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Additional file 1: Table S1 Indicator weights generated by factor analysis for the individual years. Table S2 Missing values across indicators prior and after imputing based on similar profile. Figure S1 Percentage of mortality attributable to housing inequality by the HDI 1991, sex and age group in a period of 1991-2000. Figure S2 Percentage of mortality attributable to housing inequality by the HDI 2001, sex and age group in a period of 2001-2010. Figure S3 Percentage of mortality attributable to housing inequality by the HDI 2011, sex and age group in a period of 2011-2020. Table S3 Results of the Arriaga method. Absolute contribution represents the sum of the direct and indirect effects of an age group between the most and the least deprived deciles in each period. Table S4 Example of our calculations used for plotting the adjusted Lorenz curve. Figure S4 Adjusted Lorenz curve for age-adjusted male mortality in the period between 1991-2000. Table S5 Spearman’s correlation coefficients between the indicators of the HDI 1991 and HDI 2001. Table S6 Spearman’s correlation coefficients between the indicators of the HDI 2001 and HDI 2011.

Background: Full birth histories (FBHs) are a key tool for estimating fertility and child mortality in low-and middle-income countries, but they are lengthy to collect. This is not desirable, especially for rapid turnaround surveys that ought to be short (e.g., mobile phone surveys). To reduce the length of the interview, some surveys resort to truncated birth histories (TBHs), where questions are asked only on recent births. Methods: We used 29 Malaria Indicator Surveys from 17 countries in Sub-Saharan Africa to compare full and truncated birth histories. Each set of TBHs was paired and compared to an overlapping set of FBHs. We conducted a variety of data checks, including a comparison of the proportion of children reported in the reference period and a comparison of the fertility and mortality estimates. Results: Fertility and mortality estimates from TBHs are lower than those based on FBHs. These differences are driven by the omission and displacement of births outside the reference period. Conclusions: TBHs are prone to misreporting errors that will bias both fertility and mortality estimates. These errors are not systematically associated with interviewer characteristics, but data quality markers correlate with respondent attributes, suggesting that truncation creates confusion among respondents. Rigorous data quality checks should be put in place when collecting data through this instrument in future surveys.

Background: Poor housing conditions have been associated with increased mortality. Our objective is to investigate the association between housing inequality and increased mortality in Belgium and to estimate the number of deaths that could be prevented if the population of the whole country faced the mortality rates experienced in areas that are least deprived in terms of housing. Methods: We used individual-level mortality data extracted from the National Register in Belgium and relative to deaths that occurred between Jan. 1, 1991, and Dec. 31, 2020. Spatial and time-specific housing deprivation indices (1991, 2001, and 2011) were created at the level of the smallest geographical unit in Belgium, with these units assigned into deciles from the most to the least deprived. We calculated mortality associated with housing inequality as the difference between observed and expected deaths by applying mortality rates of the least deprived decile to other deciles. We also used standard life table calculations to estimate the potential years of life lost due housing inequality. Results: Up to 18.5% (95% CI 17.7-19.3) of all deaths between 1991 and 2020 may be associated with housing inequality, corresponding to 584,875 deaths. Over time, life expectancy at birth increased for the most and least deprived deciles by about 3.5 years. The gap in life expectancy between the two deciles remained high, on average 4.6 years. Life expectancy in Belgium would increase by approximately 3 years if all deciles had the mortality rates of the least deprived decile. Conclusions: Thousands of deaths in Belgium could be avoided if all Belgian neighborhoods had the mortality rates of the least deprived areas in terms of housing. Hotspots of housing inequalities need to be located and targeted with tailored public actions. This study was conducted as part of the ELLIS project (Monitoring and Mitigat‑ ing Environmental Health Inequalities), funded by the Belgian Federal Science Policy (B2/191/P3/ELLIS) This work was produced using data from Statbel (Directorate-General Statis‑ tics – Statistics Belgium) – Demobel (adaptation of the National Register), the censuses of 1991, 2001, and 2011, and IPCAL. Computational resources were provided by the supercomputing facilities at the Université catholique de Louvain (CISM/UCL) and the Consortium des Équipements de Calcul Intensif en Fédération Wallonie Bruxelles (CÉCI), funded by the Fond de la Recherche Scientifque de Belgique (F.R.S.-FNRS) under convention 2.5020.11 and by the Walloon Region. The authors want to thank Statbel and particularly Patrick Lusyne and Cloë Ost for preparing and making pseudonymized data available for research, the Centre for Demographic Research (DEMO) at UCLouvain for allowing us to access the data, and the CISM team for managing the statistical servers.

International audience; Background: In low- and middle-income countries, mortality levels are commonly derived from retrospective reports on deceased relatives collected in sample surveys and censuses. These data sources are potentially affected by recall errors.Objective: Using high-quality data collected by the Nouna Health and Demographic Surveillance System (HDSS) in Burkina Faso, we evaluate the reliability of mortality estimates based on the 2006 national census.Methods: We extracted from the census database all records referring to the population under surveillance in the HDSS. Life tables were estimated from recent household deaths reported in the census and compared to those obtained from the prospective mortality data. To evaluate age errors and assess their impact on mortality, we linked census and HDSS records at the individual level for the surviving population and the deceased. Indirect estimates of mortality were also calculated based on the reported survival of children and parents.Results: Life expectancies at birth derived from recent household deaths pointed to a lower mortality than monitored in the HDSS, with a difference of 4 years for men and 8 years for women. Underreporting of deaths among the population aged 60 and above accounted for more than half of these differences. Age errors were small for the surviving population and larger for the deceased, but their effects on mortality estimates were modest. Indirect estimates of child mortality were consistent with the HDSS data, but orphanhood-based estimates were implausibly low.Conclusions: Additional elicitation questions should be asked during the census interviews to improve the collection of data on recent household deaths.Contribution: Mortality rates derived from recent household deaths can seriously underestimate mortality. In Burkina Faso the downward bias in the 2006 census was larger among females and was mostly attributable to underreporting of deaths.

