Better individual-level risk models can improve the targeting and life-saving potential of early-mortality interventions

Abstract Infant mortality remains high and uneven in much of sub-Saharan Africa. Even low-cost, highly effective therapies can only save lives in proportion to how successfully they can be targeted to those children who, absent the treatment, would have died. This places great value on maximizing the accuracy of any targeting or means-testing algorithm. Yet, the interventions that countries deploy in hopes of reducing mortality are often targeted based on simple models of wealth or income or a few additional variables. Examining 22 countries in sub-Saharan Africa, we illustrate the use of flexible (machine learning) risk models employing up to 25 generally available pre-birth variables from the Demographic and Health Surveys. Using these models, we construct risk scores such that the 10 percent of the population at highest risk account for 15-30 percent of infant mortality, depending on the country. Successful targeting in these models turned on several variables other than wealth, while models that employ only wealth data perform little or no better than chance. Consequently, employing such data and models to predict high-risk births in the countries studied flexibly could substantially improve the targeting and thus the life-saving potential of existing interventions.