Understanding inequities in child mortality in Egypt: Socioeconomic and proximate factors

Figures & data

Figure 1. The conceptual framework adapted from Mosley and Chen (1984).

Table 1. Description of study variables.

Variable name	Variable description	Coding structure
Dependent variable
Under-Five Mortality	If the child survived under the age of five at the time of the interview or not	Categorised, 0 = Yes, 1 = No
Socioeconomic factors
Mother's level of education	The highest level of education attained by the mother at the time of the interview	Categorised, 1 = No education, 2 = Primary, 3 = Secondary, 4= University or higher
Father's level of education	The highest level of education attained by the father at the time of the interview	Categorised, 1 = No education, 2 = Primary, 3 = Secondary, 4 = University or higher
Mother's work	If the mother is employed or not	Categorised, 1 = Not working, 2 = Working
Marital status	Current marital status	Categorised, 01= Not married, 2 = Married
Wealth status	Wealth index of the household	Categorised, 1 = Poorest, 2 = Poor, 3 = Middle, 4 = Rich, 5 = Richest
Location of Residence	The current location of the household	Categorised, 1 = Frontier governorates, 2 = Lower Egypt-rural, 3 = Lower Egypt-urban, 4 = Upper Egypt-rural, 5 = Upper Egypt-urban, 6 = Urban governorates
Religion	Mother's religion	Categorised, 1 = Other religion, 2 = Muslim
Proximate factors
Maternal age	Maternal age in years	Categorised, 1 = Less than 20, 2 = 20-40, 3 = Above 40
Number of births in the last five years	The number of births the mother had in the five years prior to the survey	Categorised, 1 = Three or above, 2 = two birth, 3 = one birth
First birth age	The age of mother at first birth	Continuous Variable
Child sex	Sex of the birth	Categorised, 1 = Male, 2 = Female
Breastfeeding	If the child ever breastfed	Categorised, 1 = No, 2 = Yes
Size of the child^1	Size of the child at birth	Categorised, 1 = Large, 2 = Average, 3 = Small
Health insurance	If the mother is covered by health insurance	Categorised, 1 = No, 2 = Yes
Place of delivery^2	The type of place of delivery	Categorised, 1 = Home, 2 = government medical facilities, 3 = Private medical facilities, 4 = Nongovernmental
Source of drinking water^3	What is the main source of drinking water for members of your PIPED WATER household?	Categorised, 1 = Not protected, 2 = Protected
Type of toilet facilities^4	What kind of toilet facility do members of your household usually FLUSH OR POUR FLUSH TOILET use?	Categorised, 1 = Unimproved, 2 = Improved

Table 2. The summary statistics for all, urban, and rural households.