Optimal health and development from preconception to adulthood are critical for human flourishing and the formation of human capital. The Nurturing Care Framework, as adapted to age 20 years, conceptualizes the major influences during periods of development from pre-conception, through pregnancy, childhood and adolescence that affect human capital. In addition to mortality in children under five years of age, it is important to consider earlier (stillbirths) or later (from five to 20 years) loss of life. The global rate of mortality before 20 years has declined substantially since 2000, yet in 2019 an estimated 8·6 million deaths occurred between 28 weeks of gestation and 20 years of age, with over half, including stillbirths, occurring before 28 days of age. The 1,000 days from pre-conception to two years are especially influential for human capital. The prevalence of low birth weight is high in sub-Saharan Africa and even higher in South Asia. Growth faltering, especially from birth to two years of age, occurs in most world regions while overweight increases in many regions from the pre-primary school period through adolescence. Analyses of cohort data show that growth trajectories in early years of life are strong determinants of nutritional outcomes in adulthood.The accrual of knowledge and skills is affected by health, nutrition and home resources in early childhood and by educational opportunities. Linear growth in the first two years of life better predicts intelligence quotients among adults than increases in height in older children and adolescents. Learning-adjusted years of schooling range from about four years for sub-Saharan Africa to about 11 years in high-income countries. Human capital depends on children and adolescents surviving, thriving and learning until adulthood.

Additional file 1 Supplementary materials.

International audience

International audience

info:eu-repo/semantics/inPress

Un système d’information démographique fonctionnel est l’une des conditions nécessaires à une allocation optimale des ressources et à la planification des programmes de développement. Que ce soit dans le domaine de la santé publique, de l’éducation ou encore de l’emploi, les décideurs politiques ont régulièrement besoin de données actualisées sur la structure de la population et sur sa dynamique. L’état civil, en tant que système d’observation exhaustif et continu des phénomènes démographique...

Fondé en 1962 en zone rurale à 150 km de Dakar, en pays Sereer, l'observatoire de Niakhar est le plus ancien observatoire de population en Afrique encore en activité. Au cœur d'une histoire scientifique et humaine originale, il a permis d'assurer, depuis sa création, le suivi sanitaire, démographique, social, économique et environnemental de plus de deux générations. Les résultats de recherche de Niakhar, avec des indicateurs suivis dans le temps long, ont éclairé et accompagné les politiques nationales et internationales en matière de santé, notamment pour la prévention du paludisme. En revisitant 50 années de recherche sur le site de Niakhar, cet ouvrage décrit et analyse la construction de cette plate-forme d'observation prospective pluridisciplinaire. Il illustre l'intérêt de l'approche sur le long terme dans les différents domaines de recherche et ouvre une réflexion sur les enjeux éthiques particuliers à cet instrument de collecte. Enfin, il propose des pistes d'évolution méthodologique et de gouvernance pour la recherche. Cette première synthèse sur l'observatoire de Niakhar permettra à l'État sénégalais et aux décideurs ouest-africains, avec les institutions internationales et les scientifiques, de disposer de bases concrètes pour optimiser ces plates-formes de recherche et les mobiliser dans la perspective des objectifs de développement durable.

Using data collected in the Nouna HDSS in Burkina Faso, we evaluate the reliability of mortality estimates based on the 2006 national census. We extracted from the census database all records referring to the population under surveillance in the HDSS. Life tables were estimated from recent household deaths reported in the census and compared to those obtained from the prospective mortality data. We linked census and HDSS records at the individual level and evaluated the reported ages of household members and those who died in the 12 months preceding the census against those in the HDSS. Life expectancies derived from recent deaths reported in households pointed to lower mortality than monitored in the HDSS, with a difference of 3.2 years for men and 6.8 years for women. Age errors were limited for the surviving population, but larger for the deceased. Underreporting of deaths plays a larger role than age errors.

In Belgium, life expectancy is now twice what it was 170 years ago due to improvements in public and private hygiene, nutrition, medical procedures and the organization of health services. The average lifespan of a Belgian resident is now over 80 years, but inequalities persist and sometimes even intensify. In Belgium, like in other European countries, a negative relationship has been demonstrated between socio-economic position on the one hand and health and mortality on the other hand. This project aimed to investigate whether or not this social gradient in health and mortality is associated with the growing de-standardisation of employment arrangements and family situations. The goal was to obtain information about the mechanisms by which social differences in mortality and health are generated in Belgium, in order to provide insight in policy measures that could prove effective in countering these inequalities. In a first part of the project, the evolution of mortality inequalities in Belgium between 1991 and 2016 was studied. It has been shown, based on a multidimensional indicator combining educational level, employment category and housing characteristics, that social inequalities in death are significant in Belgium and that they have been increasing for both women and men since at least the 1990s. In relative terms, gaps between social groups are especially wide between 25 and 50 years but have little impact on differences in life expectancy because the risk of dying is inherently low at these ages. The social disparities in mortality for older people (65+) – and especially the delay of the underprivileged in the health transition and the fight against cardiovascular diseases – have a far greater effect on differences in life expectancy. In general, social inequalities in mortality and their variation along the social continuum are observed for each of the major causes of death, but they are particularly pronounced for diseases of the respiratory and circulatory systems. The results also point out that spatial disparities in mortality linger and have been worsening for at least a quarter century. The spatial pattern of mortality for the underprivileged social group resembles the spatial patterns of the privileged and intermediate social groups. Within the same social group, spatial disparities endure. This indicates that beyond the socioeconomic composition of regions and districts, other factors – environmental, cultural and behavioural – are involved and affect mortality across social groups in the same way. The second part of the project focused on the relationship between employment situation and (cause-specific) mortality. Mortality inequalities by employment status were considered, controlled for other dimensions of socio-economic position. The association between mortality and unemployment in Belgium was investigated in detail at the individual level. Results showed that the unemployed have a two times higher mortality risk than the employed. Even when they have a high educational level, excellent housing conditions and healthy living arrangements, unemployed men still have a higher mortality risk than their employed counterparts. Conclusions for women were comparable, but inequalities were smaller. A slight protective effect of education against the detrimental health impact of unemployment was demonstrated. Analyses clearly showed that the mortality excess of the unemployed results from an excess mortality in practically all main cause groups. Focusing on specific causes within each main group, we observed large inequalities for alcohol-related mortality. Furthermore, our results illustrated the importance of municipality of district characteristics, such as urbanicity, the aggregated unemployment rate, etcetera. The mortality excess for unemployed men and women was for example smaller in regions with higher aggregate unemployment levels. The higher mortality of the unemployed suggests a positive effect of having a job, which is a reasonable assumption since employment is a key factor determining the financial and psychological wellbeing of individuals and their families. Getting people into work should therefore be an important goal of labour market policies and is of critical importance for reducing health inequalities. However, this is not the whole picture. Analyses including non-standard types of contract show that jobs need to be sustainable as well. Overall and cause-specific mortality differentials by marital status and type of family situation were the focus of a third part of the CAUSINEQ project, in order to gain insight into the effect of the de-standardisation of family formation processes. With regard to marital status, it does appear that matrimonial behaviour varies from one Belgian administrative region to another. Flanders is characterised by a greater share of married couples and a lower proportion of divorced and single people. In contrast, isolated individuals are overrepresented in Brussels, compared to Flanders in particular, but also compared to Wallonia. At the same time, married individuals and those who are not married but live in a couple do seem to be subject to lower levels of mortality in each of the three regions of Belgium. Results from Poisson regression models point out the interactions between the undermortality of (married) couples and the differences in matrimonial behaviour between the three regions are relatively small and do not provide a satisfying explanation for the differences in mortality observed between the regions. The main factor explaining regional differences in mortality is the socio-economic situation of the residents. With regard to type of family situation, excess mortality was revealed for children under 5 years of age living in single-parent families, even after controlling for the main socio-demographic variables. This excess mortality is particularly pronounced for violent deaths. This observation raises questions. Is this a manifestation of less parental supervision or is it a reflection of less safe housing or living conditions? In order to characterise violent deaths in single-parent families and to distinguish them from those in two-parent families, Chi-square tests were used with the place of death (home, school, etc.), the type of death (traffic accident, other accidents, etc.) and the day of the week in which the death occurred. However, none of these analyses was statistically significant. Finally, analyses were performed to show how adverse health – as an important precursor of mortality – varies jointly by employment and living arrangements. A typology of labour market positions was constructed and enriched with survey-data information about respondents’ employment conditions (for those in waged employment). This endeavour shows Belgium as a country with a stable, low prevalence of precarious employment when compared to other EU-countries. However, the prevalence of one particular type of precarious employment is considerable and growing in Belgium, namely ‘precarious unsustainable employment’, characterised mainly by low working hours and low monthly wages and often held by female workers. The labour market typology shows clear relationships with the health of individuals. Three labour market positions are most likely to be associated with general and mental health problems: unemployment, precarious employment and instrumental employment. Controlling for social precarity indicators causes a (sometimes spectacular) reduction in the odds for poor health, which clearly shows how the broader social situation “interacts” with labour market positions in creating social health inequalities. It is therefore important to keep in mind that the accumulation of health-damaging positions in different life spheres is in fact a worrisome reality for a part of the Belgian population. These results indicate that precarious labour market situations are to be taken serious as a public health risk and suggest that stable and secure employment of good quality is the “healthiest form of employment”. From a policy perspective, our findings make clear that the potential health impact of labour market policies should be considered whenever labour market reforms are planned. Policy makers should be aware of the fact that flexible labour market policies may stand at odds with policies aiming for longer and sustainable working careers.

