Inequalities in diarrhoea, pneumonia and measles deaths: estimates for 21 sub-Saharan African countries.

Objective: To develop new methods to analyse the distributions of diarrhoea, pneumonia and measles deaths in children younger than 5 years across wealth quintiles.

Methods: We used Demographic and Health Surveys conducted since 2013 from 21 sub-Saharan African countries. We implemented multidimensional optimization techniques to estimate the joint impact of risk factors (that is, stunting, wasting, underweight, vitamin A deficiency and unsafe sanitation), immunization coverage and treatment utilization, on the distribution of deaths from diarrhoea, pneumonia and measles across wealth quintiles in each country. For each country, we created wealth-related gradients to show the risk of dying from either diarrhoea, pneumonia or measles.

Findings: Across all countries and diseases, the risks of dying from diarrhoea, pneumonia and measles decrease with increasing household wealth: children in the wealthiest quintile are at the lowest risk (set to 1), except in a few rare instances. Yet, the magnitudes of these estimated risk gradients varied considerably across diseases and countries, from under 2 to above 10. Wealth-related risks of dying seemed to be unrelated to the countries' levels of under-5 mortality.

Conclusion: We estimate that inequalities in deaths from diarrhoea, pneumonia and measles are large in many countries of sub-Saharan Africa, with more deaths occurring among children in the poorest wealth quintiles compared with the richest. Our new and generalizable methods can help research on health disparities to explore new directions.