Income and child mortality in developing countries

a systematic review and meta-analysis

O'Hare, Bernadette
Makuta, Innocent
Chiwaula, Levison
Bar-Zeev, Naor

¹St. Andrews University, Scotland, UK and College of Medicine, University of Malawi, Malawi, Central Africa
²Chancellor College, University of Malawi, Blantye, Malawi, Central Africa
³Chancellor College, University of Malawi, Malawi, Central Africa
⁴Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi, Central Africa

Corresponding author: Bernadette O'Hare. Email: [email protected]

Journal of the Royal Society of Medicine 106(10):p 408-414, October 2013. | DOI: 10.1177/0141076813489680

Objective

We aimed to quantify the relationship between national income and infant and under-five mortality in developing countries.

Design

We conducted a systematic literature search of studies that examined the relationship between income and child mortality (infant and/or under-five mortality) and meta-analysed their results.

Setting

Developing countries.

Main outcome measures

Child mortality (infant and /or under-five mortality).

Results

The systematic literature search identified 24 studies, which produced 38 estimates that examined the impact of income on the mortality rates. Using meta-analysis, we produced pooled estimates of the relationship between income and mortality. The pooled estimate of the relationship between income and infant mortality before adjusting for covariates is −0.95 (95% CI −1.34 to −0.57) and that for under-five mortality is −0.45 (95% CI −0.79 to −0.11). After adjusting for covariates, pooled estimate of the relationship between income and infant mortality is −0.33 (−0.39 to −0.26) while the estimate for under-five mortality is −0.28 (−0.37 to −0.19). If a country has an infant mortality of 50 per 1000 live births and the gross domestic product per capita purchasing power parity increases by 10%, the infant mortality will decrease to 45 per 1000 live births.

Conclusion

Income is an important determinant of child survival and this work provides a pooled estimate for the relationship.