This research was conducted to evaluate the contribution of verbal autopsies (VA) integrated in the 72 civil registration centers of the Dakar region. Reported deaths over a two-month period were identified and the 2016 WHO-VA instrument was administered to relatives of the deceased. The InterVA5 software identified the main causes and circumstances of death. VA were completely administered to 42.8% of deaths reported in vital registration centers, and 66.7% of eligible cases. Death occurred at home in 35.9% of cases, in a health facility in 36.6%. The primary respondent designated to answer the questions was the father or mother of the deceased, in 39.5% of the cases. The analysis of the causes of death found a preponderance of cardiovascular diseases. VA integrated in vital registration centers are an accessible mean of collecting cause-of-death data in urban settings in Senegal to strengthen the health information system.

Based on deaths registers maintained by the Municipal Hygiene Office from Antananarivo, this study assesses seasonal patterns and its changes over the period 1976-2015 of all-cause and cause-specific mortality by age groups, using Generalized Additive Mixed regression models. Among children, risks of dying were the highest during the hot and rainy season, but the seasonality in child mortality significantly reduced since the mid-1970s, due to declines in the burden of infectious diseases and nutritional deficiencies. In adults aged 60 and above, all-cause mortality rates are the highest in the dry and cold season, due to peaks in cardiovascular diseases, with little change over time. Changes in the seasonality within broad categories of causes of death have been modest. To conclude, shifts in disease patterns brought by the epidemiological transition, rather than changes in seasonal variations in cause-specific mortality, are the main drivers of trends in the seasonality of all-cause mortality.

All-cause and cause-specific mortality rates in sub-Saharan Africa remain poorly estimated due to the incompleteness of death registration systems and a high percentage of home deaths. Even though health facility data are increasingly used to monitor changes in disease patterns, they are not representative of the general population. We take advantage of a death notification system that was set up in Antananarivo (Madagascar) to document over time (1976-2015) the hidden causes of deaths that are not usually reported in health facility data. In Antananarivo, age at death has increased and the overall proportion of death occurring in health facilities has declined over time. However, these changes have been uneven across causes of death and the concordance between cause-specific mortality fractions inferred from deaths that occurred in health facilities and those based on all deaths is gradually increasing. Yet some deaths remain consistently under-represented, especially those due to respiratory diseases.

Supplemental information on estimation of the population at risk of dying, redistribution of garbage codes, unstandardized cause-specific mortality fractions from death notification data, computation of the composite index, and death report forms used by the Municipal Hygiene Office. (DOCX 794 kb)

Across the world, around one million children aged between 5 and 15 years died in 2017. For a child on its fifth birthday, the risk of dying before reaching its fifteenth birthday is 7.2 per 1,000. This is five times lower than the risk for a newborn of dying before age 5 (39 per 1,000). Mortality between ages 5 and 15 halved between 1990 and 2017, and most deaths in this age group now occur in low- and middle-income countries. In 2017, one-third of all deaths were concentrated in West and Central Africa, where the probability of dying at these ages is more than 20 times higher than in Western Europe.

