An assessment of the relative contributions of household economics, maternal educational attainment and health service accessibility to rapid child mortality decline in three rural Tanzanian districts

Malick Kante, Columbia University
Amon Exavery, Ifakara Health Institute (IHI)
Kate Ramsey, United Nations Population Fund (UNFPA)
Stephane Helleringer, Columbia University
James F. Phillips, Columbia University

This paper examines hypotheses about the contribution of social and economic change relative to proximity to health services as determinants of the rapid decline in under-five year olds in three rural districts of Tanzania. Ever since 1996, a longitudinal demographic surveillance system of the Ifakara Health Institute has registered data on demographic dynamics, social and household economic characteristics and precise geographic coordinates of households and health facilities. This paper estimates the relationship of child survival to distance between households and nearest source of primary healthcare. Multivariate analysis adjusts for the confounding effects of characteristics of children, parents and households. Over the decade from 2000 to 2010, child mortality declined by 40% owing to a transition in 5q0 from 110 to 70 per 1000. Despite evidence that health equity improved during this period, educational attainment and household relative wealth remained as significant covariates of childhood survival.