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

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.