Background From 1990 to 2016, the mortality of children younger than 5 years decreased by more than half, and there are plentiful data regarding mortality in this age group through which we can track global progress in reducing the under-5 mortality rate. By contrast, little is known on how the mortality risk among older children (5–9 years) and young adolescents (10–14 years) has changed in this time. We aimed to estimate levels and trends in mortality of children aged 5–14 years in 195 countries from 1990 to 2016. Methods In this analysis of empirical data, we expanded the United Nations Inter-agency Group for Child Mortality Estimation database containing data on children younger than 5 years with 5530 data points regarding children aged 5–14 years. Mortality rates from 1990 to 2016 were obtained from nationally representative birth histories, data on household deaths reported in population censuses, and nationwide systems of civil registration and vital statistics. These data were used in a Bayesian B-spline bias-reduction model to generate smoothed trends with 90% uncertainty intervals, to determine the probability of a child aged 5 years dying before reaching age 15 years. Findings Globally, the probability of a child dying between the ages 5 years and 15 years was 7·5 deaths (90% uncertainty interval 7·2–8·3) per 1000 children in 2016, which was less than a fifth of the risk of dying between birth and age 5 years, which was 41 deaths (39–44) per 1000 children. The mortality risk in children aged 5–14 years decreased by 51% (46–54) between 1990 and 2016, despite not being specifically targeted by health interventions. The annual number of deaths in this age group decreased from 1·7 million (1·7 million–1·8 million) to 1 million (0·9 million–1·1 million) in 1990–2016. In 1990–2000, mortality rates in children aged 5–14 years decreased faster than among children aged 0–4 years. However, since 2000, mortality rates in children younger than 5 years have decreased faster than mortality rates in children aged 5–14 years. The annual rate of reduction in mortality among children younger than 5 years has been 4·0% (3·6–4·3) since 2000, versus 2·7% (2·3–3·0) in children aged 5–14 years. Older children and young adolescents in sub-Saharan Africa are disproportionately more likely to die than those in other regions; 55% (51–58) of deaths of children of this age occur in sub-Saharan Africa, despite having only 21% of the global population of children aged 5–14 years. In 2016, 98% (98–99) of all deaths of children aged 5–14 years occurred in low-income and middle-income countries, and seven countries alone accounted for more than half of the total number of deaths of these children. Interpretation Increased efforts are required to accelerate reductions in mortality among older children and to ensure that they benefit from health policies and interventions as much as younger children.

Chapitre 20; International audience; Un système d’information démographique fonctionnel est l’une des conditions nécessaires à une allocation optimale des ressources et à la planification des programmes de développement. Que ce soit dans le domaine de la santé publique, de l’éducation ou encore de l’emploi, les décideurs politiques ont régulièrement besoin de données actualisées sur la structure de la population et sur sa dynamique. L’état civil, en tant que système d’observation exhaustif et continu des phénomènes démographiques, devrait idéalement constituer une source de données régulières à cet effet. Malheureusement, dans la plupart des pays africains, les systèmes d’état civil restent incomplets. Au Sénégal, malgré une volonté politique prononcée, le système d’enregistrement des faits d’état civil demeure limité, à la fois en termes de couverture et de qualité des données collectées. Le recensement de la population de 2013 indique que seuls 35 % des décès survenus au cours des douze mois ayant précédé le recensement ont fait l’objet d’une déclaration auprès d’un officier de l’état civil (au niveau national). Dans le domaine de la nuptialité, seuls 28 % des mariages ont été déclarés. Bien que plus fréquente, la déclaration des naissances reste en deçà d’une couverture complète (80 %).

International audience; Lorsque la taille ou la composition des ménages se modifient, la question se pose de savoir si ces changements sont liés à l’évolution des règles de cohabitation entre personnes apparentées (enfants, petits-enfants, frères etsoeurs, oncles et tantes, etc.) ou s’ils sont imputables à des modifications du nombre d’apparentés, qui seraient dues elles-mêmes aux évolutions de la mortalité, du mariage et de la fécondité. Quelle est la part qui tientaux contraintes démographiques, et celle venant des changements sociaux ? Nous examinons cette question en Afrique contemporaine par une étude de cas dans une région rurale du Sénégal (Bandafassi) où la polygamieest fréquente et les familles très étendues. La population étudiée fait l’objet d’une observation démographique depuis près de 40 ans, et des généalogies ont été recueillies, permettant de décrire de façon relativement exhaustivela structure démographique de la parenté et son évolution. Des micro-simulations viennent compléter ces généalogies en dessinant les contours de la parenté au vu des paramètres démographiques. La comparaison desréseaux de parenté avec les arrangements résidentiels observés entre apparentés renseigne alors sur l’influence des différents facteurs dans l’évolution des ménages et de la famille.

En 2017 un million d’enfants ayant entre 5 et 15 ans sont morts dans le monde. Le risque pour un enfant fêtant son 5e anniversaire de mourir avant d'atteindre son 15e anniversaire s’élève à 7,2 pour mille, il est cinq fois moindre que celui pour un nouveauné de mourir avant son 5e anniversaire (39 pour mille). La mortalité entre 5 et 15 ans a baissé de moitié entre 1990 et 2017. Elle est concentrée dans les pays à revenu faible et moyen. L'Afrique de l’Ouest et l'Afrique centrale rassemblent à elles seules un tiers des décès mondiaux en 2017. Dans ces régions, la probabilité de décéder à ces âges est plus de vingt fois plus élevée qu'en Europe de l’Ouest.

Background From 1990 to 2016, the mortality of children younger than 5 years decreased by more than half, and there are plentiful data regarding mortality in this age group through which we can track global progress in reducing the under-5 mortality rate. By contrast, little is known on how the mortality risk among older children (5–9 years) and young adolescents (10–14 years) has changed in this time. We aimed to estimate levels and trends in mortality of children aged 5–14 years in 195 countries from 1990 to 2016. Methods In this analysis of empirical data, we expanded the United Nations Inter-agency Group for Child Mortality Estimation database containing data on children younger than 5 years with 5530 data points regarding children aged 5–14 years. Mortality rates from 1990 to 2016 were obtained from nationally representative birth histories, data on household deaths reported in population censuses, and nationwide systems of civil registration and vital statistics. These data were used in a Bayesian B-spline bias-reduction model to generate smoothed trends with 90% uncertainty intervals, to determine the probability of a child aged 5 years dying before reaching age 15 years. Findings Globally, the probability of a child dying between the ages 5 years and 15 years was 7·5 deaths (90% uncertainty interval 7·2–8·3) per 1000 children in 2016, which was less than a fifth of the risk of dying between birth and age 5 years, which was 41 deaths (39–44) per 1000 children. The mortality risk in children aged 5–14 years decreased by 51% (46–54) between 1990 and 2016, despite not being specifically targeted by health interventions. The annual number of deaths in this age group decreased from 1·7 million (1·7 million–1·8 million) to 1 million (0·9 million–1·1 million) in 1990–2016. In 1990–2000, mortality rates in children aged 5–14 years decreased faster than among children aged 0–4 years. However, since 2000, mortality rates in children younger than 5 years have decreased faster than mortality rates in children aged 5–14 years. The annual rate of reduction in mortality among children younger than 5 years has been 4·0% (3·6–4·3) since 2000, versus 2·7% (2·3–3·0) in children aged 5–14 years. Older children and young adolescents in sub-Saharan Africa are disproportionately more likely to die than those in other regions; 55% (51–58) of deaths of children of this age occur in sub-Saharan Africa, despite having only 21% of the global population of children aged 5–14 years. In 2016, 98% (98–99) of all deaths of children aged 5–14 years occurred in low-income and middle-income countries, and seven countries alone accounted for more than half of the total number of deaths of these children. Interpretation Increased efforts are required to accelerate reductions in mortality among older children and to ensure that they benefit from health policies and interventions as much as younger children. Funding UN Children's Fund, Bill & Melinda Gates Foundation, United States Agency for International Development.

