Understanding the age- and cause-specific determinants of child survival: A study of child mortality in “slum” settlements of Accra, Ghana

UNHABITAT estimates that one in three urban residents live in inadequate housing with no or few basic services. And while gains in urban health outcomes have outpaced gains in rural areas, intra-urban differentials persist and may be growing wider. We present results on child survival from a representative population-based sample of urban areas in Accra which meet the UNHABITAT “slum” criteria. The 2009 Housing and Welfare Study of Accra was carried out by Harvard School of Public Health and the University of Ghana-Legon. The HAWS study consists of interviews with women age 18+ in 1703 households within 37 census areas in Accra. Results describe the differentials in infant, child and under-five mortality among slum dwellers and non-slum dwellers. Trends in mortality are explored using the HAWS data, the 2003 UNHABITAT slum survey of the same areas, and the 2008 Ghana Demographic and Health Survey. Individual analysis results are presented on the determinants of mortality. In addition to individual, maternal and household level factors which contribute to child survival, we also explore the role of migration status. The frequency of moving (among mothers) and locations of previous five residences within and outside of Accra are included in the analysis of child survival outcomes. The results contribute towards the knowledge and understanding of child survival differentials among residents of slum areas in Accra. These results may help inform policy makers and program managers in efforts to achieve the MDG target for significant improvement in the lives of slum dwellers.