	All Household			Urban Households			Rural Households
Variables	freq.	Per cent	cum.	freq.	Per cent	cum.	freq.	Per cent	cum.
Mother’s highest educational level
No education	2704	17.06	17.06	590	9.22	9.22	2114	22.37	22.37
Primary	1345	8.49	25.55	458	7.16	16.38	887	9.39	31.76
Secondary	9191	57.99	83.54	3779	50.06	75.43	5412	57.28	89.04
Higher	2608	16.46	100	1572	24.57	100	1036	10.96	100
Husband/partner’s highest educational level
No education	1951	12.31	12.31	556	8.69	8.69	1395	14.77	14.77
Primary	2051	12.94	25.26	739	11.55	20.24	1312	13.89	28.65
Secondary	9122	57.57	82.83	3597	56.23	76.47	5525	58.48	87.13
Higher	2721	17.17	100	1505	23.53	100	1216	12.87	100
Currently working
No	13,803	87.1	87.1	5436	84.95	84.95	8367	88.55	88.55
Yes	2045	12.9	100	963	15.05	100	1082	11.45	100
Current marital status
Married	15588	98.36	98.36	6292	98.33	98.33	9296	98.38	98.38
Widowed	87	0.55	98.91	30	0.47	98.8	57	0.6	98.98
Divorced	91	0.57	99.48	47	0.73	99.53	44	0.47	99.45
No longer living together/separated	82	0.52	100	30	0.47	100	52	0.55	100
Wealth index
Poorest	2965	18.71	18.71	392	6.13	6.13	2573	27.23	27.23
Poorer	2979	18.8	37.51	216	3.38	9.5	2763	29.24	56.47
Middle	3282	20.71	58.22	353	5.52	15.02	2929	31	87.47
Richer	3264	20.6	78.81	2080	32.51	47.52	1184	12.53	100
Richest	3358	21.19	100	3358	52.48	100	0
Mother's religion
Muslim	15293	96.51	96.51	6110	95.5	95.5	9183	97.2	97.2
Christian	539	3.4	99.91	286	4.47	99.97	253	2.68	99.87
Other	14	0.09	100	2	0.03	100	12	0.13	100
Mother’s age
Below 20	378	2.39	2.39	86	1.34	1.34	292	3.09	3.09
Between 20 and 40	15004	94.67	97.06	6090	95.17	96.52	8914	94.34	97.43
Above 40	466	2.94	100	223	3.48	100	243	2.57	100
Births in last five years
1 birth	7576	47.8	47.8	3273	51.15	51.15	4303	45.54	45.54
2 birth	7032	44.37	92.18	2742	42.85	94	4290	45.4	90.94
3 birth	1122	7.08	99.26	348	5.44	99.44	774	8.19	99.13
>3 birth	118	0.74	100	36	0.56	100	82	0.87	100
Sex of the child
Male	8258	52.11	52.11	3333	52.09	52.09	4925	52.12	52.12
Female	7590	47.89	100	3066	47.91	100	4524	47.88	100
Breastfeeding	7590	47.89	100
No	8619	54.39	54.39	3717	58.09	58.09	4902	51.88	51.88
Yes	7229	45.61	100	2682	41.91	100	4547	48.12	100
Size of the child at birth
Larger than average	440	2.79	2.79	171	2.68	2.68	269	2.86	2.86
Average	12947	81.98	84.77	5340	83.79	86.47	7607	80.75	83.61
Smaller than average	2406	15.23	100	862	13.53	100	1544	16.39	100
Mother's health insurance
No	14578	91.99	91.99	5605	87.59	87.59	8973	94.96	94.96
Yes	1270	8.01	100	794	12.41	100	476	5.04	100
Place of delivery
Home	1975	12.46	12.46	420	6.56	6.56	1555	16.46	16.46
government medical facilities	4350	27.45	39.91	1986	31.04	37.6	2364	25.02	41.48
Private medical facilities	9431	59.51	99.42	3933	61.46	99.06	5498	58.19	99.66
Nongovernmental	92	0.58	100	60	0.94	100	32	0.34	100
Toilet facilities (de jure)
Unimproved	49	0.33	0.33	1	0.02	0.02	48	0.53	0.53
Improved	14929	99.67	100	5993	99.98	100	8936	99.47	100
Source of water (de jure)
Unprotected	216	1.44	1.44	97	1.62	1.62	119	1.32	1.32
Protected	14767	98.56	100	5898	98.38	100	8869	98.68	100
Region
Urban Governorates	2278	14.37	14.37
Lower Egypt urban	1572	9.92	24.29
Lower Egypt rural	4251	26.82	51.12
Upper Egypt urban	1873	11.82	62.94
Upper Egypt rural	4812	30.36	93.3
Frontier Governorates	1062	6.7	100

Table 3. The results for socioeconomic variables for all households (odds ratios).

Under-five mortality	Odd Ratios (Standard Error)	95% CI (Lower-Upper)	p-value
Mother's level of education
No education	R
Primary	1.098 (0.217)	(0.746-1.618)	0.6350
Secondary	0.891 (0.124)	(0.664-1.195)	0.4410
Higher	0.593** (0.150)	(0.360-0.974)	0.0390
Father's level of education
No education	R
Primary	0.749 (0.149)	(0.507-1.105)	0.1450
Secondary	0.871 (0.138)	(0.639-1.188)	0.3840
Higher	0.951 (0.217)	(0.608-1.488)	0.8270
Wealth index
Poorest	R
Poorer	0.758* (0.117)	(0.560-1.025)	0.0720
Middle	0.849 (0.136)	(0.620-1.162)	0.3070
Richer	0.724 (0.144)	(0.491-1.069)	0.1040
Richest	0.611* (0.155)	(0.371-1.006)	0.0530
Marital status
Married	0.637 (0.209)	(0.335-1.214)	0.1710
Not married	R
If mother is working
Yes	0.897 (0.159)	(0.634-1.269)	0.5380
No
Religion
Muslim	0.764 (0.195)	(0.463-1.259)	0.2910
Other religion	R
Place of residence
Urban Governorates	1.370 (0.417)	(0.759-2.462)	0.2980
Lower Egypt-Urban	1.328 (0.417)	(0.718-2.457)	0.3660
Lower Egypt- Rural	1.238 (0.322)	(0.743-2.062)	0.4120
Upper Egypt-Urban	1.357 (0.391)	(0.772-2.386)	0.2890
Upper Egypt-Rural	1.634* (0.412)	(0.997-2.680)	0.0520
Frontier governorates	R
Constant	0.059*** (0.029)	(0.023-0.154)	0.0000
Number of Observations	15,843
Pseudo R^2	0.0126
Log likelihood	−1777.68
Households	All

Note: ***denotes the estimate is significant at 1%, **denotes the estimate is significant at 5%, *denotes the estimate is significant at 10%, R refers to the reference group.