Entre 1990 et 2015, la plupart des pays en développement ont connu des progrès notables de leur espérance de vie, mais d’ampleur très diverse. Cet article fait le point sur l’évolution de la mortalité des enfants (à moins de 5 ans) et de la mortalité adulte (de 15 à 60 ans) dans les 109 pays à bas et moyen revenu de plus d’un million d’habitants. Il met l’accent sur l’évolution des disparités géographiques et de sexe entre pays, et sur les inégalités internes (instruction, niveaux de vie, milieux d’habitat) dans dix pays retenus aux caractéristiques très différentes sur les plans socioéconomique, politique et démographique (Afghanistan, Afrique du Sud, Bolivie, Brésil, Burkina Faso, Chine, Égypte, Inde, Indonésie, Nigeria). Il revisite également la question de la transition épidémiologique et examine plus particulièrement la mortalité par sida et la mortalité maternelle. Les progrès ont bénéficié principalement aux enfants, et souvent (mais pas toujours) aux femmes et aux pays et groupes sociaux les plus défavorisés. Parler de convergence vers une faible mortalité paraît néanmoins prématuré, car en dépit des progrès réalisés, les inégalités entre pays et internes aux pays demeurent conséquentes, et méritent une attention particulière tant des acteurs de la santé publique que des chercheurs.

In this paper, we consider the challenge of death registration and mortality estimation for populations affected by conflict and displacement, where conventional systems of civil registration are seldom functional. Our analysis and discussion are framed around a short case study that showcases existing registration systems in Yemen and presents a descriptive mortality analysis based on these existing data sources. We first provide a general discussion of the registration of displaced people, who are playing an increasingly key role in shaping the demographic trends in the Arab region. We then introduce some of the challenges to death registration in Yemen and review the registration process in place in the country for refugees and IDPs. We describe two databases maintained by UNHCR: the refugee registration information system (ProGres) and the Health Information System (Twine). We present preliminary results based on changes in the size and composition of populations of PoCs, basic demographic rates, and cause-specific mortality fractions. Finally, we discuss the potential for data collected by UNHCR to contribute to official vital statistics in Yemen.

Objective: Due to incomplete death registration in Madagascar, trends in cause-specific mortality are known from epidemiological models such as the Global Burden of Disease Study 2013 (GBD 2013). The external validity of such model-based estimates is difficult to establish, however, since all possible data are usually included. In Madagascar, the GBD 2013 study used death registration data from Antananarivo but only for the period 1984-1995. Using death records up to 2014, we aim to describe trends in mortality by age and sex and compare the distribution of causes of death observed in death records with GBD 2013. Methods: Information on the sex of the deceased, date of birth and death and underlying cause of death were transcribed from death registers. Causes of death were converted in GBD cause categories. The completeness of the registration of deaths was assessed using indirect demographic techniques. Findings: The completeness of the registration of deaths is higher than 90% in Antananarivo. The proportion of deaths attributed to "garbage codes" amounts to 19.4% when considering codes for symptoms, signs and ill-defined conditions, deaths from injuries whose intent is not determined, and ill-defined cardiovascular diseases and neoplasms. Significant differences are observed between the distributions of deaths by cause in the GBD 2013 estimates and death registers referring to the capital city. Conclusions: Death registration in Antananarivo, and possibly other African cities, is a low-cost and untapped data source which can help to refine disease burden estimates.

Analyse de l'évolution des inégalités sociales de mortalité en Belgique et de ses déterminants (état-civil, emploi, niveau d'instruction et conditions de logement)

En Afrique sub-saharienne, les recensements constituent une source de données fondamentale pour estimer la mortalité, en raison de l’incomplétude de l’enregistrement des décès à l'état civil. Afin d’évaluer la fiabilité des niveaux de mortalité qui peuvent en être déduits, nous appliquons différentes méthodes d’estimation à des extraits des recensements sénégalais de 2002 et 2013, couvrant trois observatoires de population situés à Bandafassi, Mlomp et Niakhar. Les taux de mortalité des moins de cinq ans tirés du nombre d’enfants nés vivants et survivants s’avèrent plus bas que les niveaux attendus au vu des données du suivi démographique. Les estimations déduites des déclarations sur la survie des parents sont largement inférieures aux niveaux de mortalité adulte réellement observés selon le suivi. Par contre, les taux de mortalité par âge basés sur les décès récents déclarés dans les ménages sont conformes aux données du suivi, sauf pour la mortalité infantile qui est sensiblement sous-déclarée en 2002. Cette évaluation confirme que les méthodes indirectes procurent des estimations qui ne peuvent être considérées isolément mais doivent plutôt être systématiquement comparées les unes aux autres. Des études d’évaluation directes menées au niveau individuel à l’aide d’appariements sont nécessaires pour mieux identifier les différentes sources de biais.

Cette introduction place l’édition spéciale sur la santé et la mortalité en Afrique francophone dans son contexte, en relevant les spécificités de la transition sanitaire qui est en cours dans cette région. Elle présente également les différentes contributions rassemblées dans cette édition et résume les nouvelles orientations de recherche qu’elles esquissent.

Analyses de l'évolution des inégalités sociales de mortalité en Belgique et de ses déterminants (emploi, logement, niveau d'instruction, état-civil)

Survey data on sibling survival provide a crucial source of information for estimating adult mortality in countries where vital records are incomplete. This article assesses the quality of these data by comparing sibship sizes reported in Demographic and Health Surveys with women’s mean number of children ever born in the previous generation. This comparison, conducted at aggregate level, suggests that a high proportion of siblings are omitted, since the sibship sizes are 15% lower, on average, than would be expected on the basis of number of children ever born. Such omissions are more frequent in sub-Saharan Africa than in other developing regions, and their extent increases slightly with the respondents’ age. Adult mortality deduced from these data is not necessarily underestimated, however, since omissions appear to mainly concern siblings who died in childhood.

