IDEAS home Printed from
MyIDEAS: Log in (now much improved!) to save this paper

Association between economic growth, coverage of maternal and child health interventions, and under-five mortality: a repeated cross-sectional analysis of 36 sub-Saharan African countries

Listed author(s):
  • Corsi, Daniel J
  • S V Subramanian
Registered author(s):

    Infant and child mortality rates are among the most important indicators of child health, nutrition, implementation of key survival interventions, and the overall social and economic development of a population. In this report, using data from 99 Demographic and Health Surveys (DHS) conducted in 36 sub-Saharan African countries, we investigate factors that have contributed to the declines in under-five mortality rates (U5MR) in sub-Saharan Africa. Specifically, we focus on the extent to which changes in country-level economic growth and changes in the coverage of key maternal, neonatal, and child health (MNCH) interventions have contributed to reductions in under-five mortality. For this analysis we constructed two distinct data structures: (1) an ecological time series (with countries repeatedly observed) and (2) a multilevel repeated cross-section (which in addition took account of the variability between children within a country at any time). We employed a country-level fixed effects regression to model changes in U5MR across survey periods as a function of changes in economic growth and coverage of MNCH interventions for ecological time series data. The multilevel repeated cross-sectional data was used to examine the probability of a child being reported to have died at age 0-59 months, corresponding with different levels of economic growth and coverage, while accounting for within-country between-child factors that could influence both child mortality and the country-level economic development and coverage indicators. Our results show that changes in country-level per capita GDP (pcGDP) are not consistently associated with a reduction in U5MR across different model specifications. In ecological time series models, a unit increase in pcGDP is associated with a reduction in U5MR of 11.6 deaths per 1000 live births (95% CI: -29.1, 5.9), while a composite index of MNCH interventions is associated with a reduction in U5MR of 31.9 deaths per 1000 live births (95% CI: -48.6, -15.3). The results of the multilevel repeated cross-section data structure suggest that MNCH coverage indicators are important. For example, pcGDP is associated for a decreased likelihood of child mortality with an odds ratio of 0.96 (95% CI: 0.92 -1.00) and an increase of 1 standard deviation in the composite coverage index (CCI) is also associated with a decrease in child mortality [odds ratio 0.92 (95% CI: 0.88 - 0.96)]. A measure of improvements in sanitary facilities is associated with an odds ratio of 0.57 (95% CI: 0.50-0.65) for child mortality. Together, these results indicate that MNCH interventions are important in reducing U5MR, while the effects of economic growth in sub-Saharan Africa remain weak and inconsistent. Sub-Saharan Africa continues to have the highest U5MR globally, and progress toward reducing mortality rates has been slow. Our findings indicate that improved coverage of proven life-saving interventions and access to clean water and sanitation will likely contribute to further reductions in U5MR in sub-Saharan Africa in the future.

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.

    File URL:
    Download Restriction: no

    Paper provided by Harvard University OpenScholar in its series Working Paper with number 144146.

    in new window

    Date of creation: Feb 2017
    Handle: RePEc:qsh:wpaper:144146
    Contact details of provider: Postal:
    1737 Cambridge Street, Cambridge, MA 02138

    Phone: 617-496-2450
    Fax: 617-496-5149
    Web page:

    More information through EDIRC

    No references listed on IDEAS
    You can help add them by filling out this form.

    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

    When requesting a correction, please mention this item's handle: RePEc:qsh:wpaper:144146. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Richard Brandon)

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    This information is provided to you by IDEAS at the Research Division of the Federal Reserve Bank of St. Louis using RePEc data.