Dynamics of maternal union dissolution and childhood mortality in sub-Saharan Africa

Figures & data

Table 1. Survey year, probability of first union dissolution and under-five mortality rates in the most recent DHS from 23 countries in sub-Saharan Africa.

Sub-region	Country	Most recent survey year	First union dissolution (%)^a	U5MR^b (per 1000 live births)
Western Africa	Benin	2011/2	17.9	70
	Cote d’Ivoire	2011/2	29.3	108
	Gambia	2013	NA	54
	Ghana	2014	40.4^c	60
	Guinea	2012	22.0	123
	Liberia	2013	51.6	94
	Mali	2012/3	9.6	95
	Niger	2012	25.0	127
	Nigeria	2013	20.5	128
	Senegal	2012/3	23.4^d	54
	Sierra Leone	2013	32.5	156
	Togo	2013/4	30.7	88
Central Africa	Cameroun	2011	37.7	122
	Congo-Brazzaville	2011/2	51.0	68
	Congo DRC	2013	34.4	104
	Gabon	2012	42.9	65
Eastern Africa	Ethiopia	2011	39.6	88
	Kenya	2014	24.2^e	52
	Uganda	2011	37.5	90
Southern Africa	Mozambique	2011	38.8	97
	Namibia	2013	32.9	54
	Zambia	2013/4	39.1	75
	Zimbabwe	2010/1	35.3	84

^aSource: Clark & Brauner-Otto (2015).

^bSource: DHS Stat compiler.

^cSource: Estimated from Ghana 2008 DHS.

^dSource: Estimated from Senegal 2010/1 DHS.

^eSource: Estimated from Kenya 2008 DHS.

Note: DHS = Demographic and Health Surveys; U5MR = under-five mortality rate.

Table 2. Background characteristics according to current dissolution status and number of dissolution episodes, most recent DHS for 23 sub-Saharan Africa countries.

	Under-five children		Current maternal union dissolution		Dissolution episodes
Variable	Number	%	Yes (%)	No (%)	None	First order	Higher order
Total (n)	235 454		6.6	93.4	85.8	12.9	1.3
Maternal age at child’s birth
<20 years	28 824	12.2	14.6	12.1	13.3	5.9	7.1
20 to 35 years	16 7424	71.1	68.2	71.8	72.1	68.5	66.4
above 35 years	39 206	16.7	17.2	16.1	14.6	25.7	26.5
Maternal education
No formal education	107 099	45.5	27.1	45.9	44.2	48.7	33.6
Primary	73 502	31.2	40.7	30.0	30.1	33.7	43.7
Secondary/higher	54 843	23.3	32.2	24.1	25.7	17.6	22.7
Maternal occupation
Not working	90 247	38.3	33.2	38.7	39.3	33.0	26.8
Professional/services	15 426	6.6	8.9	6.7	7.0	5.6	8.3
Sales	46 103	19.6	22.1	20.4	20.3	21.3	26.2
Agriculture/manual	83 678	35.5	35.8	34.2	33.4	40.1	38.7
Maternal age at first marriage
<15 years	41 730	17.7	14.5	18.2	16.8	25.1	21.1
15 to 19 years	126 929	53.9	53.1	53.3	53.3	53.1	54.4
≥20 years	66 795	28.4	32.5	28.5	29.9	21.8	24.5
Household wealth index
Poor	114 999	48.8	45.3	44.9	44.1	49.7	54.4
Middle	45 550	19.4	20.2	19.9	19.8	20.7	19.0
Rich	74 905	31.8	34.5	35.2	36.1	29.6	26.6
Residence
Rural	163 220	69.3	59.5	67.9	66.8	71.4	63.1
Urban	72 234	30.7	40.5	32.1	33.2	28.6	36.9
Birth order
1	43 185	18.3	22.9	18.6	20.7	7.7	9.4
2 to 3	81 690	34.7	38.1	35.1	36.1	30.2	32.7
4 to 5	57 497	24.4	21.7	24.1	23.0	29.8	30.7
6+	53 082	22.5	17.4	22.2	20.2	32.3	27.2
Birth interval
First birth	43 646	18.5	23.1	18.8	21.0	7.9	9.6
≤24 months	42 234	18.0	14.5	18.0	17.8	18.1	15.1
25 to 36 months	68 171	28.9	21.9	29.1	28.5	29.9	23.3
>36 months	81 403	34.6	40.5	34.1	32.8	44.1	52.0
Sub-region
West	123 869	52.6	3.5	96.5	87.0	12.4	0.7
Central	42 181	17.9	9.6	90.4	82.8	15.7	2.0
East	38 607	16.4	9.1	90.9	87.1	11.1	1.7
South	30 797	13.1	11.2	88.8	84.2	13.5	2.4
Childhood mortality rate
IMR (per 1000 live births)			61.2	53.7	52.2	66.3	66.6
U5MR (per 1000 live births)			96.6	86.6	83.2	113.1	96.2

