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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2011

Open Access 01-12-2011 | Research

Explaining household socio-economic related child health inequalities using multiple methods in three diverse settings in South Africa

Authors: Lungiswa L Nkonki, Mickey Chopra, Tanya M Doherty, Debra Jackson, Bjarne Robberstad

Published in: International Journal for Equity in Health | Issue 1/2011

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Abstract

Background

Despite free healthcare to pregnant women and children under the age of six, access to healthcare has failed to secure better child health outcomes amongst all children of the country. There is growing evidence of socioeconomic gradient on child health outcomes

Methods

The objectives of this study were to measure inequalities in child mortality, HIV transmission and vaccination coverage within a cohort of infants in South Africa. We also used the decomposition technique to identify the factors that contribute to the inequalities in these three child health outcomes. We used data from a prospective cohort study of mother-child pairs in three sites in South African. A relative index of household socio-economic status was developed using principal component analysis. This paper uses the concentration index to summarise inequalities in child mortality, HIV transmission and vaccination coverage.

Results

We observed disparities in the availability of infrastructure between least poor and most poor families, and inequalities in all measured child health outcomes. Overall, 75 (8.5%) infants died between birth and 36 weeks. Infant mortality and HIV transmission was higher among the poorest families within the sample. Immunisation coverage was higher among the least poor. The inequalities were mainly due to the area of residence and socio-economic position.

