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Disease environments and subnational patterns of under-five mortality in sub-Saharan Africa.


 This study examined the subregional spatial distribution of child mortality risk (CMR) in sub-Saharan Africa. Data for maps were obtained from Demographic and Health Surveys in the 1980s and 1990s for 95 provinces. Two distinct regions are identified: West Africa and a belt of countries spanning East to Southern Africa. Some countries are missing from the analysis. CMR was higher in West Africa. East/Southern Africa had the following patterns: low mortality in Central/South and North/West provinces of Namibia, Botswana, and all of Zimbabwe, except Manicaland and Mashonaland Central provinces (adjoining areas with moderately low mortality); low mortality in the Kenya/Tanzania highlands, with the Rift Valley, Central, Eastern, Nairobi, and northern highlands of Tanzania (adjacent provinces with moderately low or moderate mortality); high mortality in northern Zambia and Malawi (adjacent provinces with moderately high mortality); and moderate or moderately high mortality in the Lake Victoria basin and western provinces. West Africa had south/north or coastal/interior patterns. Coastal and southern provinces had low or moderately low mortality, while interior provinces had high mortality. Regression models indicate that the spatial patterns in West Africa were due to socioeconomic differences. In East/Southern Africa, mortality differences were due to differences in intensity of malaria transmission.
