Changes in child mortality over time across the wealth gradient in less-developed countries

Area of Science:

• Global Health
• Demography
• Socioeconomic Health Disparities

Background:

• Under-5 mortality rates in low- and middle-income countries (LMICs) show wealth-based inequalities.
• The trend of these inequalities, whether increasing or decreasing, remains largely unknown.

Purpose of the Study:

• To analyze trends in under-5 mortality inequalities across different wealth groups in LMICs.
• To determine if mortality declines are equitable across wealth tertiles.

Main Methods:

• Utilized data from 85 Demographic and Health Surveys (2002-2012) across 54 LMICs.
• Assessed under-5 mortality trends using within-survey and between-survey analyses across three wealth tertiles.
• Examined the ratio of mortality between the poorest and least-poor wealth groups.

Main Results:

• In countries with repeat surveys, annual under-5 mortality declined by 4.36, 3.36, and 2.06 deaths per 1000 live births for the poorest, middle, and least-poor tertiles, respectively.
• The ratio of under-5 mortality between the poorest and least-poor declined from 1.68 to 1.48 overall.
• Good governance indicators were associated with a greater decline in mortality disparities.

Conclusions:

• Under-5 mortality has decreased faster among the poorest populations in LMICs between 1995 and 2012.
• Progress in reducing mortality inequalities is uneven, with some countries lagging, particularly those with weaker governance.