Health inequalities of children in sub-Saharan Africa from 1990 to 2010 : comparative analysis using data from Health and Demographic Surveys

Philosophiae Doctor - PhDThis study is based on the assumption that the under-five mortality rate, in recent decades, has declined, particularly in developing countries. However, all the social strata across many countries do not seem to benefit from this reduction of mortality - and mortality remains abnormally high among children especially those from underprivileged social strata. This research is, therefore, a holistic approach to analyse and quantify the inequalities of health among children under five in sub-Saharan Africa over the last two decades (1990-2010). The research sought to investigate the trend and determinants of health inequalities of under-five years (mortality and morbidity) in sub-Saharan Africa (SSA) from 1990 to 2010. An essential point has been devoted to the decomposition of effects and analysis of the contribution of the factors explaining these inequalities. The data used in the study come from Demographic and Heath Surveys (DHS) done between 1990 and 2015 in sub-Saharan Africa countries. In order to analyse the inequalities in trends of mortality and morbidity of children, different selected countries that have conducted at least three DHS during the 1990-2010 period. Several statistical methods were used for data analysis. There were four chapters which is prepared with an article style. For the first paper titled "Decomposing Inequalities in Under- Five Mortality in Selected African Countries", concentration index (CI) and Generalised Linear Model (GLM) with a logit link were used to analyse and measure under 5 mortality inequalities and the associated factors. This paper has been published in the Iranian Journal of Public Health. For the second paper titled "Determinants of Under-Five Mortality in Burkina Faso: A Concentration Dimension". The study used logistics regression and Oaxaca-Blinder decomposition method for the binary outcome to analyse data was involved. For data analysis of the third paper titled "Women Education, Health Inequalities in Under-Five Mortality in sub-Saharan Africa, 1990 – 2013", logistic regression and Bius's decomposition method were used to examine the effect of mother's education level on childhood mortality. In the fourth paper titled "Trends and Risk Factors for Childhood Diarrheal in sub-Saharan Countries (1990-2010): Assessing the Neighbourhood Inequalities", a multilevel logistic regression modelling was used to determine the fixed and random effects of the risk factors associated with the diarrheal morbidity. The work carried out during this on-going thesis helps to understand the magnitude of inequalities in under-five mortality in sub-Saharan countries. The findings showed that the contributing factors of inequalities of child mortality were birth order, maternal age, parity and household size. With regards to the relationship between mother's education level and inequalities in mortality of children under-five in sub-Saharan Africa, findings showed that children of mothers who did not attend school have a higher rate of death compared to those who had been to school. However, we have observed that the inequalities have narrowed over time. The results showed the risk factors of diarrheal morbidity varied from one country to another, but the main factors included: child's age, the size of the child at birth, the quality of the main floor material, mother's education and her occupation, type of toilet, and place of residence. In conclusion, the results of this study show that inequalities in under-five mortality are still important among different social strata in sub-Saharan Africa countries. It is then urgent to take actions to save the lives of children in disadvantaged social strata.National Research Foundatio

Women's education and health inequalities in under-five mortality in selected sub-Saharan African countries, 1990–2015

The aim of the study was to analyse trends in the relationship between mother’s educational level and mortality of children under the year of five in Sub-Saharan Africa, from 1990 to 2015.Data used in this study came from different waves of Demographic and Health Surveys (DHS) of Sub-Saharan countries. Logistic regression and Buis’s decomposition method were used to explore the effect of mother’s educational level on the mortality of children under five years

Mothers' Preventive Health Care Practices and Children's Survival in Burkina Faso: Findings from Repeated Cross-sectional Household Surveys

The significant reduction in the level of child mortality in both developed and developing countries over recent decades has led to an improvement in children’s health. The implementation, monitoring, and evaluation of the health programs needed to reduce child mortality require determination and an understanding of the factors responsible for this reduction. This study investigated factors that have contributed to the recent improvement in the survival of children under five, focusing on the contribution of preventive health care in improving children's survival rates in Burkina Faso. The data used come from baseline and end-line surveys designed to evaluate the impact of performance-based financing (PBF) on health programs in Burkina Faso. Using time-series for health districts and child-level logistic regression models, we estimated the effect of preventive health care, as summarized by the changes in the composite coverage index (CCI), on under-five child survival of temporal trends and covariates at the household, maternal, and child levels. At the health district level, a unit increase in standardized CCI was associated with an improvement in under-five child survival after adjustment for survey period effects. The linear regression analysis showed that a standardized unit increase in CCI was associated with an increase in the percentage of children under five who survive. At the child level, the logistic regression showed that a skilled attendant at birth (SBA), wealth index, and mother's parity were associated with under-five children's survival, after adjustment for the survey period effects and a set of household, maternal, and child-level covariates. Preventive health care is important in improving under-five children's survival, whereas the effects of economic growth in Burkina Faso remain weak and inconsistent. Improved coverage of preventive health care interventions are likely to contribute to further reductions in under-five mortality in Burkina Faso

Lieu du décès au Burkina : influence des caractéristiques sociodémographiques et environnementales

Cet article explore les facteurs associés au lieu de décès au Burkina Faso à partir des données de mortalité du système de surveillance démographique et de santé de Kaya (Kaya HDSS). Un modèle de régression logistique multiniveau à intercept aléatoire est utilisé pour déterminer les facteurs associés au lieu de décès. Plus de la moitié des décès (55%) surviennent à domicile. En analyse bivariée, l’âge, le milieu de résidence, la distance par rapport au centre de santé et la cause de décès sont statistiquement associées au lieu de décès. Les personnes âgées (50 ans et +) sont plus nombreux à décéder à domicile par rapport aux autres groupes d’âges (66,81% contre 35,9% chez les 5-14 ans et 44,9% chez les moins de 5 ans; p =0,001). Les résultats multivariés confirment l’effet de l’âge, du milieu de résidence, du quintile de niveau de vie et de la cause de décès. La forte proportion des décès à domicile interpelle les décideurs du système de santé et incite à développer davantage de programmes visant à adapter l’offre des soins aux besoins des populations

Effects of selected factors assisted with under five mortality (Model 2: Adjusted effects).

<p>Effects of selected factors assisted with under five mortality (Model 2: Adjusted effects).</p

Decomposition of Direct and Indirect effect of mother’s educational level on under five years old mortality.

<p>Decomposition of Direct and Indirect effect of mother’s educational level on under five years old mortality.</p

Numbers of children under five years old and the survival status per birth-cohorts per country.

<p>Numbers of children under five years old and the survival status per birth-cohorts per country.</p

Trend of female primary completion rate (%).

<p>Trend of female primary completion rate (%).</p

Comparison of the mortality rates of children under five years old by birth-cohorts in the selected countries.

<p>Comparison of the mortality rates of children under five years old by birth-cohorts in the selected countries.</p

Direct and indirect effect of the education of the mother and under-five mortality.

<p>Direct and indirect effect of the education of the mother and under-five mortality.</p