Global Patterns of Sex Differentials in Child Mortality in Sub-Saharan Africa: A Cross National Meta Analysis of 30 Demographic and Health Surveys

Although the relationships between child’s sex and risk of death before the age of 5 have often been studied, the mechanisms by which sex uniquely influences childhood mortality are not well understood or empirically documented. Most studies estimating sex differences in childhood mortality reported an unadjusted effect without controlling for covariates. In this paper the main purpose is to estimate and interpret adjusted effects on child mortality of child’s sex, adjusting for the matrices of social, economic, demographic, and biological factors. Data come from the most recent Demographic and Health Surveys in 30 sub-Saharan African nations. I conducted country-by-country multivariable analysis to assess sex differentials in under-five mortality (among recent singleton livebirth in the 5 years preceding the survey) using multilevel discrete-time hazard model. I used meta-analysis techniques to combine and summarize results from multiple countries. The results show a systematically higher mortality for male children compared to females in all countries except Sierra Leone and the relationship is significant in 18 of 30 countries. These patterns withstood controls for observed individual-and community level factors, as well as unobserved heterogeneity.