Pursuing the limits of child survival in the most and least developed countries

Abstract

This study analyzes compression, convergence, and age-inequality of under-5 mortality patterns in sub-Saharan Africa (SSA). We hypothesize that accelerated reductions in under-5 death rates are associated with substantive changes in the age distribution and variation of deaths. To analyze age variation rather than mean values for under-5 deaths, we adapted indicators of compression, convergence, and inequality that were developed for the total length of life. We constructed conditional life-table death rates for under-5 age children from 31 SSA countries from 1990 to 2017, using retrospective data from the Demographic and Health Surveys for these countries. We used these to identify heterogeneities across countries in the age patterns of mortality, the pace of mortality decline, and convergence. Our results revealed stronger evidence of reduced age-inequality in countries experiencing large or accelerated reductions in average under-5 mortality levels (with annual reduction rates [ARR]≥3.2%), in comparison with those showing stagnant or slower mortality decline (ARR<3.2%). Data quality issues derived from the use of survey data to approximate age patterns of mortality may affect the accuracy of the estimates and represent a limitation of this study.