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Childhood mortality in sub-Saharan Africa: cross-sectional insight into small-scale geographical inequalities from Census data

OBJECTIVES: To estimate and quantify childhood mortality, its spatial correlates and the impact of potential correlates using recent census data from three sub-Saharan African countries (Rwanda, Senegal and Uganda), where evidence is lacking. DESIGN: Cross-sectional. SETTING: Nation-wide census samp...

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Autores principales: Kazembe, Lawrence, Clarke, Aileen, Kandala, Ngianga-Bakwin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488715/
https://www.ncbi.nlm.nih.gov/pubmed/23089207
http://dx.doi.org/10.1136/bmjopen-2012-001421
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author Kazembe, Lawrence
Clarke, Aileen
Kandala, Ngianga-Bakwin
author_facet Kazembe, Lawrence
Clarke, Aileen
Kandala, Ngianga-Bakwin
author_sort Kazembe, Lawrence
collection PubMed
description OBJECTIVES: To estimate and quantify childhood mortality, its spatial correlates and the impact of potential correlates using recent census data from three sub-Saharan African countries (Rwanda, Senegal and Uganda), where evidence is lacking. DESIGN: Cross-sectional. SETTING: Nation-wide census samples from three African countries participating in the 2010 African Census round. All three countries have conducted recent censuses and have information on mortality of children under 5 years. PARTICIPANTS: 111 288 children under the age of 5 years in three countries. PRIMARY AND SECONDARY OUTCOME MEASURES: Under-five mortality was assessed alongside potential correlates including geographical location (where children live), and environmental, bio-demographic and socioeconomic variables. RESULTS: Multivariate analysis indicates that in all three countries the overall risk of child death in the first 5 years of life has decreased in recent years (Rwanda: HR=0.04, 95% CI 0.02 to 0.09; Senegal: HR=0.02 (95% CI 0.02 to 0.05); Uganda: HR=0.011 (95% CI 0.006 to 0.018). In Rwanda, lower deaths were associated with living in urban areas (0.79, 0.73, 0.83), children with living mother (HR=0.16, 95% CI 0.15 to 0.17) or living father (HR=0.38, 95% CI 0.36 to 0.39). Higher death was associated with male children (HR=1.06, 95% CI 1.02 to 1.08) and Christian children (HR=1.14, 95% CI 1.05 to 1.27). Children less than 1 year were associated with higher risk of death compared to older children in the three countries. Also, there were significant spatial variations showing inequalities in children mortality by geographic location. In Uganda, for example, areas of high risk are in the south-west and north-west and Kampala district showed a significantly reduced risk. CONCLUSIONS: We provide clear evidence of considerable geographical variation of under-five mortality which is unexplained by factors considered in the data. The resulting under-five mortality maps can be used as a practical tool for monitoring progress within countries for the Millennium Development Goal 4 to reduce under-five mortality in half by 2015.
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spelling pubmed-34887152012-11-05 Childhood mortality in sub-Saharan Africa: cross-sectional insight into small-scale geographical inequalities from Census data Kazembe, Lawrence Clarke, Aileen Kandala, Ngianga-Bakwin BMJ Open Epidemiology OBJECTIVES: To estimate and quantify childhood mortality, its spatial correlates and the impact of potential correlates using recent census data from three sub-Saharan African countries (Rwanda, Senegal and Uganda), where evidence is lacking. DESIGN: Cross-sectional. SETTING: Nation-wide census samples from three African countries participating in the 2010 African Census round. All three countries have conducted recent censuses and have information on mortality of children under 5 years. PARTICIPANTS: 111 288 children under the age of 5 years in three countries. PRIMARY AND SECONDARY OUTCOME MEASURES: Under-five mortality was assessed alongside potential correlates including geographical location (where children live), and environmental, bio-demographic and socioeconomic variables. RESULTS: Multivariate analysis indicates that in all three countries the overall risk of child death in the first 5 years of life has decreased in recent years (Rwanda: HR=0.04, 95% CI 0.02 to 0.09; Senegal: HR=0.02 (95% CI 0.02 to 0.05); Uganda: HR=0.011 (95% CI 0.006 to 0.018). In Rwanda, lower deaths were associated with living in urban areas (0.79, 0.73, 0.83), children with living mother (HR=0.16, 95% CI 0.15 to 0.17) or living father (HR=0.38, 95% CI 0.36 to 0.39). Higher death was associated with male children (HR=1.06, 95% CI 1.02 to 1.08) and Christian children (HR=1.14, 95% CI 1.05 to 1.27). Children less than 1 year were associated with higher risk of death compared to older children in the three countries. Also, there were significant spatial variations showing inequalities in children mortality by geographic location. In Uganda, for example, areas of high risk are in the south-west and north-west and Kampala district showed a significantly reduced risk. CONCLUSIONS: We provide clear evidence of considerable geographical variation of under-five mortality which is unexplained by factors considered in the data. The resulting under-five mortality maps can be used as a practical tool for monitoring progress within countries for the Millennium Development Goal 4 to reduce under-five mortality in half by 2015. BMJ Publishing Group 2012 2012-10-22 /pmc/articles/PMC3488715/ /pubmed/23089207 http://dx.doi.org/10.1136/bmjopen-2012-001421 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
spellingShingle Epidemiology
Kazembe, Lawrence
Clarke, Aileen
Kandala, Ngianga-Bakwin
Childhood mortality in sub-Saharan Africa: cross-sectional insight into small-scale geographical inequalities from Census data
title Childhood mortality in sub-Saharan Africa: cross-sectional insight into small-scale geographical inequalities from Census data
title_full Childhood mortality in sub-Saharan Africa: cross-sectional insight into small-scale geographical inequalities from Census data
title_fullStr Childhood mortality in sub-Saharan Africa: cross-sectional insight into small-scale geographical inequalities from Census data
title_full_unstemmed Childhood mortality in sub-Saharan Africa: cross-sectional insight into small-scale geographical inequalities from Census data
title_short Childhood mortality in sub-Saharan Africa: cross-sectional insight into small-scale geographical inequalities from Census data
title_sort childhood mortality in sub-saharan africa: cross-sectional insight into small-scale geographical inequalities from census data
topic Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488715/
https://www.ncbi.nlm.nih.gov/pubmed/23089207
http://dx.doi.org/10.1136/bmjopen-2012-001421
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