Les âges auxquels sont vécus les premières relations sexuelles, les premières unions et les premières naissances varient sensiblement entre les différentes régions d’Afrique sub-saharienne, et l’examen de chacun de ces trois événements pris individuellement est mal adapté pour rendre compte de cette variation. A l’aide de l’analyse des séquences, nous construisons une typologie des parcours vécus par les jeunes femmes entre 15 et 24 ans, à partir des Enquêtes Démographiques et de Santé (EDS). Nous identifions six types parcours distincts, et examinons ensuite comment ils se répartissent dans l’espace. Des schémas régionaux assez contrastés se dégagent, à un niveau plus fin que celui des grandes régions. La répartition de la population entre ces parcours est très corrélée aux principaux indicateurs de développement socio-économique, à l’état d’avancement des régions dans la transition de la fécondité, à la pratique de la polygamie, ainsi que, de façon plus inattendue, à des variables d’ordre socio-culturel telles que la fréquence de la co-résidence entre mères et enfants ou l’indépendance financière des femmes en emploi. Cette analyse illustre la diversité des parcours de vie des jeunes femmes en Afrique sub-saharienne, et rappelle l’importance de considérer ces parcours comme étant englobés dans des systèmes matrimoniaux et sociaux cohérents.

Despite a renewed interest for the situation of orphans, census data on parental survival remain seldom used. Numerous African censuses contain information on parental deaths, and census data have the potential to portray a much more exhaustive picture of orphanhood than sample surveys. The chapter starts with prevalence of orphanhood estimated from a large series of countries. When successive censuses are available, trends are assessed. We also show how census data can be used to work at the district level and identify sub-national regions with high orphan burden. Finally, the chapter focus on the vulnerability of orphans by studying school enrollment, living arrangements and labor participation of orphans.

Due to the lack of civil registration data in sub-Saharan Africa, adult mortality rates are often estimated in two stages; first, measures of child survival are combined with model schedules of mortality, then AIDS-related deaths are factored in. Model-based estimates are mostly sensitive to the choice of age pattern used to infer the background mortality and to violations of assumptions made to predict the number of AIDS-related deaths. They need to be regularly evaluated against survey or census data. In this paper, United Nations estimates of adult mortality are compared with survival probabilities calculated from sibling histories collected in DHS surveys. UNAIDS orphan prevalences are compared with proportions of orphaned children observed in censuses and household surveys. If parental and sibling survival provide plausible lower bounds, then adult mortality rates are underestimated in countries severely affected by the HIV/AIDS epidemic, especially in Southern Africa and among males. In addition, as the HIV epidemic unfolds, the age patterns of mortality derived from DHS surveys differ markedly from model outputs.

Adult mortality in Sub-Saharan Africa remains a neglected issue in the realm of population studies. Due to the lack of civil registration systems, risks of dying in adulthood still need to be estimated from defective and deficient data. Among these data, the survival of parents and siblings, as collected in censuses and surveys, can be used to reconstruct past trends in mortality. This PhD dissertation combines reports on kin survival with microsimulations to revisit methodological aspects of the estimation of adult mortality. The main selection biases of kin survivorship statistics are discussed, alongside problems of data quality. Recent estimates of the probability of dying between ages 15 and 60 are also presented. Overall, this dissertation highlights the considerable heterogeneity of mortality in Sub-Saharan Africa, where adult mortality rates vary up to threefold from one country to another, mainly because of the differential impact of the HIV/AIDS epidemic. (DEMO 3) -- UCL, 2010

Plus de trois décennies après les premiers moments de la diffusion du VIH-sida, de nombreux pays africains font face à des épidémies matures, et voient leur prévalence baisser ou se stabiliser. Par contre, en raison de la longue période d'incubation du VIH, la diminution du nombre d'infections ne se traduit pas directement par une baisse des risques de mortalité aux âges adultes. Ce maintien sur une longue durée de niveaux de mortalités élevées et fortement concentrés aux premiers âges adultes a profondément modifié les structures par âge des populations, la composition des ménages, ou encore les mouvements entre communautés rurales et urbaines. Par ce biais, le VIH-sida a redistribué les cartes des échanges intergénérationaux. Cette communication est axée sur les orphelins et leurs grands parents, à partir d’un modèle de microsimulation calibré sur les projections démographiques des Nations Unies et des estimations de l’ONUSIDA. L'objectif consiste à documenter les effets de l'épidémie sur le nombre et la structure par âge des orphelins, ainsi que sur les soutiens dont ils peuvent disposer dans leur famille proche.

En dépit de l'attention accordée aux clivages ethniques en Afrique sub-saharienne, la santé des ethnies minoritaires reste peu analysée. Quelques recherches ont porté sur la mortalité des enfants, mais les disparités interethniques restent quasiment inexplorées en matière de survie des adultes. Ces inégalités interethniques peuvent pourtant être analysées de façon relativement précise et systématique à partir des données d'enquêtes démographiques et de santé, quand ces enquêtes collectent des informations sur la survie des frères et soeurs. Ces données permettent de répondre aux interrogations suivantes : dans quels pays l'appartenance à une ethnie minoritaire se traduit-elle par une surmortalité adulte ? Peut-on déceler des points de ruptures dans le temps ? Comment la crise sanitaire qui a affecté l’Afrique subsaharienne ces dernières années a-t-elle modifié la structure des écarts ?

