Abstract
BackgroundIn sub-Saharan Africa, socioeconomic factors such as place of residence, mother’s educational level, or household wealth, are strongly associated with risk factors of under-five mortality (U5M) such as health behavior or exposure to diseases and injuries. The aim of the study was to assess the relative contribution of four known socioeconomic factors to the variability in U5M in sub-Saharan countries.MethodsThe study was based on birth histories from the Demographic and Health Surveys conducted in 32 sub-Saharan countries in 2010–2016. The relative contribution of sex of the child, place of residence, mother’s educational level, and household wealth to the variability in U5M was assessed using a regression-based decomposition of a Gini-type index.ResultsThe Gini index – measuring the variability in U5M related to the four socioeconomic factors – varied from 0.006 (95%CI: 0.001–0.010) in Liberia 2013 to 0.034 (95%CI: 0.029–0.039) in Côte d’Ivoire 2011/12. The main contributors to the Gini index (with a relative contribution higher than 25%) were different across countries: mother’s educational level in 13 countries, sex of the child in 12 countries, household wealth in 11 countries, and place of residence in 8 countries (in some countries, more than one main contributor was identified).ConclusionsFactors related to socioeconomic status exert varied effects on the variability in U5M in sub-Saharan African countries. The findings provide evidence in support of prioritizing intersectoral interventions aiming at improving child survival in all subgroups of a population.
Highlights
In sub-Saharan Africa, socioeconomic factors such as place of residence, mother’s educational level, or household wealth, are strongly associated with risk factors of under-five mortality (U5M) such as health behavior or exposure to diseases and injuries
under-5 mortality rate (U5MR) was significantly lower in females compared to males in 9 countries, in urban compared to rural areas in 12 countries, in children born to mothers with at least a primary education compared to children born to mothers without any formal education in 19 countries, and in the richest households compared to the poorest of middle wealth households in 17 countries
Factors associated with U5MR in the multivariate analyses, and their relative contribution to the variability in U5MR Table 2 shows all components of the Gini index decomposition: the overall Gini index, the mean of the predicted death rates, variables’ means, regression coefficients, and concentration indexes
Summary
In sub-Saharan Africa, socioeconomic factors such as place of residence, mother’s educational level, or household wealth, are strongly associated with risk factors of under-five mortality (U5M) such as health behavior or exposure to diseases and injuries. Population sub-groups may be defined by different dimensions such as place of residence, sex of children, Van Malderen et al BMC Public Health (2019) 19:760 ethnicity, and maternal factors such as educational level, occupation or income [7]. These socioeconomic factors are included in the Mosley and Chen conceptual framework as the distal determinants of child mortality [7]. Socioeconomic determinants operate at three levels (the community, the household, and the individual) and affect mortality through proximate determinants such as maternal factors, environmental contamination, nutrient deficiency, injury, and personal illness control
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