Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Research article

Socioeconomic factors contributing to under-five mortality in sub-Saharan Africa: a decomposition analysis

Authors: Carine Van Malderen, Agbessi Amouzou, Aluisio J. D. Barros, Bruno Masquelier, Herman Van Oyen, Niko Speybroeck

Published in: BMC Public Health | Issue 1/2019

Login to get access

Abstract

Background

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. 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.

Methods

The 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.

Results

The 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).

Conclusions

Factors 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.
Appendix
Available only for authorised users
Literature
1.
2.
Black RE, Levin C, Walker N, Chou D, Liu L, Temmerman M. Reproductive, maternal, newborn, and child health: key messages from disease control priorities 3rd edition. Lancet. 2016;388(10061):2811–24.PubMedCrossRef
3.
4.
UN Inter-agency Group for Child Mortality Estimation. Levels & Trends in child mortality. Report 2018. United nations Children's fund 2018.
5.
Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the sustainable development goals. Lancet. 2016;388(10063):3027–35.PubMedPubMedCentralCrossRef
6.
Tabutin D, Masquelier B. Mortality inequalities and trends in low-and middle-income countries, 1990-2015. Population. 2017;72(2):221–96.CrossRef
7.
World Health Organization. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 2010.
8.
Gwatkin DR, Rutstein S, Johnson K, Suliman E, Wagstaff A, Amouzou A. Socio-economic differences in health, nutrition, and population within developing countries. Country reports on HNP and poverty; 2007.
9.
Gwatkin DR. Reducing health inequalities in developping countries. In: Oxford Textbook of Public Health. 4th ed; 2002.
10.
Chao F, You D, Pedersen J, Hug L, Alkema L. National and regional under-5 mortality rate by economic status for low-income and middle-income countries: a systematic assessment. Lancet Glob Health. 2018;6(5):e535–47.PubMedPubMedCentralCrossRef
11.
Van Malderen C, Van Oyen H, Speybroeck N. Contributing determinants of overall and wealth-related inequality in under-5 mortality in 13 African countries. J Epidemiol Community Health. 2013;67:667–76.PubMedCrossRef
12.
Fields GS. Regression-based decompositions: a new tool for managerial decision-making. Ithaca: Working paper, Department of Labor Economics, Cornell University; 2004.
13.
Mosley WH, Chen LC. An analytical framework for the study of child survival in developing countries. 1984. Bull World Health Organ. 2003;81(2):140–5.PubMedPubMedCentral
14.
Alkema L, Chao F, You D, Pedersen J, Sawyer CC. National, regional, and global sex ratios of infant, child, and under-5 mortality and identification of countries with outlying ratios: a systematic assessment. Lancet Global Health. 2014;2(9):e521–30.PubMedCrossRef
15.
World Health Organization. State of inequality. Reproductive, maternal, newborn and child health. Geneva: World Health Organization; 2015.
16.
Measure DHS. The demographic and health surveys program. 2013. Macro International http://​www measuredhs.com. Accessed 26 Feb 2013.
17.
18.
Balia S, Jones AM. Mortality, lifestyle and socio-economic status. J Health Econ. 2008 Jan;27(1):1–26.PubMedCrossRef
19.
Wagstaff A, van Doorslaer E, Watanabe N. On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J Econ. 2003;112(1):207–23.CrossRef
20.
Wagstaff A, van Doorslaer E. Overall versus socioeconomic health inequality: a measurement framework and two empirical illustrations. Health Econ. 2004;13(3):297–301.PubMedCrossRef
21.
van Doorslaer E, Jones AM. Inequalities in self-reported health: validation of a new approach to measurement. J Health Econ. 2003;22(1):61–87.PubMedCrossRef
22.
Drevenstedt GL, Crimmins EM, Vasunilashorn S, Finch CE. The rise and fall of excess male infant mortality. Proc Natl Acad Sci U S A. 2008;105(13):5016–21.PubMedPubMedCentralCrossRef
23.
24.
Boco AG. Assessing sex differentials in under-five mortality in sub-Saharan Africa: a cross-national comparative analysis. Can Stud Popul. 2015;41(3–4):49–87CrossRef
25.
Kanmiki EW, Bawah AA, Agorinya I, Achana FS, Awoonor-Williams JK, Oduro AR, et al. Socio-economic and demographic determinants of under-five mortality in rural northern Ghana. BMC Int Health Hum Rights. 2014;14:24
26.
Kimani-Murage EW, Fotso JC, Egondi T, Abuya B, Elungata P, Ziraba AK, Kabiru CW, Madise N. Trends in childhood mortality in Kenya: The urban advantage has seemingly been wiped out. Health Place. 2014;29:95-103.CrossRef
27.
Günther I, Harttgen K. Deadly cities? Spatial inequalities in mortality in sub-saharan africa. Popul Dev Rev. 2012;38(3):469–86.CrossRef
28.
Bocquier P, Madise NJ, Zulu EM. Is There an Urban Advantage in Child Survival in Sub-Saharan Africa? Evidence From 18 Countries in the 1990s. Demography. 2011;48(2):531-58.PubMedCrossRef