Figure 2. Concentration curve for under five mortality all households.

Figure 3. Concentration curve for urban under five mortality.

Figure 4. Concentration curve for rural under five mortality.

Figure 5. Concentration curve for under five mortality.

Table 4. The results for all households, urban and rural regressions (odds ratios).

	All households			Urban households			Rural households
Under-five mortality	Odd ratios (standard error)	95% CI (lower-upper)	p-value	Odd ratios (standard error)	95% CI (lower-upper)	p-value	Odd ratios (standard error)	95% CI (lower-upper)	p-value
Mother's level of education
No education	R			R			R
Primary	0.943 (0.2058)	(0.615–1.446)	0.7880	1.009 (0.4772)	(0.400–2.550)	0.9840	0.911 (0.2258)	(0.561–1.481)	0.7070
Secondary	0.785 (0.1283)	(0.570–1.082)	0.1390	1.012 (0.3732)	(0.491–2.085)	0.9750	0.649** (0.1218)	(0.449–0.938)	0.0210
Higher	0.597* (0.1672)	(0.345–1.033)	0.0650	0.388* (0.2019)	(0.140–1.076)	0.0690	0.829 (0.2819)	(0.426–1.614)	0.5810
Father's level of education
No education	R			R			R
Primary	0.622** (0.1376)	(0.403–0.959)	0.0320	0.498* (0.2083)	(0.220–1.131)	0.0960	0.749 (0.1970)	(0.448–1.254)	0.2730
Secondary	0.902 (0.1552)	(0.643–1.263)	0.5470	0.647 (0.2112)	(0.341–1.227)	0.1820	1.092 (0.2217)	(0.734–1.626)	0.6640
Higher	1.028 (0.2581)	(0.628–1.681)	0.9130	0.875 (0.3667)	(0.385–1.989)	0.7500	1.098 (0.3512)	(0.587–2.056)	0.7690
Wealth index
Poorest	R			R			R
Poorer	0.78 (0.1342)	(0.557–1.093)	0.1490	1.035 (0.5847)	(0.342–3.132)	0.9520	0.736* (0.1345)	(0.515–1.054)	0.0940
Middle	0.916 (0.1601)	(0.650–1.290)	0.6150	0.664 (0.3437)	(0.240–1.832)	0.4290	0.89 (0.645)	(0.620–1.279)	0.5300
Richer	0.769 (0.1722)	(0.496–1.193)	0.2410	0.592 (0.2395)	(0.268–1.309)	0.1950	0.814 (0.2339)	(0.464–1.430)	0.4740
Richest	0.761 (0.2150)	(0.437–1.324)	0.3340	0.667 (0.2757)	(0.297–1.500)	0.3270
Marital status
Married	1.041 (0.4550)	(0.442–2.452)	0.9270	1.742 (1.7865)	(0.233–13.001)	0.5880	0.883 (0.4296)	(0.340–2.292)	0.7980
Not married	R			R			R
If mother is working
Yes	1.024 (0.2087)	(0.687–1.527)	0.9080	0.842 (0.3304)	(0.390–1.817)	0.6620	1.145 (0.2734)	(0.717–1.828)	0.5700
No	R			R			R
Religion
Muslim	0.718 (0.2038)	(0.412–1.253)	0.2440	0.679 (0.2837)	(0.299–1.540)	0.3540	0.799 (0.3108)	(0.372–1.712)	0.5630
Other religion	R		R
Mother's age
Below 20	R			R			R
Between 20 and 40	0.339*** (0.1179)	(0.171–0.670)	0.0020	0.354 (0.2170)	(0.079–1.587)	0.1750	0.309*** (0.1213)	(0.143–0.667)	0.0030
Above 40	0.359** (0.1754)	(0.138–0.935)	0.0360	0.171 (0.1830)	(0.021–1.393)	0.0990	0.439 (0.2430)	(0.148–1.299)	0.1370
Birth in last five years
1 birth	0.033*** (0.0092)	(0.019–0.057)	0.0000	0.081*** (0.0648)	(0.017–0.389)	0.0020	0.025*** (0.0079)	(0.013–0.046)	0.0000