Conclusion

This study provides evidence that socio-economic inequalities are highly prevalent within the relatively poor black population. Poor socio-economic position exposes infants to ill health. In addition, the use of immunisation services was lower in the poor households. These inequalities need to be explicitly addressed in future programme planning to improve child health for all South Africans.
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Literature
1.
Bhorat H, van der Westhuizen C, Jacobs T: Income and Non-Income Inequality in Post-Apartheid South Africa: What are the Drivers and Possible Policy Interventions?. 2009, Working Papers, University of Cape Town, Development Policy Research Unit
2.
Eyob Zere and, McIntyre D: Inequities in under-five child malnutrition in South Africa. International Journal for Equity in Health. 2003, 2 (7):
3.
Victora CG, Wagstaff A, Schellenberg JA, Gwatkin D, Claeson M, Habicht J-P: Applying an equity lens to child health and mortality: more of the same is not enough. The Lancet. 2003, 362 (9379): 233-241. 10.1016/S0140-6736(03)13917-7.CrossRef
4.
Moser KA, Leon DA, Gwatkin DR: How does progress towards the child mortality millennium development goal affect inequalities between the poorest and least poor? Analysis of Demographic and Health Survey data. British Medical Journal. 2005, 331 (7526): 1180-1182. 10.1136/bmj.38659.588125.79.PubMedCentralCrossRefPubMed
5.
McIntyre D, Gilson L: Putting equity back onto the social policy agenda: experience from South Africa. Social Science & Medicine. 2002, 54: 1637-1656.CrossRef
6.
Terreblance S: A History of Inequality in South Africa. 2003, Pietermaritzburg and Johannesburg University of Natal Press and KMM Review Publishing Company
7.
Burgard SA, Treiman DJ: Trends and racial differences in infant mortality in South Africa. Social Science & Medicine. 2006, 62 (5): 1126-1137.CrossRef
8.
Nannan N, Timaeus I, Laubscher R, Bradshaw D: Levels and Differentials in Childhood Mortality in South Africa, 1977-1998. Journal of Biosocial Science. 2006, 39 (4): 1-20.
9.
Bradshaw D: Determinants of Health and their Trends. South African Health Review. Edited by: Barron P, Roma-Reardon J. 2008, Durban: Health Systems Trust
10.
Antenatal Survey 2007: The National HIV and Syphilis Prevalence Survey South Africa 2007. 2008, Pretoria: Department of Health
11.
Stewart Q, Simelane S: Are assets a Valid Proxy for Income? An analysis of Socio-economic Status and Child Mortality in South Africa. 2005, University of Pennysylvia
12.
Schellenberg JA, Victora CG, Mushi A, de Savigny D, Schellenberg D, Mshinda H, Bryce J: Inequities among the very poor: health care for children in rural southern Tanzania. The Lancet. 2003, 361 (9357): 561-566. 10.1016/S0140-6736(03)12515-9.CrossRef
13.
Chowdhury ME, Ronsmans C, Killewo J, Anwar I, Gausia K, Das-Gupta S, Blum LS, Dieltiens G, Marshall T, Saha S: Equity in use of home-based or facility-based skilled obstetric care in rural Bangladesh: an observational study. The Lancet. 2006, 367 (9507): 327-332. 10.1016/S0140-6736(06)68070-7.CrossRef
14.
Krieger N, Williams DR, Moss NE: Measuring Social Class in US Public Health Research: Concepts, Methodologies, and Guidelines. Annual Review of Public Health. 1997, 18 (1): 341-378. 10.1146/annurev.publhealth.18.1.341.CrossRefPubMed
15.
Filmer D, Pritchett LH: Estimating wealth effects without expenditure data- or tears: an application to educational enrollments in states of India. Demography. 2001, 38: 115-132.PubMed
16.
Gwatkin DR: Health inequalities and the health of the poor: what do we know? What can we do?. Bulletin of the World Health Organization. 2000, 78 (1): 3-18.PubMedCentralPubMed
17.
Filmer D, Pritchett L: Estimating wealth effects without expenditure data- or tears: an application to educational enrollments in states of India. Demography. 2001, 38: 115-132.PubMed
18.
Cortinovis I, Vela V, Ndiku J: Construction of a socio-economic index to facilitate analysis of health in data in developing countries. Social Science & Medicine. 1993, 36: 1087-1097.CrossRef
19.
McKenzie DJ: Measure inequality with asset indicators. BREAD Working Paper No. 042. 2003, Harvard University, Bureau for Research and Economic Analysis of Development, Center for International Development
20.
Bicego GT, Boerma JT: Maternal education and child survival: a comparative study of survey data from 17 countries. Social science & medicine (1982). 1993, 36 (9): 1207-1227.CrossRef
21.
Timaeus I, Louision L: Intra-urban differentials in child health. Health Transition Review. 1995, 5 (2): 163-190.
22.
Brockerhoff M, Hewett P: Inequality of child mortality among ethnic groups in sub-Saharan Africa. Bulletin of the World Health Organization. 2000, 78 (1): 30-41.PubMedCentralPubMed
23.
Justesen A, Kunst A: Post neonatal and child mortality among twins in Southern and Eastern Africa. International Journal of Epidemiology. 2000, 29 (4): 678-683. 10.1093/ije/29.4.678.CrossRefPubMed
24.
