Abstract:
While researchers have devoted considerable attention to the impact of individual-level factors on child mortality, less is known about how community characteristics affect health outcomes for children, even though they have a prominent role in theoretical models. Using data from the latest round of Demographic Health Surveys (DHS) for all countries in sub-Saharan Africa, this study uses multivariate and multilevel discrete-time event history analysis to systematically examine the impact of contextual factors on the risk of dying before age five, and their relative importance in relation to individual factors. The results indicate that some attributes of the community influence the mortality risks of children, over and above the intermediate factors included in this investigation. For instance, in half of the countries under study a 1% increase in the proportion of children fully immunized in the community is associated with a decrease of 17-79% in the odds of dying before age five. The proportion of women in the community completing secondary school also significantly increases child survival. In some countries, this effect is in addition to the positive individual-level effect of the child’s own mother being educated. Net of individual and household characteristics, higher community-level ethnic homogeneity is associated with decreased odds of dying before age five, in some countries. Overall, the results of this study suggest that the challenge to reduce under-five mortality goes beyond addressing individual factors, and requires a better understanding of contextual factors.
Individual and Community-level Effects on Child Mortality: An Analysis of 28 Demographic and Health Surveys in Sub-Saharan Africa (PDF, 1280K)
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