Child Mortality and Socioeconomic Status in Sub- Saharan Africa

This paper examines under-five mortality (U5MR) trends in sub-Saharan Africa, and the association between socio-economic status – indicated by per capita income, illiteracy, urbanization – and under-five mortality between 1960 and 2000. It shows substantial decline in U5MR in all Sub-Saharan Africa regions between 1970 and 1990. Regional differentials among West, Central and East Africa that existed in the 1960s have largely disappeared by 1990. However, the decline in U5MR appears to have stalled in 1990s and some countries have experienced increases. The analyses show a consistent negative relationship between U5MR and per capita income, but a given income implies lower U5MR as one moves towards the present. There is also a significant positive association between illiteracy and U5MR, and negative association between urbanization and U5MR. However, the effects of urbanization and illiteracy have diminished in the past decade, while the effect of per capita income has increased. Under-five mortality (U5MR), the probability of dying between birth and age 5 expressed per 1000 live births, and infant mortality (IMR), the probability of dying before age one expressed per 1000 live births, have been used as measures of children's well-being for many years. Data indicate that some eleven million children under the age of five die annually in the world as a whole, of whom over ten million are in the developing world. Sub-Saharan Africa is the region most affected and accounts for more than one-third of deaths of children under age of five (Hill et al., 1999). Nearly three-quarters of the child deaths in the developing world are caused by diseases (predominantly acute respiratory infections, diarrhea and malaria) for which practical, low cost interventions exist, including immunization, ORT use, and antibiotics. Numerous studies have shown a close association between child mortality and socio-economic status (for example, Preston, 1975 and 1985; Hobcraft et al., 1984; Hill, 1985; World Bank, 1993). Most indicators of socio-economic status used are income per capita, education, urban/rural residence, work status and household assets. For example, in his pioneering work Preston (1975) demonstrated a negative relationship between income and mortality. However possible other determinants were relevant since the observed relationship between income and mortality African Population Studies vol.19 n°1/Etude de la population africaine vol. 19 n° 1 2 shifted over decades and a given income level was associated with better survival for recent decades. Similarly, focusing on 28 developing countries mostly in Asia and Latin America, Hobcraft et al. (1984) found that mother’s and husband’s education; their work status and their type of residence were more or less associated with child survival. Increased socio-economic status – specifically, mother’s level of education was also found to be closely associated with improved child survival in Nigeria (Caldwell, 1979), in Nicaragua (Sandiford et al., 1995) and Costa Rica (Haines et al., 1982). The quality and quantity of data on child mortality have increased sharply over the last 30 years, particularly in Sub-Saharan Africa. However, the amounts, timeliness and quality of information available vary widely by country. The multiplicity, and in some cases inconsistency, of U5MR estimates from different sources has made the determination of national trends problematic. Hill and Yazbeck (1994), and subsequently Hill, Pande and Mahy (1999) developed and applied an explicit, objective and replicable methodology to derive a single consistent time series of estimates for infant and under-five mortality from the assembled data. In this paper we update mortality estimates produced by Hill, Pande and Mahy (1999) for Sub-Saharan African countries and describe the relationship between child mortality and socio-economic status in Sub-Saharan Africa. The first part of the paper briefly describes the child mortality trends from 1960 to 2000 and the second part examines the association of socioeconomic variables with the levels of child mortality.