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J Epidemiol Community Health 67:667-676 doi:10.1136/jech-2012-202195
  • Research report

Contributing determinants of overall and wealth-related inequality in under-5 mortality in 13 African countries

Editor's Choice
  1. 1Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
  2. 2Unit of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
  1. Correspondence to Carine Van Malderen, Institute of Health and Society (IRSS), Université catholique de Louvain, Clos Chapelle-aux-champs 30 bte B1.30.13, Woluwe-Saint-Lambert, Brussels 1200, Belgium, carine.vanmalderen{at}uclouvain.be
  • Received 23 November 2012
  • Revised 12 April 2013
  • Accepted 25 April 2013
  • Published Online First 23 May 2013

Abstract

Objective To investigate and compare the main determinants of overall inequality and wealth-related inequality in under-5 mortality in 13 African countries.

Methods Data from Demographic and Health Surveys conducted in 2007–2010 in African countries were used. The study assessed the contribution of determinants to (1) overall inequality in under-5 mortality measured by the Gini index and (2) wealth-related inequality in under-5 mortality measured by the concentration index. Techniques used were multivariate logistic regression and decomposition of Gini and concentration indexes.

Results Birth order and interval and region contributed the most to overall inequality in under-5 mortality in a majority of countries. A significant wealth-related inequality was observed in five countries: DRCongo, Egypt, Madagascar, Nigeria and Sao Tome & Principe. Overall, household wealth, father's occupation and mother's education contributed the most to this inequality, though the ranking of the most important determinants differed across countries.

Conclusions Assessing the contribution of determinants to overall inequality and to wealth-related inequality in under-5 mortality help in prioritising interventions aiming at improving child survival and equity.