Inequality of Child Mortality among Ethnic Groups in Sub-Saharan Africa
Brockerhoff, M., Hewett, P., Bulletin of the World Health Organization
Voir page 38 le resume en francais. En la pagina 39 figura un resumen en espanol.
Accounts by journalists of wars in several countries of sub-Saharan Africa in the 1990s have raised concern that ethnic cleavages and overlapping religious and racial affiliations may widen the inequalities in health and survival among ethnic groups throughout the region, particularly among children (1, 2).(a) Paradoxically, there has been no systematic examination of child survival chances in relation to ethnic groups across countries in the region, including the majority of African countries that have experienced relative peace over the past decade or more. This shortcoming is conspicuous insofar as early cross-national analysis of ethnicity and mortality, using data from the 1960s and 1970s, concluded that "ethnicity ... exerts a strong influence on mortality in countries where ethnic groups appear to be sharply differentiated" (3). Neglect of mother's ethnicity, in particular, as an influence on child survival, is remarkable in the light of countess studies that have emphasized the central importance of maternal characteristics and behaviour for child health in Africa.
This paper uses survey data from 11 countries to examine whether ethnic differentials in child mortality have been pronounced in many sub-Saharan African countries since the 1980s.(b) While some African offspring are the result of interethnic marriages, the analysis focuses on the ethnic affiliation of the mother, given women's heavy responsibility for childrearing.(c) Of particular interest is whether one of two ethnic groups selected in each country experienced better child survival chances -- compared with the test of the population in their countries -- as a result of their geographical concentration in of close to the country's largest city, or in favourable ecological settings, or in critical centres of economic activity.
The few comparative studies of ethnic group mortality in Africa are mostly based on births and deaths in the 1960s and 1970s. These demographic studies generally reveal enormous differentials but provide scant interpretation of these discrepancies. Tabutin & Akoto (11), for instance, found that the probability of dying before 2 years of age was twice as high among the Luo as among the Kikuyu in Kenya, and 40% higher among the Hutu than among the Tutsi in Rwanda. In Cameroon, ethnic membership was the strongest predictor of child survival chances. While these findings went unexplained, the authors concluded that "the .ethnic variable should always be controlled in a study of mortality" (11, p. 54). A more intensive analysis of Cameroon data showed that Hauossa-Foulbe children had higher neonatal mortality than others -- presumably because of a high incidence of sexually transmitted disease among their parents -- but lower mortality thereafter, perhaps because of some combination of dietary factors and reduced exposure to acute diseases (12). Two separate studies showed that the Peul (or Fulani), one of the largest ethnic groups in the Sahel region, had an under-2-year-old mortality that was 10% higher than that of the majority Bambara in central Mali (13), but 30% lower mortality than the majority Wolof and Serer in the Sine-Saloum region of Senegal (14). Both studies proposed that group differences in child care, notably in nutritional practice, accounted for the variation in mortality. In the mid-1960s the Tonga of the Gwembe District in southern Zambia had 20% higher child mortality ([sub.5][q.sub.0]) than the country's population as a whole (234 compared to 190 deaths per 1000 live births), but experienced a one-third reduction by the early 1990s (down to 156/ 1000) while the national level remained stable (15). Differential mortality decline was attributed, in this case, to an exhaustive set of expanded preventive health care services in Gwembe.(d)
Such imprecise accounting for ethnic child mortality differences no doubt reflects the heterogeneity of sociocultural and ecological settings in Africa. …