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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

  • Corsi, Daniel J
  • S V Subramanian
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    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.

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    File URL: http://scholar.harvard.edu/djcorsi/node/144146
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    Paper provided by Harvard University OpenScholar in its series Working Paper with number 144146.

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    Date of creation: Feb 2015
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    Handle: RePEc:qsh:wpaper:144146
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