Association Between Household Resources and Child Mortality: Ghana as a Case Study

Purpose: Child mortality, defined as death of infants and children under age of five years (United Nations, 2010) is an important measure of child health as well as an indicator of the overall health status of a country or region (Avogo & Agadjanian, 2010). Child mortality is often used as one of the strongest indicators of a country’s wellbeing, as it reflects social, economic and environmental conditions, as well as access to health care (Alderman & Behrman, 2004). Children are more vulnerable to all kinds of hazards than adults as they are dependent on parents or other care takers to provide what they need in order to survive. Furthermore, a child’s chances of survival are greatly dependent on adequate nutrition, immunization and environmental hygiene (Andoh, Umezaki, Nakamura, Kizuki, & Takano, 2007; Skolnik, 2008).Several research studies conducted recently on the impact of social determinants of health and household resources on child mortality have found that economic status of the household defined by possession of certain assets such as electricity, toilet facilities, source of drinking, water, type of fuel for cooking, roofing and flooring materials, were found to influence child mortality (Godson & Nnamdi, 2012; Gyimah, 2006; Kabubo-Mariara, Karienyeh, & Mwangi, 2010). In a study conducted by Rutaremwa to examine child mortality differentials in the capital cities of East Africa and to establish whether there are substantial differences in infant and child mortality estimates in Nairobi, Dares-Salaam and Kampala, the incidence was highest among children of mothers residing in households with no toilet facility compared to those with flush toilets; furthermore, pipe-borne water was associated with lower odds of child mortality compared to well water. From this study it is clear that more proximal social determinants than rural versus urban residence have important roles to play in child survival (Rutaremwa, 2013). The current study therefore examined associations between household resources and child mortality in Ghana. The study answered the following research questions: (1) What household resources are associated with child mortality in Ghana? (2) Does the availability of household resources contribute to child mortality over and above the influence of other measures of socioeconomic status?

Methods: This cross-sectional descriptive study analyzed the 2007 Ghana Maternal Health Survey (GMHS), the first and the only maternal health survey conducted in Ghana (Ghana Statistical Service, 2009). The primary data were collected in two-phases of fieldwork. In phase I, a nationally representative sample of 240,000 households was selected from the 10 administrative regions of Ghana across rural and urban areas, out of which 226,209 completed the household questionnaire. We analyzed the data using STATA version 13 (College Station, TX). Descriptive inferential statistics were used to summarize the means of continuous variables and proportions of categorical variables and to cross-tabulate each variable, including the household resources, by maternal report of child death in the full sample and in the sample stratified by rurality of residence. Means were compared statistically with t-tests and proportions with chi-square tests. We examined the household resources and other variables for their intra-class correlations and assessed whether variable reduction strategies (i.e. factor analysis) were required. Logistic regression analysis was used to examine the association between household resources and child mortality, controlling for the covariates. In all of the analyses, survey weights were applied to account for the complex survey design.

Results: Women who resided in the urban area were more likely to report access to all the household resources measured than those in rural area, except kerosene lantern for which more rural women reported possession. In unadjusted comparisons, a significantly lower proportion of women who reported possession of each of the household resources reported child mortality with one exception. There was no significant difference in the proportion of women reporting child mortality by the reported number of sleeping rooms. Women who had primary, middle school and secondary or tertiary education had lower odds of reporting child mortality as compared to those who had no education. The odds ratios ranged from 0.78 [95% CI: 0.65, 0.94] for primary school to 0.55 [95% CI: 0.38, 0.78] for those who had secondary or tertiary education. In the model restricted to women living in rural areas, none of the household resources were associated with child mortality. In contrast, in the model restricted to women living in urban areas and towns, having refrigerator at the time of interview was associated with lower odds of reporting child mortality 0.63 [95% CI: 0.48, 0.83]; whereas, having a kerosene lantern [AOR=1.40; 95% CI: 1.06, 1.85] or flush toilet [AOR=1.84; [95% CI: 1.23, 2.75] was associated with higher odds of reporting child mortality.

Conclusion: Possession of a refrigerator may play a role in child mortality, particularly in urban areas. This finding may reflect unmeasured SES or the importance of access to refrigeration in preventing diarrheal disease or other proximal causes of child mortality in sub-Saharan Africa. Further studies should focus on understanding the association of household resources and child mortality in rural areas and the contribution of community socio-economic attributes to child mortality.