Testing the socio-economic and environmental determinants of better child-health outcomes in Africa: a cross-sectional study among nations

Corey J A Bradshaw, Sarah P Otto, Zia Mehrabi, Alicia A Annamalay, Sam Heft-Neal, Zachary Wagner, Peter N Le Souëf

Research output: Contribution to journalArticlepeer-review

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Objective We sought to test hypotheses regarding the principal correlates of child-health performance among African nations based on previous evidence collected at finer spatial scales. Design Retrospective, cross-sectional study. Setting All countries in Africa, excluding small-island nations. Primary and secondary outcome measures We defined a composite child-health indicator for each country comprising the incidence of stunting, deaths from respiratory disease, deaths from diarrhoeal disease, deaths from other infectious disease and deaths from injuries for children aged under 5 years. We also compiled national-level data for Africa to test the effects of country-level water quality, air pollution, food supply, breast feeding, environmental performance, per capita wealth, healthcare investment, population density and governance quality on the child-health indicator. Results Across nations, child health was lowest when water quality, improved sanitation, air quality and environmental performance were lowest. There was also an important decline in child health as household size (a proxy for population density) increased. The remaining variables had only weak effects, but in the directions we hypothesised. Conclusions These results emphasise the importance of continued investment in clean water and sanitation services, measures to improve air quality and efforts to restrict further environmental degradation, to promote the UN's Sustainable Development Goal 3 target to 'end preventable deaths of newborns and children under 5' and Goal 6 to 'ensure access to water and sanitation for all' by 2030.

Original languageEnglish
Article numbere029968
Number of pages12
JournalBMJ Open
Issue number9
Publication statusPublished - 1 Sept 2019

Bibliographical note

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.


  • Africa
  • air pollution
  • breastfeeding
  • child health
  • children
  • corruption
  • diarrhoea
  • ecosystem services
  • environmental degradation
  • food supply
  • governance quality
  • health investment
  • health
  • human overpopulation
  • infectious disease
  • injury
  • Millennium Development Goals
  • overpopulation
  • paediatrics
  • pulmonary disease
  • sanitation
  • stunting
  • Sustainable Development Goals
  • United Nations
  • World Health Organization
  • water
  • wealth
  • agriculture
  • population density
  • infectious diseases
  • epidemiology
  • nutrition & dietetics
  • public health
  • health economics


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