Household context and child mortality in rural South Africa: the effects of birth spacing, shared mortality, household composition and socio-economic status
Identifieur interne : 002186 ( Ncbi/Merge ); précédent : 002185; suivant : 002187Household 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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<author><name sortKey="Madhavan, Sangeetha" sort="Madhavan, Sangeetha" uniqKey="Madhavan S" first="Sangeetha" last="Madhavan">Sangeetha Madhavan</name>
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<country xml:lang="fr">Afrique du Sud</country>
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<placeName><settlement type="city">Johannesbourg</settlement>
<region type="region" nuts="2">Gauteng</region>
</placeName>
</affiliation>
<affiliation wicri:level="2"><nlm:aff wicri:cut=" and" id="dyt149-AFF1">Department of African-American Studies, University of Maryland-College Park, College Park, MD, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of African-American Studies, University of Maryland-College Park, College Park, MD</wicri:regionArea>
<placeName><region type="state">Maryland</region>
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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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<country xml:lang="fr">Afrique du Sud</country>
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<orgName type="university">Université du Witwatersrand</orgName>
<placeName><settlement type="city">Johannesbourg</settlement>
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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>
<wicri:regionArea>Centre for Global Health Research, Umeå University, Umeå</wicri:regionArea>
<wicri:noRegion>Umeå</wicri:noRegion>
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<affiliation wicri:level="3"><nlm:aff id="dyt149-AFF1">INDEPTH Network, Accra, Ghana,</nlm:aff>
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<placeName><settlement type="city">Accra</settlement>
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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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<country xml:lang="fr">Afrique du Sud</country>
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<orgName type="university">Université du Witwatersrand</orgName>
<placeName><settlement type="city">Johannesbourg</settlement>
<region type="region" nuts="2">Gauteng</region>
</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>
<wicri:regionArea>Centre for Global Health Research, Umeå University, Umeå</wicri:regionArea>
<wicri:noRegion>Umeå</wicri:noRegion>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="dyt149-AFF1">INDEPTH Network, Accra, Ghana,</nlm:aff>
<country xml:lang="fr">Ghana</country>
<wicri:regionArea>INDEPTH Network, Accra</wicri:regionArea>
<placeName><settlement type="city">Accra</settlement>
<region nuts="2">Région du Grand Accra</region>
</placeName>
</affiliation>
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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>
<affiliation wicri:level="2"><nlm:aff id="dyt149-AFF1">Institute of Behavioral Science (IBS), University of Colorado at Boulder, Boulder, CO, USA,</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Institute of Behavioral Science (IBS), University of Colorado at Boulder, Boulder, CO</wicri:regionArea>
<placeName><region type="state">Colorado</region>
</placeName>
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<country xml:lang="fr">Afrique du Sud</country>
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<orgName type="university">Université du Witwatersrand</orgName>
<placeName><settlement type="city">Johannesbourg</settlement>
<region type="region" nuts="2">Gauteng</region>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="dyt149-AFF1">INDEPTH Network, Accra, Ghana,</nlm:aff>
<country xml:lang="fr">Ghana</country>
<wicri:regionArea>INDEPTH Network, Accra</wicri:regionArea>
<placeName><settlement type="city">Accra</settlement>
<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>
<wicri:regionArea>Department of Sociology, University of Washington, Seattle, WA</wicri:regionArea>
