Abstract
Background Household characteristics are important influences on the risk of child death. However, little is known about this influence in HIV-endemic areas. We describe the effects of household characteristics on children’s risk of dying in rural South Africa.Methods We use data describing the mortality of children younger than 5 years living in the Agincourt health and socio-demographic surveillance system study population in rural northeast South Africa during the period 1994–2008. Using discrete time event history analysis we estimate children’s probability of dying by child characteristics and household composition (other children and adults other than parents) (N = 924 818 child-months), and household socio-economic status (N = 501 732 child-months).Results Children under 24 months of age whose subsequent sibling was born within 11 months experience increased odds of dying (OR 2.5; 95% CI 1.1–5.7). Children also experience increased odds of dying in the period 6 months (OR 2.1; 95% CI 1.2–3.6), 3–5 months (OR 3.0; 95% CI 1.5–5.9), and 2 months (OR 11.8; 95% CI 7.6–18.3) before another household child dies. The odds of dying remain high at the time of another child’s death (OR 11.7; 95% CI 6.3–21.7) and for the 2 months following (OR 4.0; 95% CI 1.9–8.6). Having a related but non-parent adult aged 20–59 years in the household reduces the odds (OR 0.6; 95% CI 0.5–0.8). There is an inverse relationship between a child’s odds of dying and household socio-economic status.Conclusions This detailed household profile from a poor rural setting where HIV infection is endemic indicates that children are at high risk of dying when another child is very ill or has recently died. Short birth intervals and additional children in the household are further risk factors. Presence of a related adult is protective, as is higher socio-economic status. Such evidence can inform primary health care practice and facilitate targeting of community health worker efforts, especially when covering defined catchment areas.
Highlights
Reducing child mortality is a central MillenniumDevelopment Goal, and progress has been made in many regions, child mortality remains an important problem
Children under 24 months of age whose subsequent sibling was born within 11 months experience increased odds of dying
There is an inverse relationship between a child’s odds of dying and household socio-economic status. This detailed household profile from a poor rural setting where HIV infection is endemic indicates that children are at high risk of dying
Summary
Reducing child mortality is a central MillenniumDevelopment Goal, and progress has been made in many regions, child mortality remains an important problem. The highest mortality rates continue to be in sub-Saharan Africa where in 2009 one child in eight died before his or her fifth birthday.[1]. Studies in sub-Saharan Africa have shown how various factors influence child mortality, including parental survival and breastfeeding and their interaction with HIV infection.[2] The period following a mother’s death has been shown to be hazardous in many studies,[3,4,5,6,7] and it is evident that the risks for young children rise in the months before a mother’s death, as she becomes very unwell.[7]. Household characteristics are important influences on the risk of child death. We describe the effects of household characteristics on children’s risk of dying in rural South Africa
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