Devin RB, Erickson PI: The influence of male care givers on child health in rural Haiti. Social Science & Medicine. 1996, 43 (4): 479-488.CrossRef
25.
Yassin KM: Indices and sociodemographic determinants of childhood mortality in rural Upper Egypt. Social Science & Medicine. 2000, 51 (2): 185-197.CrossRef
26.
Hoa DP, Hojer B, Persson LA: Are there social inequities in child morbidity and mortality in rural Vietnam. Journal of tropical pediatrics. 1997, 43 (4): 226-231. 10.1093/tropej/43.4.226.CrossRefPubMed
27.
Houweling T, Kunst A, Mackenbach J: Measuring health inequality among children in developing countries: does the choice of the indicator of economic status matter?. International Journal for Equity in Health. 2003, 2 (1): 8-10.1186/1475-9276-2-8.PubMedCentralCrossRefPubMed
28.
Kakwani NC, Wagstaff A, van Doorslaer E: Socioeconomic inequalities in Health: Measurement, Computation and Statistical inference. Journal of Econometrics. 1997, 77 (1): 87-104. 10.1016/S0304-4076(96)01807-6.CrossRef
29.
Wagstaff A, Van Doorslaer E: Equity in Health Care Finance and Delivery. North Holland Handbook of Health Economics. 1998
30.
Gwatkin D, Rustein S, Johnson K, Pande R, Wagstaff A: Initial Country-Level Information about Socio-Economic Differentials in Health, Nutrition and Population, Volumes I AND II. 2003, Washington DC World Bank Health, Population and Nutrition
31.
Wagstaff A: "Socioeconomic Inequalities in Child Mortality: Comparisons across Nine Developing Countries". Bulletin of the World Health Organisation. 2000, 78 (1): 19-29.
32.
Wagstaff A, van Doorslaer E, Watanabe N: "On Decomposing the Causes of Health Sector Inequalities, with an Application to Malnutrition Inequalities in Vietnam". Journal of Econometrics. 2003, 112 (1): 219-227. 10.1016/S0304-4076(02)00161-6.CrossRef
33.
McKenzie DJ: Measuring inequality with asset indicators. Journal of Population Economics. 2005, 18: 229-260. 10.1007/s00148-005-0224-7.CrossRef
34.
O'Donnel O, van Doorslaer E, Wagstaff A, Lindelow M: Analyzing Health Equity Using Household Survey Data A Guide to Techniques and Their Implementation. Washington DC WBI LEARNING RESOURCES SERIES. 2008
35.
Doherty T: HIV and Infant Feeding: Operational Challenges of Achieving Safe Infant Feeding Practices. 2006, Uppsala University Department of Women's and Children's Health
36.
Jackson D, Chopra M, Doherty TM, Colvin MS, Levin JB, Willumsen JF, Goga AE, Moodley P: Operational effectiveness and 36 week HIV-free survival in the South African programme to prevent mother-to-child transmission of HIV-1. AIDS. 2007, 21 (4): 509-516. 10.1097/QAD.0b013e32801424d2.CrossRefPubMed
37.
StataCorp: Stata Statistical Software. Release 9.0. College station edition. 2003, TX: Stata Corporation
38.
39.
Norman R, Bradshaw D, Nannan N, Lewin S, Thomas E, Mathee A, Barnes B: Assessing the attributable burden of selected environmental risk factors in South Africa. The 3rd Public Health Conference "Making Health Systems Work" Public Health Association of South Africa (PHASA). Johannesburg, South Africa. 2006
40.
Phashwana-Mafuya N: Hygiene status of rural communities in the Eastern Cape Province. The 3rd Public Health Conference "Making Health Systems Work" Public Health Association of South Africa (PHASA). Johannesburg, South Africa. 2006
41.
Mathee A, Joffe A, Naidoo S: An overview of children's environmental health in South Africa: The long walk ahead. The 3rd Public Health Conference "Making Health Systems Work" Public Health Association of South Africa (PHASA). Johannesburg, South Africa. 2006
42.
Wandwalo E, Robberstad B, Morkve O: Cost and cost-effectiveness of community based and health facility based directly observed treatment of tuberculosis in Dar es Salaam, Tanzania. Cost Effectiveness and Resource Allocation. 2005, 3 (1): 6-10.1186/1478-7547-3-6.PubMedCentralCrossRefPubMed
43.
Nkonki L, Daniels K, group P-Es: Selling a service: experiences of peer supporters while promoting exclusive infant feeding in three sites in South Africa. International Breastfeeding Journal. 2010, 5 (1): 17-PubMedCentralCrossRefPubMed
44.
Day C, Gray A: International Perspective on Primary Health Care Over the Past 30 Years. South African Health Review. Edited by: Barron P, Roma-Reardon J. 2008, Durban: Health Systems Trust
45.
Castro-Leal F, Dayton J, Demery L, Mehra K: Public spending on health care in Africa: do the poor benefit?. Bulletin of the World Health Organization. 2000, 78 (1): 66-74.PubMedCentralPubMed
46.
Wagstaff A, Bustreo F, Bryce J, Claeson M: Child health: reaching the poor. American journal of public health. 2004, 94 (5): 726-736. 10.2105/AJPH.94.5.726.PubMedCentralCrossRefPubMed
Metadata
Title
Explaining household socio-economic related child health inequalities using multiple methods in three diverse settings in South Africa
Authors
Lungiswa L Nkonki
Mickey Chopra
Tanya M Doherty
Debra Jackson
Bjarne Robberstad
Publication date
01-12-2011
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2011
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/1475-9276-10-13

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