Household structure, composition and child mortality in the unfolding antiretroviral therapy era in rural South Africa: comparative evidence from population surveillance, 2000–2015
Date
2023-03-15
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Abstract
Objectives The structure and composition of the
household has important influences on child mortality.
However, little is known about these factors in HIVendemic areas and how associations may change with the
introduction and widespread availability of antiretroviral
treatment (ART). We use comparative, longitudinal data
from two demographic surveillance sites in rural South
Africa (2000–2015) on mortality of children younger than
5 years (n=101 105).
Design We use multilevel discrete time event history
analysis to estimate children’s probability of dying by
their matrilineal residential arrangements. We also test if
associations have changed over time with ART availability.
Setting Rural South Africa.
Participants Children younger than 5 years (n=101 105).
Results 3603 children died between 2000 and 2015.
Mortality risks differed by co-residence patterns along with
different types of kin present in the household. Children
in nuclear households with both parents had the lowest
risk of dying compared with all other household types.
Associations with kin and child mortality were moderated
by parental status. Having older siblings lowered the
probability of dying only for children in a household with
both parents (relative risk ratio (RRR)=0.736, 95%CI
(0.633 to 0.855)). Only in the later ART period was there
evidence that older adult kin lowered the probability of
dying for children in single parent households (RRR=0.753,
95%CI (0.664 to 0.853)).
Conclusions Our findings provide comparative evidence
of how differential household profiles may place children
at higher mortality risk. Formative research is needed to
understand the role of other household kin in promoting
child well-being, particularly in one-parent households that
are increasingly prevalent.