2 birth	0.077*** (0.0203)	(0.046–0.129)	0.0000	0.301 (0.2347)	(0.065–1.387)	0.1240	0.045*** (0.0135)	(0.025–0.081)	0.0000
3 birth	0.402*** (0.1096)	(0.236–0.686)	0.0010	1.276 (1.0205)	(0.266–6.118)	0.7600	0.259*** (0.0811)	(0.141–0.479)	0.0000
4 + birth	R			R			R
Sex of the child
Male	R			R			R
Female	1.182 (0.1342)	(0.946–1.477)	0.1400	1.195 (0.2389)	(0.807–1.768)	0.3740	1.149 (0.1601)	(0.874–1.510)	0.3180
breastfeeding
Yes	0.314*** (0.0401)	(0.244–0.403)	0.0000	0.381*** (0.0847)	(0.247–0.589)	0.0000	0.300*** (0.0473)	(0.220–0.409)	0.0000
No	R			R			R
Size of the child
Larger than average	R			R			R
Average	0.340*** (0.0876)	(0.205–0.564)	0.0000	0.357 (0.1764)	(0.136–0.940)	0.0370	0.341*** (0.1049)	(0.187–0.623)	0.0000
Smaller than average	0.906 (0.2426)	(0.536–1.532)	0.7140	1.773 (0.8883)	(0.664–4.733)	0.2530	0.612 (0.1994)	(0.324–1.159)	0.1320
Covered by insurance
Yes	0.692 (0.2125)	(0.379–1.263)	0.2310	1.278 (0.5136)		0.5410	0.272** (0.1686)	(0.080–0.917)	0.0360
No	R			R			R
Place of delivery
Home	R			R			R
Government medical facilities	1.163 (0.2136)	(0.812–1.667)	0.4100	1.251 (0.5300)	(0.546–2.870)	0.5970	1.22 (0.2531)	(0.813–1.832)	0.3380
Private medical facilities	1.019 (0.1793)	(0.721–1.438)	0.9170	1.434 (0.5956)	(0.636–3.237)	0.3850	0.925 (0.1832)	(0.628–1.364)	0.6950
Nongovernmental	1.027 (0.786)	(0.231–4.572)	0.9720	1.022 (1.1778)	(0.107–9.779)	0.9850	1.216(1.2661)	(0.158–9.362)	0.8510
Mother's age at first birth	1.026*** (0.0157)		0.0900	1.011 (0.0847)	(0.962–1.063)	0.6630	1.041** (0.0202)	(1.002–1.081)	0.0370
Source of water
Protected	2.171 (1.3940)	(0.617–7.642)	0.2270	2.327 (2.4872)	(0.286–18.909)	0.4300	3.07 (2.2618)	(0.724–13.009)	0.1280
Unprotected	R			R			R
Toilet facility
Improved	0.310** (0.1701)	(0.106–0.909)	0.0330				0.291** (0.1607)	(0.098–0.859)	0.0250
Unimproved	R						R
Place of residence
Urban Governorates	1.519 (0.4932)	(0.804–2.871)	0.1970
Lower Egypt-Urban	1.213 (0.4118)	(0.623–2.359)	0.5700
Lower Egypt- Rural	1.225(0.3558)	(0.693–2.165)	0.4850
Upper Egypt-Urban	1.26 (0.3963)	(0.680–2.334)	0.4630
Upper Egypt-Rural	1.492 (0.4184)	(0.861–2.585)	0.1540
Frontier governorates	R
Constant	3.674 (4.1294)	(0.406–33.254)	0.2470	0.279 (0.5625)	(0.005–14.570)	0.5270	5.534 (7.1088)	(0.446–68.623)	0.1830
Number of observations	14,921			5968			8954
Pseudo R2	0.137			0.161			0.144
Log likelihood	−1421.9			−470.2			−927.8
Households	All			Urban			Rural

Note: ***denotes the estimate is significant at 1%, **denotes the estimate is significant at 5%, *denotes the estimate is significant at 10%, R refers to the reference group.

Mosley, W. H., & Chen, L. C. (1984). An analytical framework for the study of child survival in developing countries. Population and Development Review, 10, 25–45. https://doi.org/10.2307/2807954

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