Household context and child mortality in rural South Africa: the effects of birth spacing, shared mortality, household composition and socio-economic status
Identifieur interne : 002718 ( Main/Merge ); précédent : 002717; suivant : 002719Household context and child mortality in rural South Africa: the effects of birth spacing, shared mortality, household composition and socio-economic status
Auteurs : Brian Houle [États-Unis] ; Alan Stein [Afrique du Sud, Royaume-Uni] ; Kathleen Kahn [Afrique du Sud, Suède, Ghana] ; Sangeetha Madhavan [Afrique du Sud, États-Unis] ; Mark Collinson [Afrique du Sud, Suède, Ghana] ; Stephen M. Tollman [Afrique du Sud, Suède, Ghana] ; Samuel J. Clark [États-Unis, Afrique du Sud, Ghana]Source :
- International Journal of Epidemiology [ 0300-5771 ] ; 2013.
Abstract
Url:
DOI: 10.1093/ije/dyt149
PubMed: 23912808
PubMed Central: 3807614
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PMC:3807614Le document en format XML
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<author><name sortKey="Collinson, Mark" sort="Collinson, Mark" uniqKey="Collinson M" first="Mark" last="Collinson">Mark Collinson</name>
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<author><name sortKey="Tollman, Stephen M" sort="Tollman, Stephen M" uniqKey="Tollman S" first="Stephen M" last="Tollman">Stephen M. Tollman</name>
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</placeName>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="dyt149-AFF1">Centre for Global Health Research, Umeå University, Umeå, Sweden,</nlm:aff>
<country xml:lang="fr">Suède</country>
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<wicri:noRegion>Umeå</wicri:noRegion>
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<author><name sortKey="Clark, Samuel J" sort="Clark, Samuel J" uniqKey="Clark S" first="Samuel J" last="Clark">Samuel J. Clark</name>
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<placeName><region type="state">Colorado</region>
</placeName>
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<region nuts="2">Région du Grand Accra</region>
</placeName>
</affiliation>
<affiliation wicri:level="4"><nlm:aff id="dyt149-AFF1">Department of Sociology, University of Washington, Seattle, WA, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
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<series><title level="j">International Journal of Epidemiology</title>
<idno type="ISSN">0300-5771</idno>
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<front><div type="abstract" xml:lang="en"><p><bold>Background</bold>
Household characteristics are important influences on the risk of child death. However, little is known about this influence in HIV-endemic areas. We describe the effects of household characteristics on children’s risk of dying in rural South Africa.</p>
<p><bold>Methods</bold>
We use data describing the mortality of children younger than 5 years living in the Agincourt health and socio-demographic surveillance system study population in rural northeast South Africa during the period 1994–2008. Using discrete time event history analysis we estimate children’s probability of dying by child characteristics and household composition (other children and adults other than parents) (<italic>N</italic>
= 924 818 child-months), and household socio-economic status (<italic>N</italic>
= 501 732 child-months).</p>
<p><bold>Results</bold>
Children under 24 months of age whose subsequent sibling was born within 11 months experience increased odds of dying (OR 2.5; 95% CI 1.1–5.7). Children also experience increased odds of dying in the period 6 months (OR 2.1; 95% CI 1.2–3.6), 3–5 months (OR 3.0; 95% CI 1.5–5.9), and 2 months (OR 11.8; 95% CI 7.6–18.3) before another household child dies. The odds of dying remain high at the time of another child’s death (OR 11.7; 95% CI 6.3–21.7) and for the 2 months following (OR 4.0; 95% CI 1.9–8.6). Having a related but non-parent adult aged 20–59 years in the household reduces the odds (OR 0.6; 95% CI 0.5–0.8). There is an inverse relationship between a child’s odds of dying and household socio-economic status.</p>
<p><bold>Conclusions</bold>
This detailed household profile from a poor rural setting where HIV infection is endemic indicates that children are at high risk of dying when another child is very ill or has recently died. Short birth intervals and additional children in the household are further risk factors. Presence of a related adult is protective, as is higher socio-economic status. Such evidence can inform primary health care practice and facilitate targeting of community health worker efforts, especially when covering defined catchment areas.</p>
</div>
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