BACKGROUND: In countries with limited vital registration, adult mortality is frequently estimated using siblings' survival histories (SSHs) collected during Demographic and Health Surveys (DHS). These data are affected by reporting errors. We developed a new SSH questionnaire, the siblings' survival calendar (SSC). It incorporates supplementary interviewing techniques to limit omissions of siblings and uses an event history calendar to improve reports of dates and ages. We hypothesized that the SSC would improve the quality of adult mortality data. METHODS AND FINDINGS: We conducted a retrospective validation study among the population of the Niakhar Health and Demographic Surveillance System in Senegal. We randomly assigned men and women aged 15–59 y to an interview with either the DHS questionnaire or the SSC. We compared SSHs collected in each group to prospective data on adult mortality collected in Niakhar. The SSC reduced respondents' tendency to round reports of dates and ages to the nearest multiple of five or ten (“heaping”). The SSC also had higher sensitivity in recording adult female deaths: among respondents whose sister(s) had died at an adult age in the past 15 y, 89.6% reported an adult female death during SSC interviews versus 75.6% in DHS interviews (p = 0.027). The specificity of the SSC was similar to that of the DHS questionnaire, i.e., it did not increase the number of false reports of deaths. However, the SSC did not improve the reporting of adult deaths among the brothers of respondents. Study limitations include sample selectivity, limited external validity, and multiple testing. CONCLUSIONS: The SSC has the potential to collect more accurate SSHs than the questionnaire used in DHS. Further research is needed to assess the effects of the SSC on estimates of adult mortality rates. Additional validation studies should be conducted in different social and epidemiological settings.

Background: In the past, deprivation has been mostly captured through simple and univariate measures such as low income or poor educational attainment in research on health and social inequalities in Belgium. This paper presents a shift towards a more complex, multidimensional measure of deprivation at the aggregate level and describes the development of the first Belgian Indices of Multiple Deprivation (BIMDs) for the years 2001 and 2011.Methods: The BIMDs are constructed at the level of the smallest administrative unit in Belgium, the statistical sector. They are a combination of six domains of deprivation: income, employment, education, housing, crime and health. Each domain is built on a suite of relevant indicators representing individuals that suffer from a certain deprivation in an area. The indicators are combined to create the domain deprivation scores, and these scores are then weighted to create the overall BIMDs scores. The domain and BIMDs scores can be ranked and assigned to deciles from 1 (the most deprived) to 10 (the least deprived).Results: We show geographical variations in the distribution of the most and least deprived statistical sectors in terms of individual domains and overall BIMDs, and we identify hotspots of deprivation. The majority of the most deprived statistical sectors are located in Wallonia, whereas most of the least deprived statistical sectors are in Flanders.Conclusion: The BIMDs offer a new tool for researches and policy makers for analyzing patterns of deprivation and identifying areas that would benefit from special initiatives and programs. This study was conducted as part of the ELLIS project (Monitoring and Mitigating Environmental Health Inequalities), funded by the Belgian Federal Science Policy (B2/191/P3/ELLIS). This work was produced using data from Statbel (Directorate-general Statistics – Statistics Belgium) – Demobel (adaptation of the National Register), Census 1991, 2001, 2011, and IPCAL. Computational resources have been provided by the supercomputing facilities of the Universit´e catholique de Louvain (CISM/UCL) and the Consortium des Equipements ´ de Calcul Intensif en F´ed´eration Wallonie Bruxelles (CECI) ´ funded by the Fond de la Recherche Scientifique de Belgique (F.R.S.-FNRS) under convention 2.5020.11 and by the Walloon Region. The authors want to thank Statbel and particularly Patrick Lusyne and Clo¨e Ost for preparing and making pseudonymized data available for research, the centre for Demographic Research (DEMO) of UCLouvain for allowing us to access the data, the CISM team for managing the statistical servers, and the Federal Police Belgium – DRI – Business Police Accounting for providing us with data on crime.

Subnational mortality estimation allows measuring spatial disparities in mortality and their evolution over time. It thus reflects a fundamental aspect of health inequalities. This however means estimating mortality indicators for small population sizes where the stochasticity in death counts is high. This, in turn, can lead to unclear underlying mortality levels. In these contexts, Bayesian Hierarchical Models (BHM) offer good performances, finding an appropriate balance between robustness and sensitivity. This dissertation is articulated around three applications where the research questions related to subnational mortality estimation are addressed thanks to statistical opportunities offered by BHM. First, I assess the possibility to estimate the probability of dying for children aged 5 to 14 years old at a subnational level in a sample of Sub-Saharan countries using survey data. Second, I measure the heterogeneity of the mortality shock in the context of the COVID-19 pandemic at the district level in Belgium. Third, I compare the performances of models allowing to estimate mortality age schedules at a subnational level. These three applications allow defining general guidelines for subnational mortality estimation. (POLS - Sciences politiques et sociales) -- UCL, 2023

Many protracted crises are largely in resource poor settings affecting billions of people around the world. Efforts are being made globally to mitigate the impact of protracted crises on affected populations. However, these places typically lack the required health information systems for the collection of birth and death records needed to conduct a comprehensive assessment of the public health status and needs of the population. In particular, Yemen has been experiencing drawn out conflict, exposing children and adults to untold hardship and diseases as well as the risk of losing their lives increases as the crisis continues. A comprehensive nationwide analysis of the impact of the protracted crisis in Yemen on mortality is lacking. However, over the course of the crisis in Yemen, series of small-scale surveys have been conducted on regional/zonal levels for planning purposes by humanitarian organizations operating on ground. Because of the costs and the impracticability of conducting an indepth, nation-wide assessment, we have attempted to conduct an effective and robust investigation for a better understanding of the impact of the conflict on mortality by combining the sparse, publicly available data. We started by assessing the methods used for the collection and presentation of mortality data obtained from the small-scale survey. We found no strict adherence to standardized methodology guidelines, and reporting of mortality and sample size data. Adherence to methodological guidelines and complete reporting of surveys in humanitarian settings will vastly improve the estimation of mortality rate and also uptake of key data on health indicators of the affected population. We also assessed the change in number of deaths as a result of the conflict using a Bayesian mixture model approach. Despite an increase in the estimated number of deaths attributed to the conflict, we observed uncertainty surrounding the point estimates, which calls for caution while interpreting the result from our data. The difference observed could range from fewer deaths, or more deaths during the conflict when compared to period before the conflict. In addition, we developed a simple and parsimonious classification of insecurity level using publicly available data. We examined the relationship between patterns in under-five mortality and level of insecurity using a Bayesian finite mixture model, and we found that high number of under-five deaths are clustered around regions/zones experiencing high levels of insecurity. (SP - Sciences de la santé publique) -- UCL, 2022