<placeName><region type="state">Washington (État)</region>
<settlement type="city">Seattle</settlement>
</placeName>
<orgName type="university">Université de Washington</orgName>
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<series><title level="j">International Journal of Epidemiology</title>
<idno type="ISSN">0300-5771</idno>
<idno type="eISSN">1464-3685</idno>
<imprint><date when="2013">2013</date>
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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>
</front>
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</back>
</TEI>
<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Epidemiol</journal-id>
<journal-id journal-id-type="iso-abbrev">Int J Epidemiol</journal-id>
<journal-id journal-id-type="publisher-id">ije</journal-id>
<journal-id journal-id-type="hwp">intjepid</journal-id>
<journal-title-group><journal-title>International Journal of Epidemiology</journal-title>
</journal-title-group>
<issn pub-type="ppub">0300-5771</issn>
<issn pub-type="epub">1464-3685</issn>
<publisher><publisher-name>Oxford University Press</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">23912808</article-id>
<article-id pub-id-type="pmc">3807614</article-id>
<article-id pub-id-type="doi">10.1093/ije/dyt149</article-id>
<article-id pub-id-type="publisher-id">dyt149</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Inequalities</subject>
</subj-group>
</article-categories>
<title-group><article-title>Household context and child mortality in rural South Africa: the effects of birth spacing, shared mortality, household composition and socio-economic status</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Houle</surname>
<given-names>Brian</given-names>
</name>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>1</sup>
</xref>
<xref ref-type="corresp" rid="dyt149-COR1">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Stein</surname>
<given-names>Alan</given-names>
</name>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kahn</surname>
<given-names>Kathleen</given-names>
</name>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>4</sup>
</xref>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Madhavan</surname>
<given-names>Sangeetha</given-names>
</name>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Collinson</surname>
<given-names>Mark</given-names>
</name>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>4</sup>
</xref>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tollman</surname>
<given-names>Stephen M</given-names>
</name>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>4</sup>
</xref>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Clark</surname>
<given-names>Samuel J</given-names>
</name>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>5</sup>
</xref>
<xref ref-type="aff" rid="dyt149-AFF1"><sup>7</sup>
</xref>
</contrib>
</contrib-group>
<aff id="dyt149-AFF1"><sup>1</sup>
Institute of Behavioral Science (IBS), University of Colorado at Boulder, Boulder, CO, USA,<sup>2</sup>
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,<sup>3</sup>
Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK,<sup>4</sup>
Centre for Global Health Research, Umeå University, Umeå, Sweden,<sup>5</sup>
INDEPTH Network, Accra, Ghana,<sup>6</sup>
Department of African-American Studies, University of Maryland-College Park, College Park, MD, USA and<sup>7</sup>
Department of Sociology, University of Washington, Seattle, WA, USA</aff>
<author-notes><corresp id="dyt149-COR1">*Corresponding author. Institute of Behavioral Science, University of Colorado at Boulder, 1440 15th Street, 483 UCB, Boulder, CO 80309-0483, USA. E-mail: <email>brian.houle@colorado.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>10</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="epub"><day>2</day>
<month>8</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>2</day>
<month>8</month>
<year>2013</year>
</pub-date>
<pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
. </pmc-comment>
<volume>42</volume>
<issue>5</issue>
<fpage>1444</fpage>
<lpage>1454</lpage>
<history><date date-type="accepted"><day>25</day>
