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. 2011 Apr 4:10:13.
doi: 10.1186/1475-9276-10-13.

Explaining household socio-economic related child health inequalities using multiple methods in three diverse settings in South Africa

Lungiswa L Nkonki  1 , Mickey Chopra, Tanya M Doherty, Debra Jackson, Bjarne Robberstad
Affiliations

Explaining household socio-economic related child health inequalities using multiple methods in three diverse settings in South Africa

Lungiswa L Nkonki et al. Int J Equity Health. .

Abstract

Background: Despite free healthcare to pregnant women and children under the age of six, access to healthcare has failed to secure better child health outcomes amongst all children of the country. There is growing evidence of socioeconomic gradient on child health outcomes

Methods: The objectives of this study were to measure inequalities in child mortality, HIV transmission and vaccination coverage within a cohort of infants in South Africa. We also used the decomposition technique to identify the factors that contribute to the inequalities in these three child health outcomes. We used data from a prospective cohort study of mother-child pairs in three sites in South African. A relative index of household socio-economic status was developed using principal component analysis. This paper uses the concentration index to summarise inequalities in child mortality, HIV transmission and vaccination coverage.

Results: We observed disparities in the availability of infrastructure between least poor and most poor families, and inequalities in all measured child health outcomes. Overall, 75 (8.5%) infants died between birth and 36 weeks. Infant mortality and HIV transmission was higher among the poorest families within the sample. Immunisation coverage was higher among the least poor. The inequalities were mainly due to the area of residence and socio-economic position.

Conclusion: This study provides evidence that socio-economic inequalities are highly prevalent within the relatively poor black population. Poor socio-economic position exposes infants to ill health. In addition, the use of immunisation services was lower in the poor households. These inequalities need to be explicitly addressed in future programme planning to improve child health for all South Africans.

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Figures

Figure 1
Figure 1
Study profile. The left hand side of the figure above indicates all completed interviews at different interviewing periods. The positive and negative sign (+/-) indicates HIV positive and negative women respectively. The right hand side of the figure indicates all missing data which was a result of either mother moving or withdrawal from the study and child mortality.
Figure 2
Figure 2
Wealth quintiles and education. Primary- no education and successful completion of standard 1&2. Secondary - successful completion standard 3-9. Matric-successful completion of the last year of school.
Figure 3
Figure 3
Wealth quintiles and child health outcomes.
Figure 4
Figure 4
Concentration curve for child mortality <9 months.
Figure 5
Figure 5
Concentration curve for HIV transmission.
Figure 6
Figure 6
Concentration curve for Immunisation coverage.
See this image and copyright information in PMC

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