Hidden by national averages: Unveiling the complex dynamics of ethnic disparities in under-five survival across sub-Saharan Africa
Vincent Bio Bediako

TL;DR
This study reveals how ethnic disparities in child survival persist in sub-Saharan Africa despite overall improvements, highlighting the role of socioeconomic factors and healthcare access.
Contribution
The study introduces a novel approach combining survey data and decomposition methods to trace ethnic disparities in under-five mortality across multiple countries.
Findings
Ethnic disparities in child survival persist, with maternal education accounting for 25-33% of inequality.
Geographic factors mediate 15.4% of disparities in Ghana and 35.1% in Nigeria, indicating healthcare access differences.
Targeted policies in Ghana have successfully reduced ethnic gaps in child survival.
Abstract
Under-five mortality in sub-Saharan Africa has declined markedly, yet ethnic gaps persist and may even widen despite overall gains. This study uses two consecutive rounds of Demographic and Health Surveys (2007–2022) from twelve countries to trace how child characteristics, maternal education, household wealth, and urban-rural residence drive ethnic differentials in child survival. Country-specific total births ranged from 23,109 to 127,545 per survey round. Employing survey-weighted quasi-Poisson models with person-year offsets and a sequential Shapley-value decomposition, the study estimates crude and adjusted rate ratios for pairwise ethnic comparisons. It predicts mortality rates under counterfactual socioeconomic conditions. Results show enduring disparities, for example, among the Luo versus the Kalenjin in Kenya (adjusted RR 2.15, 95 % CI 1.83–2.51) and the Hausa versus the…
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Taxonomy
TopicsGlobal Maternal and Child Health · Global Health Care Issues · Child Nutrition and Water Access
