title: Association between coverage of maternal and child health interventions, and under-5 mortality: a repeated cross-sectional analysis of 35 sub-Saharan African countries.
abstract: BACKGROUND
  Infant and child mortality rates are among the most important indicators of child health, nutrition, implementation of key survival interventions, and the overall social and economic development of a population. In this paper, we investigate the role of coverage of maternal and child health (MNCH) interventions in contributing to declines in child mortality in sub-Saharan Africa.
  
  
  METHODS
  Data are from 81 Demographic and Health Surveys from 35 sub-Saharan African countries. Using ecological time-series and child-level regression models, we estimated the effect of MNCH interventions (summarized by the percent composite coverage index, or CCI) on child mortality with in the first 5 years of life net of temporal trends and covariates at the household, maternal, and child levels.
  
  
  RESULTS
  At the ecologic level, a unit increase in standardized CCI was associated with a reduction in under-5 child mortality rate (U5MR) of 29.0 per 1,000 (95% CI: -43.2, -14.7) after adjustment for survey period effects and country-level per capita gross domestic product (pcGDP). At the child level, a unit increase in standardized CCI was associated with an odds ratio of 0.86 for child mortality (95% CI: 0.82-0.90) after adjustment for survey period effect, country-level pcGDP, and a set of household-, maternal-, and child-level covariates.
  
  
  CONCLUSIONS
  MNCH interventions are important in reducing U5MR, while the effects of economic growth in sub-Saharan Africa remain weak and inconsistent. Improved coverage of proven life-saving interventions will likely contribute to further reductions in U5MR in sub-Saharan Africa.
authors.affiliation: Center for Population & Development Studies, Harvard School of Public Health, Cambridge, MA, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Corsi
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA; svsubram@hsph.harvard.edu.
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
mesh_terms: D017954:Africa South of the Sahara; D046688:Child Mortality / Q000639:trends*; D002669:Child Welfare / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000706:statistics & numerical data*; D004032:Diet; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D064890:Social Determinants of Health / Q000706:statistics & numerical data; D012959:Socioeconomic Factors
keywords: Africa; child health; child mortality; low-income countries; maternal and child health interventions; socioeconomic factors; trends