ObjectivesMore than 20 people die each year in snow avalanches in Switzerland. Previous studies have primarily described these victims, but were not population based. We investigated sociodemographic factors for avalanche mortality between 1995 and 2014 in the entire Swiss resident population.Design and methodsWithin the Swiss National Cohort we ascertained avalanche deaths by anonymous data linkage with the avalanche accident database at the Swiss WSL Institute of Snow and Avalanche Research SLF. We calculated incidence rates, by dividing the number of deaths from avalanches by the number of person-years, and hazard ratios (HRs) for sociodemographic and economic characteristics using Cox proportional hazard models.ResultsThe data linkage yielded 250 deaths from avalanche within the SNC population for the 20 years 1995 to 2014. The median distance between the place of residence and the place of the event (avalanche) was 61.1 km. Male gender, younger age (15-45 years), Swiss nationality, living in the Alpine regions, higher education, living in the highest socioeconomic quintile of neighbourhoods, being single, and living in a household with one or more children were associated with higher avalanche mortality rates. Furthermore, for younger persons (ConclusionOver a 20-year period in Switzerland, higher rates of dying in an avalanche were observed in men, in younger age groups, and persons with tertiary education, living in the highest socioeconomic quintile of neighbourhoods, and living in an Alpine region. For younger persons (

BackgroundGoal 3.2 from the Sustainable Development Goals (SDG) calls for reductions in national averages of Under-5 Mortality. However, it is well known that within countries these reductions can coexist with left behind populations that have mortality rates higher than national averages. To measure inequality in under-5 mortality and to identify left behind populations, mortality rates are often disaggregated by socioeconomic status within countries. While socioeconomic disparities are important, this approach does not quantify within group variability since births from the same socioeconomic group may have different mortality risks. This is the case because mortality risk depends on several risk factors and their interactions and births from the same socioeconomic group may have different risk factor combinations. Therefore mortality risk can be highly variable within socioeconomic groups. We develop a comprehensive approach using information from multiple risk factors simultaneously to measure inequality in mortality and to identify left behind populations.MethodsWe use Demographic and Health Surveys (DHS) data on 1,691,039 births from 182 different surveys from 67 low and middle income countries, 51 of which had at least two surveys. We estimate mortality risk for each child in the data using a Bayesian hierarchical logistic regression model. We include commonly used risk factors for monitoring inequality in early life mortality for the SDG as well as their interactions. We quantify variability in mortality risk within and between socioeconomic groups and describe the highest risk sub-populations.FindingsFor all countries there is more variability in mortality within socioeconomic groups than between them. Within countries, socioeconomic membership usually explains less than 20% of the total variation in mortality risk. In contrast, country of birth explains 19% of the total variance in mortality risk. Targeting the 20% highest risk children based on our model better identifies under-5 deaths than targeting the 20% poorest. For all surveys, we report efficiency gains from 26% in Mali to 578% in Guyana. High risk births tend to be births from mothers who are in the lowest socioeconomic group, live in rural areas and/or have already experienced a prior death of a child.InterpretationWhile important, differences in under-5 mortality across socioeconomic groups do not explain most of overall inequality in mortality risk because births from the same socioeconomic groups have different mortality risks. Similarly, policy makers can reach the highest risk children by targeting births based on several risk factors (socioeconomic status, residing in rural areas, having a previous death of a child and more) instead of using a single risk factor such as socioeconomic status. We suggest that researchers and policy makers monitor inequality in under-5 mortality using multiple risk factors simultaneously, quantifying inequality as a function of several risk factors to identify left behind populations in need of policy interventions and to help monitor progress toward the SDG.

Research on urban health in developing countries is becoming an increasingly research issue, as in some Sub-Saharan Africa settings we had to observe a few cases of urban health penalties. In addition, research results are sometimes marked by contradictions or uncertainties in relation to health advantage for people living in cities, in particular for children. With a view of contributing to the scientific debate on urban health issues and the influencing factors, the main purpose of this study is to analyze the role and mechanisms through which migration, poverty and the living environment contribute to heterogeneity of health status and to lead to more urban health inequalities among children in Ouagadougou, Burkina Faso. Based on prospective longitudinal data, we used events history analysis, Heckman selection models and multilevel modelling to identify not only the overall health prevailing in the city, but health situations that would reflect the plurality or intra-urban disparities in health according to socioeconomic characteristics and demographic factors or dynamics in the city. The study is based on the premise that socioeconomic disparities related to poverty and poor living conditions among migrants in Ouagadougou contribute to produce urban health inequalities in terms of birth weight, vaccination coverage and under-five child mortality; out of favour of children in poor living conditions, migrant children or children born to migrants. Through an empirical testing of this theoretical proposition, the aim of this study is to increase political awareness about urban health plurality and inequities among children in order to develop appropriate and adapted health programs tackling both the increase and diversity of child health needs from an equity perspective. Les enjeux de recherche sur la santé urbaine dans les pays en développement deviennent d’autant plus importants qu’on a eu à observer dans certains contextes des paradoxes sanitaires urbains, des contradictions, des incertitudes ou des interrogations par rapport à l’avantage sanitaire des villes notamment pour la santé des enfants. Dans la perspective de contribuer au débat scientifique sur les enjeux sanitaires urbains et les facteurs d’influence, l’objectif général de cette étude est d’analyser le rôle et les mécanismes à travers lesquels la migration et l’environnement de vie contribuent à l’hétérogénéité des situations sanitaires et à la production d’inégalités urbaines de santé des enfants à Ouagadougou au Burkina Faso. Sur la base de données longitudinales prospectives, des modèles d’analyses biographiques, de régressions de Heckman adaptées aux biais de sélection ou multi-niveaux cherchent à cerner non pas l’état sanitaire général prévalant dans cette ville, mais des situations sanitaires qui refléteraient la pluralité ou les disparités intra-urbaines de santé au regard des caractéristiques et des dynamiques sociodémographiques de la ville. L’étude repose sur le postulat que les disparités socioéconomiques liées à la précarité de l’environnement de vie et aux conditions de pauvreté des migrants à Ouagadougou contribuent à la production d’inégalités urbaines de santé des enfants, en termes de poids à la naissance, de statut vaccinal et de mortalité avant l’âge de cinq ans. Les indicateurs de santé relatifs à ces différents phénomènes seraient davantage négatifs parmi les enfants vivant dans des conditions de précarité socioéconomique, les enfants migrants ou ayant des parents migrants. A travers une vérification empirique de cette proposition théorique, il s’agit d’accroître la prise de conscience des politiques sur la pluralité et les iniquités urbaines de santé des enfants, afin que des programmes de santé adéquats et adaptés à la fois à l’ampleur et à la diversité des besoins puissent être éventuellement développés dans une perspective d’équité. (POLS - Sciences politiques et sociales) -- UCL, 2016