Discovering Subgroups of Children With High Mortality in Urban Guinea-Bissau: Exploratory and Validation Cohort Study

• Published in: JMIR public health and surveillance 2024-04, Vol.10, p.e48060
• Main Authors: Rieckmann, Andreas, Nielsen, Sebastian, Dworzynski, Piotr, Amini, Heresh, Mogensen, Søren Wengel, Silva, Isaquel Bartolomeu, Chang, Angela Y, Arah, Onyebuchi A, Samek, Wojciech, Rod, Naja Hulvej, Ekstrøm, Claus Thorn, Benn, Christine Stabell, Aaby, Peter, Fisker, Ane Bærent
• Format: Article
• Language: English
• Subjects: Age; causal discovery; Child; Child mortality; Child, Preschool; Children & youth; Cohort Studies; Dry season; Economic factors; Emigration; Estimates; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; Geography; Guinea-Bissau; Guinea-Bissau - epidemiology; Health policy; Health promotion; Health risks; Health Sciences; Humans; Hypotheses; Hälsovetenskap; inductive-deductive; Infant; Low income areas; Machine Learning; Medical and Health Sciences; Medicin och hälsovetenskap; Mortality risk; Multimedia; Neighborhoods; Original Paper; Population; Public Health; Public Health, Global Health, Social Medicine and Epidemiology; Regression analysis; Risk factors; risk-mitigating interventions; Spatial analysis; targeted preventive; Urban areas
• ISSN: 2369-2960; 2369-2960
• DOI: 10.2196/48060

The decline in global child mortality is an important public health achievement, yet child mortality remains disproportionally high in many low-income countries like Guinea-Bissau. The persisting high mortality rates necessitate targeted research to identify vulnerable subgroups of children and formulate effective interventions. This study aimed to discover subgroups of children at an elevated risk of mortality in the urban setting of Bissau, Guinea-Bissau, West Africa. By identifying these groups, we intend to provide a foundation for developing targeted health interventions and inform public health policy. We used data from the health and demographic surveillance site, Bandim Health Project, covering 2003 to 2019. We identified baseline variables recorded before children reached the age of 6 weeks. The focus was on determining factors consistently linked with increased mortality up to the age of 3 years. Our multifaceted methodological approach incorporated spatial analysis for visualizing geographical variations in mortality risk, causally adjusted regression analysis to single out specific risk factors, and machine learning techniques for identifying clusters of multifactorial risk factors. To ensure robustness and validity, we divided the data set temporally, assessing the persistence of identified subgroups over different periods. The reassessment of mortality risk used the targeted maximum likelihood estimation (TMLE) method to achieve more robust causal modeling. We analyzed data from 21,005 children. The mortality risk (6 weeks to 3 years of age) was 5.2% (95% CI 4.8%-5.6%) for children born between 2003 and 2011, and 2.9% (95% CI 2.5%-3.3%) for children born between 2012 and 2016. Our findings revealed 3 distinct high-risk subgroups with notably higher mortality rates, children residing in a specific urban area (adjusted mortality risk difference of 3.4%, 95% CI 0.3%-6.5%), children born to mothers with no prenatal consultations (adjusted mortality risk difference of 5.8%, 95% CI 2.6%-8.9%), and children from polygamous families born during the dry season (adjusted mortality risk difference of 1.7%, 95% CI 0.4%-2.9%). These subgroups, though small, showed a consistent pattern of higher mortality risk over time. Common social and economic factors were linked to a larger share of the total child deaths. The study's results underscore the need for targeted interventions to address the specific risks faced by these identified high-risk subgroups. The