries between 1985 and 2011. We incorporate both individual-level data when available, as well as aggregated summary statistics from studies whose individual-level data could not be obtained. We place a hierarchical Bayesian probit stick-breaking model on the mixture weights. The model allows for nonlinear changes in time, and it borrows strength in time, in covariates, and within and across regional country clusters to make estimates where data are uncertain, sparse, or missing. This work addresses three important problems that often arise in the fields of public health surveillance and global health monitoring. First, data are always incomplete. Second, different data sources commonly use different reporting metrics. Last, distributions, and especially their tails, are often of substantive interest.
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Notes on contributors
Mariel M. Finucane
Mariel M. Finucane is Statistician, Mathematica Policy Research, Cambridge, MA 02139 (E-mail: [email protected]). Christopher J. Paciorek is Associate Research Statistician, Department of Statistics, University of California, Berkeley, CA 94720 (E-mail: [email protected]). Gretchen A. Stevens is Technical Officer, Department of Health Statistics and Information Systems, WHO, Geneva, Switzerland (E-mail: [email protected]). The author is staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy, or views of the World Health Organization. Majid Ezzati is Professor, MRC-PHE Center for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, United Kingdom (E-mail: [email protected]). Funding was provided by The Bill & Melinda Gates Foundation, Grand Challenges Canada, and the UK Medical Research Council.
Christopher J. Paciorek
Mariel M. Finucane is Statistician, Mathematica Policy Research, Cambridge, MA 02139 (E-mail: [email protected]). Christopher J. Paciorek is Associate Research Statistician, Department of Statistics, University of California, Berkeley, CA 94720 (E-mail: [email protected]). Gretchen A. Stevens is Technical Officer, Department of Health Statistics and Information Systems, WHO, Geneva, Switzerland (E-mail: [email protected]). The author is staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy, or views of the World Health Organization. Majid Ezzati is Professor, MRC-PHE Center for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, United Kingdom (E-mail: [email protected]). Funding was provided by The Bill & Melinda Gates Foundation, Grand Challenges Canada, and the UK Medical Research Council.
Gretchen A. Stevens
Mariel M. Finucane is Statistician, Mathematica Policy Research, Cambridge, MA 02139 (E-mail: [email protected]). Christopher J. Paciorek is Associate Research Statistician, Department of Statistics, University of California, Berkeley, CA 94720 (E-mail: [email protected]). Gretchen A. Stevens is Technical Officer, Department of Health Statistics and Information Systems, WHO, Geneva, Switzerland (E-mail: [email protected]). The author is staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy, or views of the World Health Organization. Majid Ezzati is Professor, MRC-PHE Center for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, United Kingdom (E-mail: [email protected]). Funding was provided by The Bill & Melinda Gates Foundation, Grand Challenges Canada, and the UK Medical Research Council.
Majid Ezzati
Mariel M. Finucane is Statistician, Mathematica Policy Research, Cambridge, MA 02139 (E-mail: [email protected]). Christopher J. Paciorek is Associate Research Statistician, Department of Statistics, University of California, Berkeley, CA 94720 (E-mail: [email protected]). Gretchen A. Stevens is Technical Officer, Department of Health Statistics and Information Systems, WHO, Geneva, Switzerland (E-mail: [email protected]). The author is staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy, or views of the World Health Organization. Majid Ezzati is Professor, MRC-PHE Center for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, United Kingdom (E-mail: [email protected]). Funding was provided by The Bill & Melinda Gates Foundation, Grand Challenges Canada, and the UK Medical Research Council.