29.
Van de Poel E, O'Donnell O, van DE. What explains the rural-urban gap in infant mortality: household or community characteristics? Demography. 2009;46(4):827–50.PubMedCrossRef
30.
Aheto JMK. Predictive model and determinants of under-five child mortality: evidence from the 2014 Ghana demographic and health survey. BMC Public Health. 2019;19(1):64.PubMedPubMedCentralCrossRef
31.
Oyekale AS, Maselwa TC. Maternal education, fertility, and child survival in Comoros. Int J Environ Res Public Health. 2018;15(12):1-17.CrossRef
32.
Tayie FA, Lartey A. Antenatal care and pregnancy outcome in Ghana, the importance of women's education. Afr J Food Agric Nutr Dev. 2008;8(3):291-303.
33.
Asamoah BO, Agardh A, Pettersson KO, Ostergren PO. Magnitude and trends of inequalities in antenatal care and delivery under skilled care among different socio-demographic groups in Ghana from 1998-2008. BMC Pregnancy and Childbirth. 2014;14:295.PubMedPubMedCentralCrossRef
34.
Gyimah SO. A cohort analysis of the timing of first birth and fertility in Ghana. Popul Res Policy Rev. 2003;22(3):251–66.CrossRef
35.
Tsala Dimbuene Z, Amo-Adjei J, Amugsi D, Mumah J, Izugbara C, Beguy D. Women’s education and utilization of maternal health services in Africa: a multi-country and socioeconomic stratus analysis. J Biosoc Sci. 2018;50(6):725–48.PubMedCrossRef
36.
Bado AR, Susuman AS. *Women's Education and Health Inequalities in Under-Five Mortality in Selected Sub-Saharan African Countries, 1990–2015. PLoS One. 2016;11(7):e0159186.PubMedPubMedCentralCrossRef
37.
Moser KA, Leon DA, Gwatkin DR. How does progress towards the child mortality millennium development goal affect inequalities between the poorest and least poor? Analysis of demographic and health survey data. BMJ. 2005;331(7526):1180–2.PubMedPubMedCentralCrossRef
38.
39.
Braveman P. Monitoring equity in health: a policy-oriented approach in low - and middle-income countries. Geneva: World Health Organization; 1998.
40.
Masquelier B, Hug L, Sharrow D, You D, Hogan D, Hill K, Liu J, Pedersen J, Alkema L. Global, regional, and national mortality trends in older children and young adolescents (5-14 years) from 1990 to 2016: an analysis of empirical data. Lancet Glob Health. 2018;6(10):e1087–99.PubMedPubMedCentralCrossRef
41.
Boerma T, Sommerfelt AE. Demographic and health surveys (DHS): contributions and limitations. App Trimest Statist Sanit Mond. 1993;46(4):222-6.
42.
43.
Alkema L, You D. Child mortality estimation: a comparison of UN IGME and IHME estimates of levels and trends in under-five mortality rates and deaths. PLoS Med. 2012;9(8):e1001288.PubMedPubMedCentralCrossRef
44.
Victora CG, Huttly SR, Fuchs SC, Olinto MT. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol. 1997;26(1):224–7.PubMedCrossRef
45.
Wagner Z, Heft-Neal S, Bhutta ZA, Black RE, Burke M, Bendavid E. Armed conflict and child mortality in Africa: a geospatial analysis. Lancet. 2018;392(10150):857–65.PubMedCrossRef
46.
47.
Spinakis AAGPVSKPSYJ. Expert review and proposal for measurement of health inequalities in the European Union- summary report. European Commission Directorate general for health and consumers Luxembourg; 2011.
48.
49.
Yokota RT, de Moura L, Andrade SS, de Sa NN, Nusselder WJ, Van Oyen H. Contribution of chronic conditions to gender disparities in disability in the older population in Brazil, 2013. Int J Public Health. 2016;61(9):1003–12.PubMedCrossRef
50.
Amouzou A, Hill K. Child mortality and socioeconomic status in sub-Saharan Africa. Afr Popul Stud. 2004;19:1.
51.
52.
Metadata
Title
Socioeconomic factors contributing to under-five mortality in sub-Saharan Africa: a decomposition analysis
Authors
Carine Van Malderen
Agbessi Amouzou
Aluisio J. D. Barros
Bruno Masquelier
Herman Van Oyen
Niko Speybroeck
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7111-8

Other articles of this Issue 1/2019

BMC Public Health 1/2019 Go to the issue

Research article

The impact of a new exercise facility on physical activity at the community level: a non-randomized panel study in Japan

Study protocol

From prospective clinical trial to reducing social inequalities in health: The DESSEIN trial, concept and design of a multidisciplinary study in precarious patients with breast cancer

Research article

The impact of pop-up warning messages of losses on expenditure in a simulated game of online roulette: a pilot study

Research article

“Why would you want to stand?” an account of the lived experience of employees taking part in a workplace sit-stand desk intervention

Research article

Yield of systematic household contact investigation for tuberculosis in a high-burden metropolitan district of South Africa

Research article

Relationship between cumulative exposure to pesticides and sleep disorders among greenhouse vegetable farmers