Structural determinants of child mortality in sub-Saharan Africa: A cross-national study of economic and social influences from 1970 to 1997.

This cross-national study seeks to understand the lagging child mortality declines in sub-Saharan Africa by using World Bank data to investigate social and economic factors at three points in time: 1970, 1985, and 1997. Women's education, foreign debt-to-export ratio, and GNP per capita are among the strongest correlates of under five mortality over time. Cross-sectional and longitudinal results suggest that female education is the best overall predictor of child mortality. Average national income does not emerge as a strong predictor, particularly since 1985. Increasing levels of foreign debt are associated with a substantial excess mortality burden. In 1997, the effect of adult HIV prevalence on child mortality was moderate and statistically significant. The study concludes that, although future gains in social factors such as female education will likely be beneficial, without simultaneously addressing high levels of foreign debt and high HIV prevalence, it may be difficult to improve child mortality rates across sub-Saharan Africa.