MSc (Med), Popualtion-Based Field Epidemiology, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand / Background
Improving the health of the poor and reducing health inequalities between the poor
and non-poor has become central goals of international organizations like the World
Bank and WHO as well as, national governments in the contexts of their domestic
policies and development assistance programmes.
There are also unquantified and poorly understood inequalities in access to health
services within and between various population groups. Little is known about the
factors that determine these inequalities and the mechanisms through which they
operate in various sub-groups.
Objectives
The aim of the study was first to describe under-five mortality trend according to
wealth index; second to describe risk factors for under five mortality; and finally to
investigate the relationship between socio-economic and demographic factors and
under five mortality during the period 2001 to 2006.
Methods
The study involved all children born in 2001-2006. A total of 22,422 children younger
than 5 years were found in 21,494 households yielding 36603.13 Person-Years
Observed (PYOs) up to 31st December 2006. Household wealth index was constructed
by use of Principal Component Analysis (PCA), as a proxy measure of each
household SES. From this index households were categorized into five quintiles (i.e.,
poorest, poorer, poor, less poor and least poor). Life table estimates were used to
estimate mortality rates per 1000 PYO for infants (0-1), childhood (1-5) and underfives
children. Health inequality was measured by poorest to least poor mortality rate
ratio and by computing mortality concentration indices. Trend test chi-square was
used to determine significance in gradient of mortality rates across wealth index
quintiles. Risk factors of child mortality were assessed by the use of Cox proportional
hazard regression taking into account potential confounders.
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Results
The result indicates unexpected low mortality rate for infant (33.4 per 1,000 PYO,
95% CI (30.4 – 35.6)) and childhood (15.0 per 1,000 PYO, 95% CI (13.9 – 16.3)).
Under-five mortality rate was 18.2 per 1,000 PYO (95% CI (75.6 – 108.0)). The
poorest to least poor ratios were 1.1, 1.5 and 1.5 for infants, childhood, and under-five
year olds respectively, indicating that children in the poorest quintile were more likely
to die as compared to those in the least poor household. Computed values for
concentration indices were negative (infant C= -0.02, children C= -0.09 and underfive
C= -0.04) indicating a disproportionate concentration of under-five mortality
among the poor. The mortality rates trend test chi-square across wealth index quintiles
were significant for both childhood (P=0.004) and under-five year old children
(P<0.005) but not for infants (P=0.134).
In univariate Cox proportional hazard regression, children in the least poor
households were shown to have a 35% reduced risks of dying as compared to children
in the poorest category [crude H.R =0.65, P=0.001, 95% C.I (0.50 – 0.84)]. The
results showed that for under five children, a boy is 1.15 times more likely to die as
compared to a girl [crude H.R =1.14, P=0.038, 95% C.I (1.00 - 1.31)]. Second born
had a 18% reduced risk of dying as compared to first born [crude H.R =0.82, P=0.048,
95% C.I (0.67 – 0.99)]. After controlling for potential confounders, the adjusted
hazard ratio for wealth index decreased slightly. The estimated hazard for wealth
index in the univariate was 0.65 while in the multivariate modeling the estimated
hazard ratio is 0.60 in the first model.
Conclusion
The study shows that household socio-economic inequality is associated with underfive
mortality in the Navrongo DSS area. The findings suggest that reductions in
infant, childhood, and under five mortalities are mainly conditional in health and
education interventions as well as socioeconomic position of households. The findings
further call for more pragmatic strategies or approaches for reducing health
inequalities. These could include reforms in the health sector to provide more
equitable resource allocation. Improvement in the quality of the health services
offered to the poor and redesigning interventions and their delivery to ensure they are
more inclined to the poor.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/9225 |
| Date | 24 March 2011 |
| Creators | Ndiath, Mahamadou Mansoor |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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