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CSU 176/2011: CHILD HEALTH INEQUALITIES IN SOUTH AFRICA

Wednesday, 11th of May 2011 Print

Explaining household socio-economic related child health inequalities using multiple methods in three diverse settings in South Africa

From the authors' conclusions:

'The South African government provides free basic healthcare to pregnant women and children under 6 years of age. Despite this, the differences in immunisation coverage suggest that the use of this free healthcare is uneven. This is further supported by the differences found in HIV transmission and mortality. We believe that most of the inequalities observed in this study are avoidable and remediable, and that they are therefore unjust.

'In the light of these observations, it appears that child health programmes in South Africa need to be more explicitly designed to reduce inequalities in health.

'Programme planners should realise that universal rollout strategies are not sufficiently effective in reaching communities that have suffered chronic deprivation and marginalisation. Benefit incidence studies have shown the rich to benefit most from public investments in education and health compared to the poor [45].

'Furthermore, economic development translates faster into mortality trend declines among the better-off [3, 46]. Thus, it is important to recognise that an underlying lack of basic infrastructural services, such as running water, adequate sanitation and electricity, can undermine child health programmes such as prevention of mother to child transmission of HIV. Therefore, to ensure that children who are in greater need of health interventions access and benefit from health interventions, delivery strategies should specifically target them.

'The South African government should consider geographical targeting for future health service provision programmes. The National Community Health Worker (CHW) programme is currently under discussion. This could be an opportunity to reach the most poor as they are in greater need.'

 
 

Abstract

Background

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

Methods

The 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 socioeconomic

status was developed using principal component analysis. This paper uses the

concentration index to summarise inequalities in child mortality, HIV transmission and

vaccination coverage.

Results

We 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.

Conclusion

This 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.

http://www.equityhealthj.com/content/pdf/1475-9276-10-13.pdf

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