Worldwide more than 10 million children die each year before their fifth birthday (Black et al. 2003). Not only are these deaths concentrated in low and middle income countries; children of the poor and less educated within these countries too exhibit systematically higher mortality levels. Policy makers are learning that improving average population health is not enough. Monitoring and tackling inequalities in health between socio-economic groups within countries has become an increasingly important objective. Whereas research on socio-economic health inequalities is a well-established tradition in high income countries, it is only recently that such inequalities are being studied more systematically in relation to low and middle income countries as well. This has raised new issues regarding measurement and methodology, but also provides opportunities for contributing to existing debates. The first aim of this thesis is to contribute to the evaluation of measures to describe socio-economic mortality inequalities in low and middle income countries. Accurate and valid measurement of socio-economic mortality inequalities is a prerequisite for establishing the magnitude of the problem, for monitoring, and for unravelling its determinants. The second aim of this thesis is to contribute to the description and explanation of time and place variations in the magnitude of socio-economic inequalities in under-5 mortality. Not much is known about how socio-economic inequalities in under-5 mortality vary across countries or over time, and what the determinants of these variations are. Understanding why inequalities are larger in some populations than in others is a first step towards evidence based public health interventions. The availability of Demographic and Health Survey data for multiple time periods for a large set of low and middle income countries, the heterogeneity across these countries and the rapid changes that some countries are experiencing, provide a unique opportunity to contribute to the issues raised above.

Mackenbach, Prof. Dr. J.P. (promotor), Netherlands Organization for Health Research and Develoment, Jurriaanse Stichting
J.P. Mackenbach (Johan)
Erasmus University Rotterdam
Erasmus MC: University Medical Center Rotterdam

Houweling, T. (2007, September 5). Socio-economic inequalities in childhood mortality in low and middle income countries. Retrieved from