Note: DHS = Demographic and Health Surveys; IMR = infant mortality rate; U5MR = under-five mortality rate.

Figure 1. Kaplan–Meier plot of probability of childhood death according to current maternal union dissolution status in sub-Saharan Africa.

Figure 2. Kaplan–Meier plot of probability of childhood death according to previous maternal union dissolution history in sub-Saharan Africa.

Figure 3. Kaplan–Meier plot of probability of childhood death according to number of maternal union dissolution episodes in sub-Saharan Africa.

Table 3. Relative risk (95% confidence interval) for the effect of marital dissolution status on childhood mortality in 23 sub-Saharan Africa countries.

Variable	Model 1	Model 2	Model 3	Model 4^a	Model 5^a
Current dissolution
Yes	1.24 (1.17–1.32)*	1.24 (1.17–1.31)*	1.24 (1.17–1.31)*	1.28 (1.29–1.35)*	1.28 (1.21–1.35)*
No	1.00	1.00	1.00	1.00	1.00
Previous history of dissolution
Yes	1.32 (1.27–1.37)*	1.29 (1.24–1.35)*	1.29 (1.24–1.34)*	1.31 (1.26–1.36)*	1.31 (1.26–1.36)*
No	1.00	1.00	1.00	1.00	1.00
Maternal education
No formal education		1.00	1.00	1.00	1.00
Primary		0.91 (0.87–0.95)*	0.94 (0.90–0.98)*	0.95 (0.92–0.99)*	0.95 (0.92–0.99)*
Secondary/higher		0.74 (0.78–0.87)*	0.80 (0.76–0.85)*	0.82 (0.77–0.86)*	0.82 (0.78–0.86)*
Maternal occupation
Not working		1.00	1.00	1.00	1.00
Professional/services		0.96 (0.89–1.04)	0.99 (0.92–1.07)	1.00 (0.93–1.08)	1.00 (0.93–1.08)
Sales		1.04 (0.99–1.09)	1.06 (1.01–1.11)*	1.08 (1.03–1.12)*	1.07 (1.03–1.12)*
Agriculture/manual		1.09 (1.05–1.14)*	1.07 (1.03–1.11)*	1.07 (1.03–1.12)*	1.07 (1.03–1.12)*
Household wealth index
Poor			1.00	1.00	1.00
Middle			0.96 (0.92–1.00)	0.97 (0.94–1.02)	0.97 (0.94–1.02)
Rich			0.86 (0.82–0.90)*	0.89 (0.85–0.93)*	0.89 (0.85–0.93)*
Sub-region
West					1.00
Central					0.95 (0.71–1.26)
East					0.82 (0.59–1.12)
South					0.96 (0.72–1.27)

^aModel controlled for maternal age at first marriage, age at child’s birth, residence, birth order and birth interval.

*p < 0.05 (statistically significant).

Table 4. Relative risk (95% confidence interval) for the effect of number of marital dissolution episodes on childhood mortality in 23 sub-Saharan Africa countries.

