Introduction
Household Structure and
Childhood Mortality in Ghana
Winfred Avogo
Victor Agadjanian
Department of Sociology/
Center for Population Dynamics, Arizona State
University
„
Child mortality public health priority in Africa
„
Analysis show mortality decline has stalled
„
Focus on socio-economic & biological factors
„
Little known about influence of living arrangements
of children on child mortality
„
Examine household structure within cultural and
socio-economic context children live
Setting
Objectives
„
„
„
2
„
Ghana; population of 20 million in West Africa
Estimate effect of household structure on child
survival
„
Economy stable; estimated poverty rate at 35% of
population
Examine variations of household structure and child
survival across rural and urban areas
„
25% Urban and 75% rural
„
Young population with 46.9% 0-14
Chart trends in childhood mortality from 1993- 2003
„
3
Overall life expectancy of 59.6 for females and 55.4
for males
4
Hypotheses
Theoretical framework
Three major theoretical perspectives:
„ ‘New household economic models’ Becker, 1981;
Schultz, 1974
¾ Critically examine household as a single entity
¾ Resource pooling within the family
¾ Household boundaries and resource availability
„ Literature on socioeconomic influences on child
survival
„ Biological proximate determinants of child survival
5
„
„
„
„
Children in nuclear households have health
advantage if constraints to resource pooling exist
Effects of nuclear households depend on mother’s
education and socio-economic status
Effects mediated by bio-demographics of mother
and utilization of maternal services
Effects of household structure stronger in rural
than in urban areas
6
1
Data and Methods
„
Ghana Demographic Health Surveys (GDHS), crosssectional; 1993, 1998 & 2003
Sample size: 6351 last born children
•Outcome Variable:
¾Childhood mortality: probability of dying from
birth to age 5
•Main predictor: Household structure: two broad
forms:
¾(1) Elementary: nuclear & single-parent Households
¾(2) Extended:three generational & lateral households
Statistical Model
„ Discrete-time logistics models
¾ 5 Age intervals specified
¾ Each child contributes 1-5 observations
depending on age at death or censoring
7
•Control variables: person months lived, socioeconomic, bio-demographic, maternal health factors
8
Figure 1: Household Structure
Analytical Strategies
¾ Model 1: Household structure, 2: socio-
Lateral extended
(20.36%)
economic, 3: biological and maternal utilization
¾ Urban and Rural Areas: Same model
specification
Nuclear
(49.28%)
Three
generational
(12.41%)
Single parent
(17.95%)
10
9
Household structure by selected characteristics
160
ild
ir th
de
108
111
100
80
77
66
60
57
64
40
20
0
1983-1987
1989-1993
1994-1998
1999-2003
Ch
ea
119
120
Approximate GDHS period
Infant mortality (1q0)
an
ag
at h
n
ba
tb
Ur
S
r al
Ru
S
w
Lo
m
Me
diu
SE
S
SE
uc
SE
gh
Hi
uc
Ed
No
uc
Ed
er
a ry
im
Pr
ig h
155
140
Nuclear
Single parent
Three generational
Lateral extended
Me
Se
c /H
180
Percent
Ed
90
80
70
60
50
40
30
20
10
0
Figure 3: Trends in Infant and Under-five Mortality Rates
Ghana 1988-2003
Deaths per 1000 Live
„
Data and Methods
Under-five mortality (5q0)
Selected Characteristics
11
12
2
Figure 4: Child Survival Estimates by Household Structure
Multivariate Results
Table : Odds ratio of the relationship between family structure and child death
All
Rural
Urban
Family Structure
Single-parent
1.06
0.87
1.08
Three-generational
1.59 +
1.89 *
1.11
Laterally extended
1.51 *
1.67 *
1.45
(Nuclear)
1
1
1
Month
('0)
1
1
1.00
'1-5
0.10 **
0.08
0.14 *
'6-11
0.09 **
0.08 *
0.08 *
'12-23
0.27 **
0.31
0.16
'24-59
0.58
0.78 *
0.27
Mother's eductaion
Secondary or Higher
0.63 +
0.82
0.78 **
Primary
0.71
0.60 *
0.32
(No education)
1
1
1
Standard of living index
High
0.27
0.81
0.27 **
Medium
0.51 *
1.09
0.61
( Low)
1
1
1
Prenatal care and delivery assistance
Received either
Received neither
(Received both)
13
„
„
0.82
0.80
1
1.241
1.58
1
14
Conclusion and Implications
Extended households seem to have negative impact on child
mortality
Household structure important for rural areas does not
appear so in urban areas
ƒ
„
Cost of health care, social inequalities may explain effects of
household structure in rural and urban areas
„
„
1
*= <.05, ** = <.01 + = <.1
Summary of findings
„
0.81
0.72
Education and standard of living more important in urban
areas
15
Community level health interventions need to
adjust to specific needs of household forms
More research is needed to identify vulnerable
children in changing household situations
Comprehensive sociological models needed to
account for household effects
16
THANK YOU
17
3