The dynamic role of household structure on under-5 mortality in southern and eastern sub-Saharan Africa
Date
2023-08-17
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Abstract
BACKGROUND
Children are born and grow up in households, where they receive essential care, including
time, socio-psychological support, and economic resources. Children’s immediate
environment, captured by household structure, changes over time.
OBJECTIVE
We evaluate the role of dynamic household structure in the risk of child death in southern
and eastern Africa.
METHODS
We use longitudinal data from 15 Health and Demographic Surveillance Systems
between 1990 and 2016, covering almost 282,000 under-5 year olds. We analyse under5 mortality using semi-parametric Cox models accounting for time-varying household
structure (household size and household typology) and controlling for maternal
characteristics.
RESULTS
We find that children in smaller households have a higher risk of death than those in large
households. In particular, children in households where they are the sole child with two
adults of opposite sexes have the lowest chances of survival, reflecting a first-child effect.