Household Structure and Childhood Mortality in Ghana
Winfred Avogo Victor Agadjanian
Department of Sociology/ Center for Population Dynamics, Arizona State University
Introduction
Child mortality public health priority in Africa Analysis show mortality decline has stalled Focus on socio-economic & biological factors Little known about influence of living arrangements of children on child mortality Examine household structure within cultural and socio-economic context children live
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Objectives
Chart trends in childhood mortality from 1993- 2003
Estimate effect of household structure on child survival Examine variations of household structure and child survival across rural and urban areas
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Setting
Ghana; population of 20 million in West Africa Economy stable; estimated poverty rate at 35% of population 25% Urban and 75% rural Young population with 46.9% 0-14 Overall life expectancy of 59.6 for females and 55.4 for males 4
Theoretical framework
Three major theoretical perspectives: ‘New household economic models’ Becker, 1981; Schultz, 1974 Critically examine household as a single entity Resource pooling within the family Household boundaries and resource availability Literature on socioeconomic influences on child survival Biological proximate determinants of child survival
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Hypotheses
Children in nuclear households have health advantage if constraints to resource pooling exist
Effects of nuclear households depend on mother’s education and socio-economic status Effects mediated by bio-demographics of mother and utilization of maternal services Effects of household structure stronger in rural than in urban areas
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Data and Methods
Ghana Demographic Health Surveys (GDHS), crosssectional; 1993, 1998 & 2003
Sample size: 6351 last born children
Statistical Model Discrete-time logistics models 5 Age intervals specified Each child contributes 1-5 observations depending on age at death or censoring
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Data and Methods
•Outcome Variable: Childhood mortality: probability of dying from birth to age 5 •Main predictor: Household structure: two broad forms: (1) Elementary: nuclear & single-parent Households (2) Extended:three generational & lateral households •Control variables: person months lived, socioeconomic, bio-demographic, maternal health factors
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Analytical Strategies
Model 1: Household structure, 2: socio-
economic, 3: biological and maternal utilization Urban and Rural Areas: Same model specification
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Figure 1: Household Structure
Lateral extended (20.36%) Three generational (12.41%) Single parent (17.95%) Nuclear (49.28%)
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Household structure by selected characteristics
90 80 70 60 50 40 30 20 10 0
Percent Nuclear Single parent Three generational Lateral extended
Urb Me an an ag ea t bi rth
Lo wS ES
No Ed uc
Se c/H igh er E duc Pri ma ry E duc
Hig hS ES Me diu m SE S
Ru ral
Selected Characteristics
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Ch ild de ath
Figure 3: Trends in Infant and Under-five Mortality Rates Ghana 1988-2003
180
Deaths per 1000 Live births
160 140 120 100 80 60 40 20 0
155 119
108
111
77
66
57
64
1983-1987
1989-1993
1994-1998
1999-2003
Approximate GDHS period
Infant mortality (1q0)
Under-five mortality (5q0)
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Figure 4: Child Survival Estimates by Household Structure
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Multivariate Results
Table : Odds ratio of the relationship between family structure and child death All Rural Urban Family Structure Single-parent 1.06 0.87 1.08 Three-generational 1.59 + 1.89 * 1.11 Laterally extended 1.51 * 1.67 * 1.45 (Nuclear) 1 1 1 Month ('0) 1 1 1.00 '1-5 0.10 ** 0.08 0.14 * '6-11 0.09 ** 0.08 * 0.08 * '12-23 0.27 ** 0.31 0.16 '24-59 0.58 0.78 * 0.27 Mother's eductaion Secondary or Higher 0.63 + 0.82 0.78 ** Primary 0.71 0.60 * 0.32 (No education) 1 1 1 Standard of living index High 0.27 0.81 0.27 ** Medium 0.51 * 1.09 0.61 ( Low) 1 1 1
Prenatal care and delivery assistance Received either Received neither (Received both)
0.81 0.72
1
0.82 0.80 1
1.241 1.58 1
*= <.05, ** = <.01 + = <.1
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Summary of findings
Extended households seem to have negative impact on child mortality
Household structure important for rural areas does not appear so in urban areas
Cost of health care, social inequalities may explain effects of household structure in rural and urban areas
Education and standard of living more important in urban areas
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Conclusion and Implications
Community level health interventions need to adjust to specific needs of household forms More research is needed to identify vulnerable children in changing household situations Comprehensive sociological models needed to account for household effects
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THANK YOU
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