Determinants of Child Mortality: A Study of Squatter Settlements in Jordan

Abstract

It is argued that the problems generated by institutions and conditions of todays cities necessitate a more precise formulation of the social determinants of health and mortality in the light of progress made in understanding the biological mechanisms of disease causation. In addition the health consequences of social policy need to become an integral part of problem definition and evaluation. The Amman upgrading project is concerned primarily with legalization of tenure and physical improvements but also includes action in a number of areas of social and economic development. The general question is whether the health of poor urban dwellers is improved by such projects. An important test of success is how much better peoples lives are made by the investment of resources. Among the benefits a principal that would make people willing to bear the costs is health. The present study looks into that prospect in the particular setting of Ammans squatter settlements. Basic objectives were: 1) to provide a baseline assessment of health conditions; and 2) to define how existing living conditions and family behavior operate as determinants of child health and mortality. The focus of the health study is on infants and young children up to the age of 3. The framework adopted is based on the premise that the social conditions of life are determinants of child survival and that these determinants make their impact through a set of intermediate mechanisms that can be decomposed analytically. Within this multilayered framework disease and death are direct consequences of a set of factors originating in the social conditions of life and behavior of families. The relationship of determinants at different levels of proximity to health outcomes and mortality is examined in 3 steps. 1st following the traditional way of identifying and estimating the socioeconomic determinants of mortality the statistical relationships are described without indicating how the intermediate mechanisms are involved. The effect of the socioeconomic determiants on child mortality is evaluated by a multiple classification analysis (MCA) model. The socioeconomic determinants examined include mothers education quality of housing household income occupation of household head and effect of sex of child. Then the direct relationship of these determinants to the intermediate mechanisms is considered. 5 groups of behavioral factors are identified: maternal reproductive behavior; diet and feeding practices; hygiene; immunizations; and sickness care practices. Results highlight the importance of physical housing quality and maternal education on child health and mortality. The role played by head of households occupation and household income is not a consistently strong one.