Volume 40 - Article 11 | Pages 279–306  

The effects of household and community context on mortality among children under five in Sierra Leone: Evidence from the 2013 Demographic and Health Survey

By Lilipramawanty Kewok Liwin, Brian Houle

Abstract

Background: Sierra Leone in sub-Saharan Africa had one of the highest under-five mortality rates in the world in 2016: 114 deaths per 1000 live births. Previous studies have mainly focused on examining individual risk factors of child mortality in the country, without examining micro and macro levels of risk factors simultaneously.

Objective: This study examines the effect of household and community context on the risk of dying for children under five in Sierra Leone.

Methods: We use data from the 2013 Sierra Leone Demographic and Health Survey (SL DHS) to estimate the probability of dying, and examine mortality determinants using discrete-time event history analysis in a multilevel framework.

Results: We find that individual child characteristics and mother- and community-level factors simultaneously affect the risk of child mortality. The substantial clustering of communities with high risk of mortality identified in the Eastern region indicates that children residing in the region have a higher risk of mortality than those in other regions. Further, the results suggest the need for targeted area interventions.

Conclusions: We provide evidence suggesting that policymakers should focus on assisting mothers through family planning programmes to promote longer birth intervals, increased coverage of health services for mothers and children, and targeted interventions to reduce child mortality in the most affected regions of Sierra Leone.

Contribution: We contribute recent evidence of determinants of child mortality in Sierra Leone from SL DHS 2013, including mother and community factors in a multilevel framework.

Author's Affiliation

• Lilipramawanty Kewok Liwin - Australian National University, Australia EMAIL
• Brian Houle - Australian National University, Australia EMAIL

Other articles by the same author/authors in Demographic Research

Comparative evidence of years lived with reproductive-age morbidity in sub-Saharan Africa (2010‒2019)
Volume 49 - Article 6

Most recent similar articles in Demographic Research

Losing the female survival advantage: Sex differentials in infant and child mortality in Pakistan
Volume 50 - Article 15    | Keywords: child mortality, family, gender discrimination, Pakistan, sex differentials, son preference, South Asia, survival analysis

Religious affiliation and child mortality in Ireland: A country-wide analysis based on the 1911 Census
Volume 50 - Article 14    | Keywords: child mortality, indirect estimation methods, Ireland, literacy, OLS regressions, place of residence, religious affiliation, socioeconomic status

Calculating contraceptive prevalence and unmet need for family planning in low-fertility countries with the Generations and Gender Survey
Volume 49 - Article 21    | Keywords: cross-national study, Demographic and Health Surveys (DHS), Europe, family planning, Fertility and Family Survey (FFS), Generations and Gender Survey (GGS), longitudinal data, panel data, unplanned births, World Fertility Survey

The dynamic role of household structure on under-5 mortality in southern and eastern sub-Saharan Africa
Volume 49 - Article 11    | Keywords: child mortality, Health and Demographic Surveillance System, household structure, sub-Saharan Africa

Women's economic empowerment in sub-Saharan Africa: Evidence from cross-national population data
Volume 47 - Article 15    | Keywords: agency, Demographic and Health Surveys (DHS), economic growth, education, employment, sub-Saharan Africa, women's economic independence