Socioeconomic determinants of under-five mortality in principal cities of east Africa community: a case study of Nairobi, Dar-es-salaam and Kigali.

Abstract

Socio-economic determinants in this study have been defined through the wealth status, highest education level and the labour participation of the mother. These factors explain the rising under-five mortality rate in many cities in Sub-Saharan Africa. A phenomenon, currently facing many cities as Africa embraces urbanization. Their measurements were used to determine how they work through proximate determinants of under-five mortality to influence child mortality as expressed in Mosley and Chen framework of 1984. Measuring the socio-economic determinants of under-five mortality helped to explain the underlying reasons through a theoretical framework to causes of under-five mortality in cities of Africa. The dependent variable was under-five mortality in major cities of Nairobi, Kigali and Dar-es-salaam. The study used secondary data from the Demographic Health Survey of the three countries whose cities were covered in the study. The study used logistic regression to establish the effects of socio-economic determinants on the proximate determinants to influence under-five mortality. The study found out that socio-economic determinants do not influence the occurrence of under-five mortality, but act through the proximate determinants to indirectly influence under-five mortality. Further, this effect was seen through the type of birth where multiple births was negatively statistically significant in the presence of socio-economic factors. An indication that multiple births in well-to-do families has little influence in under-five mortality. Age of the mother at birth was also significant indicating that whether the mother is 35years and above and as long as they are in the upper quintile of the wealth index, have higher education and are working, older ages does not affect their under-five mortality experiences. This scenario was also seen in households which had proper toilets. Lack of toilets was positively significant, an indication that it increases chances of under-five mortality in the cities. Deliveries in private health facilities were also found to be positively statistically significant. This indicated that there was more likelihood of under-five mortality in private facilities compared to home deliveries. This may be occasioned by numerous private healthcare centres which perhaps may not have very qualified personnel to handle emergencies since many people resort to private healthcare facilities when they are faced with emergencies. In conclusion, improvement in socio-economic status of a household is important in reducing child mortality. Nevertheless, more research is required in finding out how they influence under-five mortality in the slums of Nairobi, Kigali and Dar-es-Salaam where majority of the urban poor live.