Joint distribution of child mortality and wealth across 30 sub-Saharan African countries over 2000-2019

Background While reductions in child mortality have been observed across sub-Saharan African countries in the last 30 years, narrowing the gaps in un-der-five mortality across socioeconomic groups also requires an understanding of the multiple associations between health and welfare and socioeconomic drivers. We examined the probability density distributions in under-five mortality with-in countries and joint pathways of under-five mortality and wealth over time. Methods We used 69 Demographic and Health Surveys and 19 Malaria Indica-tor Surveys from 30 sub-Saharan African countries, with each country having at least two surveys conducted since 2000. We constructed a cross-country wealth index and estimated under-five death prevalence. We examined the pure distri-bution in under-five mortality prevalence and the joint probability distribution of wealth and under-five mortality prevalence over time, including the area of confidence ellipse which spanned the two dimensions of mortality and wealth and covered 75% of the mass of the joint distribution. Results Most countries experienced decreases in under-five mortality along with increases in wealth over time. However, we observed great variations in the evo-lution of the joint distributions across countries over time. For instance, the areas of confidence ellipse ranged from 0.178 in Ethiopia (2000) to 1.119 in Angola (2006). The change (over time) in the area of confidence ellipses ranged from 0.010 in Tanzania to 0.844 in Angola between the 2000s and 2010s. The rank-ing of country performance on under-five mortality varied greatly, depending on whether performance summary indicators were based on disaggregation by wealth or on full non-disaggregated distributions. Conclusions Our analysis points to the relevance of full distributions of health and joint distributions of health and wealth as complementary indicators of dis-tributions of health across socioeconomic status, in assessing country perfor-mance on health.