Fine-scale assessment of child mortality improvements and inequalities in Ghanaian cities: where and who is being left behind?

The rate of child mortality (deaths under-five) in sub-Saharan Africa (SSA) is 74 deaths per 1,000 live births - the highest worldwide, 15 times higher than in Europe and 3 times the Sustainable Development Goal target. Recently, improvements have stalled following promising rate declines from 1990 to 2010.

SSA is also facing rapid urbanisation and growing inequalities within cities affecting child survival.

There exist low-cost evidence-based interventions to reduce child deaths, but the disaggregated data needed to identify and target high risk groups are lacking.

With this award, I will combine state-of-the demographic methods for child mortality estimation with model-based approaches for data integration to empirically quantify under-five mortality levels and trends at a fine resolution (spatial and socio-economic) within SSA cities.

I will focus on Ghana’s four major cities using summary birth history data of 14,557,965 women aged 15-49 recorded in the 2010 and 2021 censuses and mapped to enumeration areas (Ghana’s smallest administrative unit; average population = 750) and geolocated complete birth history data from national surveys.

I will fit a Bayesian hierarchical model to integrate the multi-source data and draw inference by year, neighbourhood and socio-economic level for each city allowing for fine-scale examination of intra-urban child mortality inequalities, taking into account uncertainty in the estimates.

In addition to local engagement activities to disseminate my findings, I will develop a tool and training workshop that enables replication in other SSA cities, thereby leveraging existing data to promote equitable urban development and accelerate declines in child mortality.