Contents lists available at ScienceDirect Utilities Policy journal homepage: www.elsevier.com/locate/jup Research note The impact of basic utility services on infant mortality in Africa Ambe J. Njoh a,* , Faye Ricker b , Nigel Joseph b , Mah O. Tarke c , Bomin Koh b a Environmental Science & Policy, School of Geosciences, University of South Florida, Tampa, FL, USA b School of Geosciences, University of South Florida, USA c Pan African Institute for Development, Buea, Cameroon ABSTRACT Data from international online databases are analyzed using log-linear regression techniques to test the hypothesis of an inverse association between access to basic utility services and infant mortality. Four basic utility services (potable water, improved sanitation, electricity, and telecommunications) and three controlling factors (health expenditure per capita, women's literacy, and duration of the colonial era) are examined. The hypothesis is confirmed; the predictor variables explain more than half (R 2 = 0.57, significant at ⋅α = 0.000) of the variability in infant mortality. It is recommended that governments in Africa prioritize utility provisioning and women's literacy as an infant mortality reduction strategy. 1. Introduction The United Nations Children's Fund (UNICEF) recently noted that child and infant mortality rates dropped from 12.7 to 5.6 million be- tween 1990 and 2016 (Unicef.org, para. 1). While this is indicative of significant progress, high child and infant mortality rates persist in sub- Saharan Africa. The reason for this remains unclear. Analysts typically identify the source of the problem to include premature motherhood, maternal complications during labor, and early childhood diseases, particularly sepsis, pneumonia, tetanus, and diarrhea (Unicef.org, 2019). These diseases are rooted in the child's proximate environment. Only a few studies (e.g., Anyamele et al., 2017; Owili et al., 2017; Alemu, 2017) have considered remote and environmental factors, such as the child's surroundings and the socio-economic status of the child's parents. Far fewer studies have explored the link between access to basic utility services and infant and child mortality. One of these (Anyamele et al., 2017), is concerned with the effect of improved sa- nitation on infant mortality. None has investigated the way in which access to two or more basic utility services can simultaneously affect mortality. Households are typically in need of multiple services si- multaneously. Consequently, knowledge of the simultaneous effect of the elements comprising basic utilities on infant and child mortality is important for scholarship and policymaking. The main objective of the study reported in this paper is to advance this knowledge. It does so by exploring the link between access to basic utility services—potable water, improved sanitation, electricity, and telecommunications—and infant mortality. The paper initially presents a brief account of utility service initiatives as part of efforts to improve human health from pre- colonial through colonial and immediate post-colonial times in Africa. We then review the contemporary literature linking basic utility ser- vices to children's health outcomes in developing regions in general and Africa in particular. We next discuss the data and methodological issues of the study, followed by the main findings and concluding remarks. 2. Basic utility service and health outcomes in Africa The history of utility service provisioning in Africa predates the colonial era (Mavhunga and Trischier, 2014; Showers, 2011; Kanduza, 2009; Phillip, 2006). Yet, as Table 1 shows, basic utilities continue to be out of the reach of many throughout the continent. With the exception of the Maghreb, including Algeria, Tunisia, Egypt, Libya, and Morocco, countries throughout the continent lack complete access to utilities. The importance of utility services for human health, are acknowl- edged within the framework of the Sustainable Development Goals (SDGs). Potable water, improved sanitation, electricity, and tele- communications are necessary to deliver vital health-care services to rural and other enclaved populations throughout the world. The theo- retical connection implied here is neither as linear or simplistic as it may appear. In impoverished regions such as sub-Saharan Africa, the provisioning of basic services is often done at the expense of curative medical initiatives. Therefore, in the short run, this may negatively affect health, and especially children's health services. In the long run, the impact is bound to be positive on public health. Energy and water services, as well as modern plumbing, are necessary to execute many medical and health-related tasks, including routine and emergency medical procedures, refrigeration of medicines, sterilization, and the operation of medical devices. Mobile telephony and other information and communication technologies (ICTs) are needed in the delivery of https://doi.org/10.1016/j.jup.2019.100928 Received 23 May 2018; Received in revised form 27 May 2019; Accepted 27 May 2019 * Corresponding author. E-mail address: njoh@usf.edu (A.J. Njoh). Utilities Policy 59 (2019) 100928 Available online 12 June 2019 0957-1787/ © 2019 Elsevier Ltd. All rights reserved. T