Socioeconomic factors contributing to under-five mortality in sub-Saharan Africa: a decomposition analysis.
Gini decomposition
Poisson regression
Socioeconomic inequalities
Sub-Saharan Africa
Under-five mortality
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
14 Jun 2019
14 Jun 2019
Historique:
received:
12
10
2018
accepted:
05
06
2019
entrez:
16
6
2019
pubmed:
16
6
2019
medline:
23
8
2019
Statut:
epublish
Résumé
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. 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. 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). 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 31200681
doi: 10.1186/s12889-019-7111-8
pii: 10.1186/s12889-019-7111-8
pmc: PMC6570834
doi:
Types de publication
Journal Article
Langues
eng
Pagination
760Références
J Health Econ. 2003 Jan;22(1):61-87
pubmed: 12564718
Bull World Health Organ. 2003;81(2):140-5
pubmed: 12756980
Health Econ. 2004 Mar;13(3):297-301
pubmed: 14981654
BMJ. 2005 Nov 19;331(7526):1180-2
pubmed: 16284209
J Health Econ. 2008 Jan;27(1):1-26
pubmed: 17448554
Niger J Clin Pract. 2007 Dec;10(4):272-82
pubmed: 18293634
Proc Natl Acad Sci U S A. 2008 Apr 1;105(13):5016-21
pubmed: 18362357
BMC Bioinformatics. 2008 Jul 11;9:307
pubmed: 18620558
Demography. 2009 Nov;46(4):827-50
pubmed: 20084831
Demography. 2011 May;48(2):531-58
pubmed: 21590463
Int J Public Health. 2012 Feb;57(1):243-6
pubmed: 22015650
Bull World Health Organ. 2012 Aug 1;90(8):604-12
pubmed: 22893744
PLoS Med. 2012;9(8):e1001288
pubmed: 22952434
J Epidemiol Community Health. 2013 Aug;67(8):667-76
pubmed: 23704052
Health Place. 2014 Sep;29:95-103
pubmed: 25024120
BMC Int Health Hum Rights. 2014 Aug 21;14:24
pubmed: 25145383
BMC Pregnancy Childbirth. 2014 Aug 29;14:295
pubmed: 25169877
Lancet Glob Health. 2014 Sep;2(9):e521-e530
pubmed: 25304419
Pediatrics. 2014 Dec;134(6):e1551-9
pubmed: 25384496
Lancet. 2016 Dec 3;388(10061):2811-2824
pubmed: 27072119
Int J Public Health. 2016 Dec;61(9):1003-1012
pubmed: 27339159
PLoS One. 2016 Jul 21;11(7):e0159186
pubmed: 27442118
Lancet. 2017 Dec 17;388(10063):3027-3035
pubmed: 27839855
J Biosoc Sci. 2018 Nov;50(6):725-748
pubmed: 29103388
Lancet Glob Health. 2018 May;6(5):e535-e547
pubmed: 29653627
Lancet. 2018 Sep 8;392(10150):857-865
pubmed: 30173907
Lancet Glob Health. 2018 Oct;6(10):e1087-e1099
pubmed: 30223984
BMJ Glob Health. 2018 Sep 7;3(5):e000940
pubmed: 30233834
Int J Environ Res Public Health. 2018 Dec 10;15(12):
pubmed: 30544762
BMC Public Health. 2019 Jan 14;19(1):64
pubmed: 30642313
World Health Stat Q. 1993;46(4):222-6
pubmed: 8017081
Int J Epidemiol. 1997 Feb;26(1):224-7
pubmed: 9126524