Socio-economic and proximate determinants of under-five mortality in Guinea, Bright Opoki Ahinkorah et al., May 2022

Socio-economic and proximate determinants of under-five mortality in Guinea, Bright Opoki Ahinkorah et al., May 2022

Authors : Bright Opoku Ahinkorah, Eugene Budu, Abdul-Aziz Seidul, Ebenezer Agbaglo, Collins Adu, Dorothy Osei, Aduragbemi Banke-Thomas, Sanni Yaya

Type of publication : Research paper

Date of publication : May 5, 2022

Link to the original document


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Globally, the death of children under-five years is one of the critical issues in public health and improving child survival continues to be a matter of urgent concern. . However, under-five mortality remains alarmingly high in many low- and middle-income countries (LMICs). In 2018 alone, an estimated 5.3 million children under-five years died globally, with sub-Saharan Africa (SSA) contributing more than a half of the death burden (2.7 million). At an average of 78 deaths of children under-five per 1,000 live births, one in every 13 children dies before their fifth birthday in the sub-Saharan African region.

Efforts to reduce under-five mortality in any strategic manner require a clear understanding of its predictors. Several studies have been published concerning the predictors of under-five mortality in the sub-Saharan African region as a whole and specific countries such as Ethiopia, Ghana, Sierra Leone, and Nigeria. This suggests that the findings of these studies conducted in other sub-Saharan African countries may not be particularly applicable in the context of Guinea. We believe that country-specific findings from this study could contribute to identifying critical priority interventions to address under-five mortality in Guinea.

Data source

The 2018 Guinea Demographic and Health Survey provided the data for this study (GDHS). Data for 4,400 children under the age of five, who served as the study’s unit of analysis, were gathered by interviewing women who had given birth within the previous five years. Due to the inclusion of variables that asked for information about the partners of women with children under-five years, the sample size of 4400 included only children born to mothers who were either married or cohabiting at the time of the study.


Under-five mortality was 111 deaths per 1,000 live births in the country. Deaths of children under five was 136 per 1,000 live births in the Faranah region compared to 37 deaths per 1,000 live births in the Conakry region. Similarly, under-five mortality was higher in the rural areas (131 deaths per 1,000 live births) compared to the urban areas (60 deaths per 1,000 live births). Children from poorer households experienced a higher under-five mortality rate (143 deaths per 1,000 live births) compared to those from richest households (41 deaths per 1,000 live births).

In this model, religion, size of the child at birth, birth rank and birth interval, and postnatal check-ups had significant associations with under-five mortality. The likelihood of death was higher among children born to mothers who belong to other religions compared to Christians, smaller than average children compared to larger than average children and those whose mothers had no postnatal check-up visits less than 24 hours after delivery.


Our study revealed that region of residence, religion, birth order, birth interval, and postnatal check-up visits are strong predictors of under-five mortality in Guinea.

Our study also revealed a strong relationship between religion and under-five mortality in Guinea. Specifically, children born to Christians recorded a lower likelihood of under-five mortality compared to their counterparts whose mothers were practitioners of other religions. With nearly 85 percent of Guinea’s population being Muslim, Islam is the demographically, socially, and culturally dominant religion. This study’s conclusion could be explained by prior research findings on the cultural practice of keeping newborns hidden from the public due to fear of harm after birth. To reduce under-five mortality among religious groups in Guinea, religious leaders’ role in promoting maternal and child healthcare utilization must be increased. This study implies that the impact of religion on under-five mortality should be examined further to understand the underlying factors better.

Specifically, children born to Christians recorded a lower likelihood of under-five mortality compared to their counterparts whose mothers were practitioners of other religions

Children born to poor women were more likely to die compared to those born to rich women. According to research, wealthier women are more likely to use maternal and childcare. Most poor women live in rural areas where 84% of babies in urban areas receive a postnatal examination, compared to only 43% of babies in rural areas. Poor women are also characterized by a lack of essential services (such as potable water) and proper sanitation practices, the lack of which causes diarrhea and dehydration in children in rural Guinea, resulting in the death of many children in rural Guinea.

Policy implications

The study’s findings serve as a starting point for further debate. Our findings have several policy implications. While there is a need to address the different variables across Guinea, our study findings imply that special attention should be paid to some specific groups who appear to be the most susceptible among the vulnerable. For starters, children in the country’s poorer districts, such as Farannah, will benefit from steps to reduce inequality. Furthermore, behavioral change communication about the importance of postnatal checks for babies, as well as family planning and spacing, must be implemented while ensuring that those efforts reach moms and dads of large families with a low birth rank and interval, as well as non-Christians. Furthermore, campaigning on the importance of postnatal check-ups after birth can be performed both during mothers’ interaction with the health system, such as during ante-natal care clinics and more generally to the broader community, as part of outreaches.