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Am J Trop Med Hyg. 2017 Jan 11;96(1):57-64. doi: 10.4269/ajtmh.15-0745. Epub 2016 Nov 7.

Decomposing Educational Inequalities in Child Mortality: A Temporal Trend Analysis of Access to Water and Sanitation in Peru.

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Master of Public Health, School of Public Health, Ecole des Hautes Études en Santé Publique (EHESP), Rennes, France.
Institute for Health and Social Policy, McGill University, Montreal, Canada.
Institute for Health and Social Policy, McGill University, Montreal, Canada.
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.


Previous studies of inequality in health and mortality have largely focused on income-based inequality. Maternal education plays an important role in determining access to water and sanitation, and inequalities in child mortality arising due to differential access, especially in low- and middle-income countries such as Peru. This article aims to explain education-related inequalities in child mortality in Peru using a regression-based decomposition of the concentration index of child mortality. The analysis combines a concentration index created along a cumulative distribution of the Demographic and Health Surveys sample ranked according to maternal education, and decomposition measures the contribution of water and sanitation to educational inequalities in child mortality. We observed a large education-related inequality in child mortality and access to water and sanitation. There is a need for programs and policies in child health to focus on ensuring equity and to consider the educational stratification of the population to target the most disadvantaged segments of the population.

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