Socio-economic and geographical inequalities in infant mortality rates in Sierra Leone, 2008-2019

Abstract

Background: The death of a child before their first birthday remains a significant global challenge, particularly in sub-Saharan Africa. This study examined the socio-economic and geographical inequalities in infant mortality in Sierra Leone between 2008 and 2019, utilising data from the Sierra Leone demographic and health surveys.

Methods: Three Sierra Leone demographic health survey rounds (2008, 2013, 2019) were analysed. Simple [difference and ratio] and complex [population attributable risk and fraction] measures of inequality in the infant mortality rates were calculated using the World Health Organization's health equity assessment toolkit software.

Results: The national infant mortality rate dropped from 111.1/1,000 live births (LBs) in 2008 to 77.4/1,000 LBs in 2019. Inequality for age decreased from 20.1 (2008) to 14.7/1,000 LBs (2019); economic inequality from 54.9 (2008) to 30.4/1,000 LBs (2019); and inequality due to maternal education fell from 28.9 (2008) to 9.7/1,000 LBs (2019). However, inequality by urban/rural residence increased from 7.4 (2008) to 13.8/1,000 LBs (2019). The population attributable risk revealed that addressing place of residence inequality would reduce the infant mortality rate -5.4 /1,000 LBs, -5.3/1,000 LBs, and -9.1 /1,000 LBs points in 2008, 2013 and 2019 respectively. Inequality associated with the child's sex decreased from -12.8/1,000 LBs in 2008 to -17.0 in 2019. The population attributable fraction and risk were zero in all survey years, indicating that female and male children had statistically equivalent mortality rates. Provincial inequality increased (2008: 26.9/1,000 LBs; 2019: 47.0/1,000 LBs). The population attributable risk suggests if provincial inequality were eliminated the infant mortality rate would have been -15.7/1,000 LBs, -19.0 /1,000 LBs, and -23.5/1,000 LBs lower in 2008, 2013 and 2019 respectively.

Conclusion: Low socio-economic status, limited maternal education, adolescent motherhood, and residence in rural areas and Northwestern province were associated with higher infant mortality rate. Tailored interventions that target vulnerable populations, like adolescent mothers, families living in poverty, and Northwestern province, are essential to improving child health outcomes in Sierra Leone.

Keywords: Global Health; Inequality; Infant; Mortality; Sierra Leone.