Variable	Model 1	Model 2	Model 3	Model 4^a	Model 5^a
Maternal union dissolution episodes
None	1.00	1.00	1.00	1.00	1.00
First order	1.33 (1.27–1.38)*	1.31 (1.25–1.36)*	1.30 (1.25–1.36)*	1.32 (1.26–1.38)*	1.32 (1.26–1.38)*
Higher order	1.25 (1.09–1.41)*	1.24 (1.09–1.40)*	1.23 (1.09–1.39)*	1.31 (1.15–1.48)*	1.31 (1.15–1.48)*
Maternal education
No formal education		1.00	1.00	1.00	1.00
Primary		0.91 (0.88–0.95)*	0.94 (0.91–0.98)*	0.96 (0.92–0.99)*	0.96 (0.92–0.99)*
Secondary/higher		0.75 (0.71–0.78)*	0.81 (0.77–0.85)*	0.82 (0.78–0.86)*	0.82 (0.78–0.86)*
Maternal occupation
Not working		1.00	1.00	1.00	1.00
Professional/services		0.97 (0.89–1.04)	0.99 (0.92–1.07)	1.01 (0.94–1.09)	1.01 (0.94–1.09)
Sales		1.05 (1.00–1.09)*	1.07 (1.02–1.12)*	1.08 (1.03–1.13)*	1.08 (1.03–1.13)*
Agriculture/manual		1.09 (1.05–1.14)*	1.07 (1.03–1.11)*	1.08 (1.03–1.12)*	1.08 (1.03–1.12)*
Household wealth index
Poor			1.00	1.00	1.00
Middle			0.96 (0.92–1.00)	0.97 (0.93–1.01)	0.97 (0.93–1.01)
Rich			0.86 (0.82–0.90)*	0.88 (0.84–0.93)*	0.88 (0.84–0.97)*
Sub-region
West					1.00
Central					0.96 (0.72–1.27)
East					0.83 (0.61–1.14)
South					0.97 (0.73–1.29)

^aModel controlled for maternal age at first marriage, age at child’s birth, residence, birth order and birth interval.

*p < 0.05 (statistically significant).

Table 5. Relative risk (95% confidence interval) for the effect of marital dissolution on childhood mortality in sub-Saharan Africa regions.

Variable	Western region^a	Central region^a	Eastern region^a	Southern region^a	All regions^a
Marital dissolution history
Yes	1.35 (1.27–1.43)*	1.23 (1.11–1.36)*	1.39 (1.22–1.57)*	1.48 (1.32–1.66)*	1.35 (1.30–1.40)*
No	1.00	1.00	1.00	1.00	1.00
Maternal education
No formal education	1	1	1	1	1
Primary	0.99 (0.92–1.05)	0.85 (0.75–0.96)*	0.87 (0.76–0.99)*	0.99 (0.85–1.14)	0.95 (0.92–0.99)*
Secondary/higher	0.80 (0.73–0.86)*	0.72 (0.62–0.83)*	0.77 (0.62–0.94)*	0.87 (0.72–1.03)	0.82 (0.77–0.86)*
Maternal occupation
Not working	1	1	1.0	1.0	1
Professional/services	1.00 (0.89–1.13)	0.96 (0.73–1.25)	1.17 (0.95–1.44)	0.81 (0.59–1.11)	1.00 (0.93–1.08)
Sales	1.10 (1.03–1.17)*	1.09 (0.94–1.27)	1.02 (0.78–1.34)	1.09 (0.93–1.27)	1.08 (1.03–1.13)*
Agriculture/manual	1.20 (1.13–1.27)*	1.03 (0.89–1.18)	1.16 (1.03–1.31)*	0.86 (0.76–0.97)*	1.07 (1.03–1.12)*
Household wealth index
Poor	1	1	1	1	1
Middle	0.96 (0.91–1.02)	0.94 (0.82–1.07)	0.92 (0.79–1.07)	0.95 (0.82–1.09)	0.97 (0.93–1.01)
Rich	0.93 (0.86–0.99)*	0.90 (0.77–1.05)	0.87 (0.75–1.01)	0.98 (0.85–1.14)	0.89 (0.85–0.93)*

^aModel controlled for maternal age at first marriage, age at child’s birth, residence, birth order and birth interval.

*p < 0.05 (statistically significant).

Table 6. Analysis of interaction effects: Marital dissolution history with education, occupation and household wealth index.

