Disease environments and subnational patterns of under-five mortality in sub-Saharan Africa

✍ Scribed by Root, Graham P. M.

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 279 KB
• Volume: 5
• Category: Article
• ISSN: 1077-3495
• DOI: 10.1002/(sici)1099-1220(199903/04)5:2<117::aid-ijpg127>3.0.co;2-i

✦ Synopsis

In sub-Saharan Africa there are considerable variations in under-®ve mortality between and within countries. However, an examination of subnational mortality rates for spatially contiguous African countries has not been attempted since the mid-1970s. DHS mortality data at the provincial level were used to construct maps of under-®ve mortality for contiguous countries in East/ southern Africa and West Africa. These maps show spatial patterns of mortality that straddle national boundaries, suggesting the importance of regional disease environments. In East/southern Africa a saddle of high mortality is evident in northern Zambia and Malawi and low mortality belts in southern Africa and the Kenyan/Tanzanian highlands. In West Africa mortality is lowest along the coast and increases steadily into the interior, peaking in the most northerly provinces of Niger and Mali. With the aid of regression models and join-count statistics, it is argued that the spatial pattern of mortality in West Africa is primarily due to socio±economic variations within a relatively homogeneous disease environment; while in East/southern Africa the greater heterogeneity in disease environments means that differences in intensity of malaria transmission have a major spatial impact on mortality.