Background
Disparities in health outcomes between the poor and the rich are increasingly attracting
attention from researchers and policy-makers. However, policies aimed at reducing
inequities need to be based on a sound assessment of the nature, magnitude and
determinants of the problem, as policy decisions based on intuition are likely to be
misguided.
Objective
The work investigates the relationship between household socio-economic status and
under-five mortality at Rufiji DSS in year 2005. The specific objectives were; 1.To
construct wealth and concentration indices for households with children under age five. 2.
To measure health inequality by poorest / least poor mortality rate ratio and the use of
concentration index 3. To determine significance in gradient of mortality rates across
wealth index quintiles by a trend test (chi-square) 4. To assess the magnitude of association
between socio-economic status of households and under-five mortality.
Methods
Data from Rufiji DSS, Tanzania was used for the analysis. Out of 11,189 children under five
years of age from 7298 households, 251 died in the year 2005. These yielded a total of
9341.6 PYO in 2005 which was used in the analysis. 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). Kaplan-Meier (K-M) survival estimates of
incidence rates were used to estimate mortality rates per 1000 PYO for infants (0-1),
children (1-4) and under-fives. 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 Poisson regression
taking into account potential confounders.
Results
The result indicates that the mortality rate was higher for infants (123.4 per 1000 PYO,
95% CI (104.3, 146.1)) than for children aged 1-4 years (17.3 per 1000 PYO, 95% CI
(14.3, 20.9)). Under-five mortality was 26.9 per 1000 PYO (95% CI (23.7, 30.4)). The
poorest to least poor ratio were 1.5, 3.8 and 2.4 for infants, children, 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= -0.07, children C= -0.24 and under-five C= -0.16) 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 children
(P<0.001) and under-five year old children (P<0.001) but not for infants (P=0.10).
In univariate Poisson regression, children in the least poor households were shown to have
a 58% significantly reduced risk of dying as compared to the poorest households [crude
RR=0.42, P < 0.001, 95% CI (0.27 - 0.62)]. The effect of household socio-economic status
attenuated after adjusting for maternal education, maternal age and occupation. Children in
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the least poor households had a 52% significantly reduced risk of dying as compared to the
poorest households [adjusted RR=0.48, P = 0.002, 95% CI (0.30 - 0.80)].
Conclusion
The study shows that household socio-economic inequality is associated with under-five
mortality in Rufiji DSS in 2005 and that the survival advantage of under-five year old
children is associated with maternal education. Reducing poverty and making essential
health services more available to the poor are critical to improving overall childhood
mortality in rural Tanzania.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/6974 |
| Date | 22 May 2009 |
| Creators | Nattey, Cornelius |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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