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Geographic coverage of demographic surveillance systems for characterising the drivers of childhood mortality in sub-Saharan Africa
  1. C Edson Utazi1,2,
  2. Sujit K Sahu2,
  3. Peter M Atkinson3,
  4. Natalia Tejedor-Garavito1,4,5,
  5. Christopher T Lloyd1,
  6. Andrew J Tatem1,5
  1. 1 WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK
  2. 2 Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
  3. 3 Faculty of Science and Technology, Lancaster University, Lancaster, UK
  4. 4 GeoData, University of Southampton, Southampton, UK
  5. 5 Flowminder Foundation, Stockholm, Sweden
  1. Correspondence to Dr C Edson Utazi; c.e.utazi{at}


A major focus of international health and development goals is the reduction of mortality rates in children under 5 years of age. Achieving this requires understanding the drivers of mortality and how they vary geographically to facilitate the targeting and prioritisation of appropriate interventions. Much of our knowledge on the causes of, and trends in, childhood mortality come from longitudinal demographic surveillance sites, with a renewed focus recently on the establishment and growth of networks of sites from which standardised outputs can facilitate broader understanding of processes. To ensure that the collective outputs from surveillance sites can be used to derive a comprehensive understanding and monitoring system for driving policy on tackling childhood mortality, confidence is needed that existing and planned networks of sites are providing a reliable and representative picture of the geographical variation in factors associated with mortality. Here, we assembled subnational data on childhood mortality as well as key factors known to be associated with it from household surveys in 27 sub-Saharan African countries. We then mapped the locations of existing longitudinal demographic surveillance sites to assess the extent of current coverage of the range of factors, identifying where gaps exist. The results highlight regions with unique combinations of factors associated with childhood mortality that are poorly represented by the current distribution of sites, such as southern Mali, central Nigeria and southern Zambia. Finally, we determined where the establishment of new surveillance systems could improve coverage.

  • child health
  • health systems evaluation
  • geographic information systems

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Handling editor Douglas Noble

  • Contributors CEU, SKS, PMA and AJT conceived and designed the study. CEU, NT-G and CTL assembled the datasets. CEU designed and implemented the statistical methods. SKS and PMA provided guidance on methods. CEU and AJT led the writing of the manuscript and all authors contributed to editing it.

  • Funding This work was funded by a grant from the Bill and Melinda Gates Foundation (OPP1117016).

  • Competing interests AJT is supported by funding from NIH/NIAID (U19AI089674), the Bill and Melinda Gates Foundation (OPP1106427, 1032350, OPP1134076), the Clinton Health Access Initiative, National Institutes of Health, a Wellcome Trust Sustaining Health Grant (106866/Z/15/Z) and funds from DFID and the Wellcome Trust (204613/Z/16/Z).

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.