Variable	Western region^a	Central region^a	Eastern region^a	Southern region^a	All regions^a
Maternal education
No formal education	0.25 (0.19–0.31)*	0.19 (0.08–0.30)*	0.29 (0.15–0.44)*	0.26 (0.16–0.36)*	0.24 (0.20–0.28)*
Primary	0.23 (0.17–0.29)*	0.15 (0.07–0.24)*	0.25 (0.12–0.38)*	0.26 (0.15–0.37)*	0.20 (0.16–0.24)*
Secondary/higher	0.17 (0.12–0.21)*	0.11 (0.02–0.18)*	0.20 (0.09–0.31)*	0.22 (0.13–0.32)*	0.16 (0.13–0.19)*
Maternal occupation
Not working	0.22 (0.17–0.27)*	0.13 (0.06–0.21)*	0.24 (0.12–0.36)*	0.26 (0.15–0.37)*	0.19 (0.16–0.23)*
Professional/services	0.18 (0.13–0.22)*	0.10 (0.04–0.17)*	0.24 (0.11–0.37)*	0.18 (0.09–0.27)*	0.16 (0.13–0.19)*
Sales	0.22 (0.16–0.27)*	0.14 (0.06–0.22)*	0.26 (0.11–0.40)*	0.26 (0.15–0.38)*	0.21 (0.17–0.25)*
Agriculture/manual	0.26 (0.20–0.33)*	0.15 (0.07–0.24)*	0.28 (0.14–0.43)*	0.23 (0.13–0.33)*	0.23 (0.19–0.27*
Household wealth index
Poor	0.26 (0.20–0.33)*	0.16 (0.07–0.25)*	0.28 (0.14–0.43)*	0.26 (0.15–0.37)*	0.23 (0.19–0.27)*
Middle	0.23 (0.18–0.29)*	0.14 (0.06–0.22)*	0.25 (0.12–0.38)*	0.24 (0.13–0.35)*	0.21 (0.17–0.24)*
Rich	0.19 (0.14–0.23)*	0.12 (0.05–0.19)*	0.22 (0.11–0.34)*	0.23 (0.13–0.34)*	0.17 (0.14–0.21)*

Note: Data presented as contrast (95% confidence interval).

^aModels controlled for maternal age at first marriage, age at child’s birth, residence, birth order and birth interval.

*p < 0.05 (statistically significant).

Table 7. Analyses of changes in the effect of marital dissolution on childhood mortality between 1990s and 2010s in 10 selected sub-Saharan Africa countries.

Country	Year	Model 1	Model 5
Cameroun	1991	1.37 (0.89–2.11)	1.40 (0.89–2.18)
	2011	1.10 (0.85–1.42)	1.22 (0.85–1.74)
Cote D’Ivoire	1994	1.03 (0.63–1.66)	1.12 (0.69–1.82)
	2011/2	1.33 (0.95–1.87)	1.43 (0.91–2.26)
Gabon	2000	1.02 (0.73–1.43)	1.10 (0.59–2.08)
	2012	1.05 (0.72–1.55)	0.86 (0.47–1.58)
Mozambique	1997	1.17 (0.78–1.59)	1.16 (0.77–1.74)
	2011	1.28 (1.05–1.57)*	1.44 (1.19–1.86)*
Nigeria	1990	1.23 (0.89–1.71)	1.17 (0.83–1.65)
	2013	1.36 (1.12–1.66)*	1.31 (0.99–1.73)
Tanzania	1996	1.39 (1.09–1.78)*	1.10 (0.67–1.81)
	2010	1.46 (1.12–1.89)*	1.61 (0.98–2.64)
Uganda	1995	1.22 (0.93–1.59)	1.12 (0.85–1.46)
	2011	1.33 (1.03–1.72)*	1.13 (0.78–1.63)
Zimbabwe	1994	2.43 (1.58–3.72)*	2.30 (1.49–3.55)*
	2010/1	1.54 (1.16–2.04)*	1.60 (1.12–2.29)*

*p < 0.05 (statistically significant).

Clark, S & Brauner-Otto, S, 2015. Divorce in sub-Saharan Africa: Are unions becoming less stable? Population and Development Review 41, 583–605. doi: 10.1111/j.1728-4457.2015.00086.x

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