Household context and child mortality: The effects of birth spacing, shared mortality, household composition, and socio-economic status

Studies in historical and developing countries find that household characteristics are important factors on the risk of dying for children. However, little is known about these effects in HIV endemic areas. We use data from 1994 – 2008 for children aged 0 – 5 years from the Agincourt health and demographic surveillance system site in South Africa. Discrete time event history analysis estimates children's probability of dying by sex, age, mother's cause of death, birth spacing, household members, other child mortality, and household SES. Children under 24 months of age whose subsequent sibling is born within 11 months experience increased risk of dying (OR 2.51 (1.10 – 5.73)). Children experience increased risk of dying during the 6 (OR 2.10 (1.23 – 3.57)), 3 – 5 (OR 3.01 (1.54 – 5.88)), and two months (OR 11.84 (7.64 – 18.34)) immediately before another child dies. Mortality risk remains high at the time of another child's death (OR 11.67 (6.29 – 21.67)) and for the two months following (OR 4.02 (1.88 – 8.59)). Having 4 – 5 (OR 1.57 (1.05 – 2.35)) children in the household elevates mortality risk. Having a related adult age 20 – 59 years in the household protects children from dying (OR 0.62 (0.46 – 0.83)). There is an inverse relation between child mortality and household SES. These results present a detailed risk profile for the effects of the household on child mortality.