Decomposing overall and wealth-related inequality in under-5 mortality in three East-European countries: Albania, Armenia and Ukraine, 2007-2010

Abstract

C Van Malderen, N Speybroeck Institute of Health and Society (IRSS), Universite catholique de Louvain, Brussels, Belgium Contact: carine.vanmalderen@uclouvain.be Background Despite substantial progress in reducing average under-5 mortality, under-5 mortality disparities remain high in many countries. Understanding the underlying determinants of these disparities is essential to develop appropriate policy responses. The aim of the study was to investigate the main determinants of overall and wealth-related inequality in under-5 mortality in Albania, Armenia and Ukraine. Methods Data from nationally-representative and standardized household surveys – Demographic and Health Surveys – conducted in 2007-2010 in European countries were used. The study assessed the contribution of determinants to (1) overall inequality in under-5 mortality measured by the Gini index and (2) wealth-related inequality in under-5 mortality measured by the concentration index. Techniques used were multivariate logistic regression and a decomposition analysis of Gini and concentration indices. Results Quintiles of household wealth, the sex of the child, the birth order & interval and breastfeeding contributed to more than 7% of overall inequality in under-5 mortality in the three countries. A wealth-related inequality in under-5 mortality was observed in Ukraine (concentration index = -0.31, 95% CI: 0.54 to 0.08). The main contributors of this wealth-related inequality were quintiles of household wealth, birth order & interval, type of place of residence and mother’s educational attainment. Conclusions Assessing the contribution of determinants to overall and wealth-related inequality in under-5 mortality helps prioritizing interventions aiming at improving child survival equity. Key messages In the three countries, promoting breastfeeding and birth spacing would contribute to reduce overall inequality in under-5 mortality. In Ukraine, increasing women’s educational attainment would additionally contribute to reduce the wealth-related inequality in under-5 mortality.