<month>6</month>
<year>2013</year>
</date>
</history>
<permissions><copyright-statement>Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2013.</copyright-statement>
<copyright-year>2013</copyright-year>
<license license-type="creative-commons" xlink:href="http://creativecommons.org/licenses/by/3.0/"><license-p><pmc-comment>CREATIVE COMMONS</pmc-comment>
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/3.0/">http://creativecommons.org/licenses/by/3.0/</ext-link>
), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><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>
</abstract>
<kwd-group><kwd>Child mortality</kwd>
<kwd>socio-economic status</kwd>
<kwd>HIV</kwd>
<kwd>birth spacing</kwd>
<kwd>household</kwd>
<kwd>health and demographic surveillance system</kwd>
<kwd>rural</kwd>
<kwd>South Africa</kwd>
</kwd-group>
<counts><page-count count="11"></page-count>
</counts>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Afrique du Sud</li>
<li>Ghana</li>
<li>Royaume-Uni</li>
<li>Suède</li>
<li>États-Unis</li>
</country>
<region><li>Angleterre</li>
<li>Colorado</li>
<li>Gauteng</li>
<li>Maryland</li>
<li>Oxfordshire</li>
<li>Région du Grand Accra</li>
<li>Washington (État)</li>
</region>
<settlement><li>Accra</li>
<li>Johannesbourg</li>
<li>Oxford</li>
<li>Seattle</li>
</settlement>
<orgName><li>Université d'Oxford</li>
<li>Université de Washington</li>
<li>Université du Witwatersrand</li>
</orgName>
</list>
<tree><country name="États-Unis"><region name="Colorado"><name sortKey="Houle, Brian" sort="Houle, Brian" uniqKey="Houle B" first="Brian" last="Houle">Brian Houle</name>
</region>
<name sortKey="Clark, Samuel J" sort="Clark, Samuel J" uniqKey="Clark S" first="Samuel J" last="Clark">Samuel J. Clark</name>
<name sortKey="Clark, Samuel J" sort="Clark, Samuel J" uniqKey="Clark S" first="Samuel J" last="Clark">Samuel J. Clark</name>
<name sortKey="Madhavan, Sangeetha" sort="Madhavan, Sangeetha" uniqKey="Madhavan S" first="Sangeetha" last="Madhavan">Sangeetha Madhavan</name>
</country>
<country name="Afrique du Sud"><region name="Gauteng"><name sortKey="Stein, Alan" sort="Stein, Alan" uniqKey="Stein A" first="Alan" last="Stein">Alan Stein</name>
</region>
<name sortKey="Clark, Samuel J" sort="Clark, Samuel J" uniqKey="Clark S" first="Samuel J" last="Clark">Samuel J. Clark</name>
<name sortKey="Collinson, Mark" sort="Collinson, Mark" uniqKey="Collinson M" first="Mark" last="Collinson">Mark Collinson</name>
<name sortKey="Kahn, Kathleen" sort="Kahn, Kathleen" uniqKey="Kahn K" first="Kathleen" last="Kahn">Kathleen Kahn</name>
<name sortKey="Madhavan, Sangeetha" sort="Madhavan, Sangeetha" uniqKey="Madhavan S" first="Sangeetha" last="Madhavan">Sangeetha Madhavan</name>
<name sortKey="Tollman, Stephen M" sort="Tollman, Stephen M" uniqKey="Tollman S" first="Stephen M" last="Tollman">Stephen M. Tollman</name>
</country>
<country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Stein, Alan" sort="Stein, Alan" uniqKey="Stein A" first="Alan" last="Stein">Alan Stein</name>
</region>
</country>
<country name="Suède"><noRegion><name sortKey="Kahn, Kathleen" sort="Kahn, Kathleen" uniqKey="Kahn K" first="Kathleen" last="Kahn">Kathleen Kahn</name>
</noRegion>
<name sortKey="Collinson, Mark" sort="Collinson, Mark" uniqKey="Collinson M" first="Mark" last="Collinson">Mark Collinson</name>
<name sortKey="Tollman, Stephen M" sort="Tollman, Stephen M" uniqKey="Tollman S" first="Stephen M" last="Tollman">Stephen M. Tollman</name>
</country>
<country name="Ghana"><region name="Région du Grand Accra"><name sortKey="Kahn, Kathleen" sort="Kahn, Kathleen" uniqKey="Kahn K" first="Kathleen" last="Kahn">Kathleen Kahn</name>
</region>
<name sortKey="Clark, Samuel J" sort="Clark, Samuel J" uniqKey="Clark S" first="Samuel J" last="Clark">Samuel J. Clark</name>
<name sortKey="Collinson, Mark" sort="Collinson, Mark" uniqKey="Collinson M" first="Mark" last="Collinson">Mark Collinson</name>
<name sortKey="Tollman, Stephen M" sort="Tollman, Stephen M" uniqKey="Tollman S" first="Stephen M" last="Tollman">Stephen M. Tollman</name>
</country>
</tree>
</affiliations>
</record>
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