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This article is part of the supplement: The Lives Saved Tool in 2013: new capabilities and applications

Open Access Review

How within-country inequalities and co-coverage may affect LiST estimates of lives saved by scaling up interventions

Cesar G Victora12*, Aluisio J D Barros1, Tanya Malpica-Llanos2 and Neff Walker2

Author Affiliations

1 Post-Graduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil

2 Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

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BMC Public Health 2013, 13(Suppl 3):S24  doi:10.1186/1471-2458-13-S3-S24

Published: 17 September 2013

Abstract

Lives-saved estimates calculated by LiST include the implicit assumptions that there are no inequalities among different socioeconomic groups, and also that the likelihood of a mother or child receiving a given intervention is independent from the probability of receiving any other interventions. It is reasonable to assume that, as a consequence of these assumptions, LiST estimates may exaggerate the numbers of lives saved in a population, by ignoring the fact that coverage is likely to be lower and mortality higher among the poor than the rich, and also by failing to take into account that coverage with different interventions may be clustered at individual mothers and children – a phenomenon described as co-coverage. We used data from 127 DHS surveys to estimate how much these two assumptions may bias estimates produced by LiST, and conclude that under real-life conditions bias occurred in both directions, with LiST results either over or underestimating the more complex estimates. With few exceptions, bias tended to be small (less than 10% in either direction).