Estimating spatial inequalities of urban child mortality

AbstractBACKGROUNDRecent studies indicate that the traditional rural-urban dichotomy pointing to cities as places of better health in the developing world can be complicated by poverty differentials. Knowledge of spatial patterns is essential to understanding the processes that link individual demographic outcomes to characteristics of a place. A significant limitation, however, is the lack of spatial data and methods that offer flexibility in data inputs.OBJECTIVEThis paper tackles some of the issues in calculating intra-urban child mortality by combining multiple data sets in Accra, Ghana and applying a new method developed by Rajaratnam et al. (2010) that efficiently uses summary birth histories for creating local-level measures of under-five child mortality (5q0). Intra-urban 5q0 rates are then compared with characteristics of the environment that may be linked to child mortality.METHODSRates of child mortality are calculated for 16 urban zones within Accra for birth cohorts from 1987 to 2006. Estimates are compared to calculated 5q0 rates from full birth histories. 5q0 estimates are then related to zone measures of slum characteristics, housing quality, health facilities, and vegetation using a simple trendline R2 analysis.RESULTSResults suggest the potential value of the Rajaratnam et al. method at the micro-spatial scale. Estimated rates indicate that there is variability in child mortality between zones, with a spread of up to 50 deaths per 1,000 births. Furthermore, there is evidence that child mortality is connected to environmental factors such as housing quality, slum-like conditions, and neighborhood levels of vegetation.(ProQuest: ... denotes formulae omitted.)1. IntroductionDespite a half-century of improvement in life expectancy, levels in sub-Saharan Africa remain low. Almost three decades ago Farah and Preston (1982:381) noted that-mortality levels in sub-Saharan Africa are the highest in the world and are the object of substantial national and international concern." That conclusion has been repeated over time (Balk et al. 2004; Ewbank 1993), and it is still the case today even as mortality declines. Hill (1993) estimated that in 1936 the probability of a child in Ghana dying before age five was 0.371. By 1980 it had dropped to 0.164, and the 2003 Ghana Demographic and Health Survey (GDHS) produced a rate of 0.111 (GSS, NMIMR, and Orc Macro 2004). Most recently, the 2008 GDHS showed a continued drop to.080, although that rate is believed to slightly understate the actual level of child mortality (GSS, GHS, and ICF Macro 2009). While decreasing, rates are still stubbornly high and ten times higher than in the United States.High levels of child mortality are a major contributing factor to low life expectancy as sub-Saharan societies move through health and mortality transitions. These transitions are pushing mortality risks into the very young and very old cohorts due to the double burden of acute communicable and chronic degenerative diseases (Boutayeb 2006; Weeks 2011). As income and wealth rise in the context of an improving economy, they almost always do so in an unequal fashion leading to widely different risk profiles for acute and chronic illness. Child mortality is a direct consequence of high-risk profiles for acute illness. In West Africa, as in almost every other part of the world, chances of survival for children and adults are higher in cities than in rural areas (Balk et al. 2004). Yet, research indicates that the averages used to compare urban and rural areas mask significant urban inequalities (Timae us and Lush 1995; Vlahov et al. 2010).As interest in urban child mortality differentials increases, there remains a gap in our understanding of the spatial components of child mortality inequality. Spatial inequality can highlight aspects of child mortality that poverty or urban/rural classifications cannot - namely, the processes that link individual health outcomes to characteristics of a place. …