Multilevel analysis of infant mortality and its risk factors in South Africa

Samuel Abera Zewdie, Vissého Adjiwanou


The study analyzed infant mortality and its risk factors in South Africa. It aimed to examine infant mortality in the country by taking into account the hierarchical nature of the problem and investigate the with-in country variation in modeling. In addition to the usual individual level risk factors of infant mortality, living standard, mother’s education, and income inequality were defined at municipal level, while HIV prevalence was fixed at province level. A multilevel logistic regression model was then fitted with Bayesian MCMC parameter estimation procedure using the 2011 South African census data. Most of the demographic and socioeconomic variables identified at individual level were found significant. More remarkably, the result indicated that communities with better living standard and women's education were associated with lower infant mortality rates, while higher income inequality and HIV prevalence in the communities were associated higher levels of infant mortality. The changes in infants’ odds of death were estimated to be 26%, -21%, 13% and 8% respectively for HIV, women’s education, income inequality and level of the living standard. In addition, unobservable municipal and province level random effects significantly affected the level of infant mortality rates. 


Infant mortality; multilevel; poverty; inequality

Full Text:



Ashiabi GS, O'Neal KK (2007). Children’s health status: Examining the associations among income poverty, material hardship, and parental factors. PLoS ONE, e940; 2: 1–9.

Bartlett S (2005). Water, sanitation and urban children: The need to go beyond “improved” provision. Children, Youth and Environments, 15(1): 115–137.

Bawah AA and Zuberi T (2005). Socioeconomic status and child survival in southern Africa. Genus, 61(2): 55–83.

Boco AG (2010). Individual and community level effects on child mortality: An analysis of 28 demographic and health surveys in sub-saharan Africa. Calverton, Maryland, USA, ICF Macro.

Breslow NE and Clayton DG (1993). Approximate inference in generalised linear mixed models. Journal of the American Statistical Association, 88(421): 9–25. 10.1080/01621459.1993.10594284.

Browne WJ (2003). MCMC estimation in MLwiN. Avaliable from:

Caldwell JC (1979). Education as a factor in mortality decline an examination of Nigerian data. Population Studies, 33(3): 395–413.

Caldwell P (1996). Child survival: Physical vulnerability and resilience in adversity in the European past and the contemporary Third World. Social Science and Medicine, 43(5): 609.

Cleland JC (1990). Maternal education and child survival: Further evidence and explanations. What we know about health transition: The cultural, social and behavioural determinants of health. Caldwell JC et al. (editorss), Health Transition Center, The Australian National University.

Dorrington R, Johnson L, Bradshaw D, et al. (2006). The demographic impact of HIV/AIDS in south Africa. National and Provincial Indicators for 2006. Cape Town, Centre for Actuarial Research, South African Medical Research Council, Actuarial Society of South Africa.

Goldstein H (2011). Multilevel Statistical Models, John Wiley & Sons Ltd.

Hair J, Black C, Babin J, et al. (2010). Multivariate data analysis, Pearson Prentice Hall.

Heuveline P, Guillot M, Gwatkin DR (2002). The uneven tides of the health transition. Social Science and Medicine, 55(2): 313–322.

Hill K, Upchurch DM (1995). Gender differences in child health: Evidence from the demographic and health surveys. Population and Development Review, 21(1): 127–151.

Hobcraft J (1993). Women’s education, child welfare and child survival: A review of the evidence. Health Transition Review, 3(2): 159–175.

Hobcraft JN, McDonald JW and Rutstein SO (1985). Demographic determinants of infant and child mortality: A comaparative analysis. Population Studies, 39(3): 363–385. Avaliable from:

HSRC (2014). South African national HIV prevalence, incidence and behaviour survey. Human Science Research Coucil.

Kabir A, Islam MS, Ahmed MS, et al. (2001). Factors influencing infant and child mortality in Bangladesh: Research paper. The Sciences, 1(5): 292–295. Avaliable from:

Kazembe L, Clarke A and Kandala NB(2012). Childhood mortality in sub-Saharan Africa: cross-sectional insight into small-scale geographical inequalities from Census data. BMJ Open, 2(5): e001421.

Kembo J and Ginneken JKV (2009). Determinants of infant and child mortality in Zimbabwe: Results of multivariate hazard analysis. Demographic Research, 21(3): 1255–1267.

Moser KA, Leon DA and Gwatkin DR (2005). How does progress towards the child mortality millennium development goal affect inequalities between the poorest and least poor? Analysis of Demographic and Health Survey data. BMJ, 331(7526): 1180–1182.

Mosley WH and Chen L (1984). An analytical framework for the study of child survival in developing countries. Population and Development Review, 10: 25–45.

Mustafa EH and Odimegwu C (2008). Socioeconomic determinants of infant mortality in Kenya: Analysis of Kenya DHS 2003. Journal of Humanities and Social Sciences, 2(2): 1–16. Avaliable from:

Ng’weshemi J, Urassa M, Usingo R, et al. (2003). HIV impact on mother and child mortality in rural Tanzania. Journal of Acquired Immune Deficiency Syndromes, 33: 393–404.

Omariba DWR, Beaujot R and Rajulton F (2007). Determinants of infant and child mortality in Kenya: An analysis controlling for frailty effects. Population Research and Policy Review, 26(3): 299–321.

Omran AR (1971). The epidemiologic transition: A theory of the epidemiology of population change. Milbank Memorial Fund Quarterly, 49(4): 509–538. http://

Rasbash J, Charlton C, Browne WJ, et al. (2012). MLwiN Version 2.26, Centre for Multilevel Modelling, University of Bristol.

Rodgers G B (2002). Income and inequality as determinants of mortality: An international cross-section analysis. International Journal of Epidemiology, 31: 533–538.

Sastry N (1996). Community characteristics, individual and household attributes, and child survival in Brazil. Demography, 33(2): 211–229.

Victora CG, Wagstaff A, Schellenberg JA, et al. (2003). Applying an equity lens to child health and mortality: More of the same is not enough. The Lancet, 362: 233–241.

Wagstaff A (2000). Socio-economic inequalities in child mortality: Comparisons among nine developing countries. Bulletin of World Health Organization, WHO. 78.

Waldmann RJ (1992). Income distribution and infant mortality. The Quarterly Journal of Economics, 107(4): 1283–1302.

Wang H, Liddell CA, Coates MM, et al. (2014). Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 384(9947): 957–979.

Wang L (2003). Determinants of child mortality in LDCs. Empirical findings from demographic and health surveys. Health Policy, 65(3): 227–299.

Zaba B, Marston M and Floyd S (2003). The effect of HIV on child mortality trends in sub-Saharan Africa. Training Workshop on HIV/AIDS and Adult Mortality in Developing Countries, New York, Population Division Department of Economic and Social Affairs United Nations Secretariat.

(15 Abstract Views, 21 PDF Downloads)


  • There are currently no refbacks.

Copyright (c) 2018 Samuel Abera Zewdie, Visseho Adjiwanou

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.