Abstract
BackgroundDespite 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 outcomesMethodsThe 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.ResultsWe 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.ConclusionThis 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.
Highlights
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
Each socio-economic position quintile had about 20% of households in this population. 81% (123/151) of infants (
The differences in immunisation coverage suggest that the use of this free healthcare is uneven
Summary
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. South Africa is the most consistently unequal economy in the world; the Gini coefficient (measure of income inequality) has increased from 0.64 in 1994 to 0.72 in 2005[1]. These inequalities are most obvious in child health outcomes [2] Evidence suggests that unless equality is explicitly measured and addressed, public health interventions tend to perpetuate existing inequalities [3]. Leon & Gwatkin [4] have pointed out that Millennium Development Goals (MDGs) could be reached globally while child health inequalities increase. Relying solely on race and geography in order to analyse equality is becoming less useful
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