254688 Household context and child mortality: The effects of birth spacing, shared mortality, household composition, and socio-economic status

Tuesday, October 30, 2012

Brian Houle, PhD, MPH , Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO
Kathleen Kahn, PhD , MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt); School of Public Health, Faculty of Health Sci, University of the Witwatersrand, Johannesburg, South Africa
Stephen Tollman, PhD , Medical Research Council / University Unit in Rural Public Health and Health Transitions Research, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
Mark Collinson, PhD , MRC/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Acornhoek, South Africa
Alan Stein, FRCPsych , Department of Psychiatry, University of Oxford, Oxford, United Kingdom
Samuel Clark, PhD , Department of Sociology, University of Washington, Seattle, WA
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.

Learning Areas:
Epidemiology
Social and behavioral sciences

Learning Objectives:
Differentiate the effects of other children on child mortality, including birth spacing, timing of another child death, and the number of children in the household. Identify other household factors that influence child mortality in South Africa, including related adults and household socio-economic status. Assess the ability of these factors to help explain clustering of deaths in high-risk households.

Keywords: Child Health, International Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the lead analyst for several child mortality analyses in South Africa. I also have a background in demography, social statistics, and public health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.