1. Household Structure and Household Structure and Childhood Mortality in Ghana Childhood Mortality in Ghana Winfred Avogo Victor Agadjanian Department of Sociology/ Center for Population Dynamics, Arizona State University

2. 2 Introduction Child mortality public health priority in Africa Analysis show mortality decline has stalled Focus on socio-economic & biological factors Little known about influence of living arrangements of children on child mortality Examine household structure within cultural and socio-economic context children live

3. 3 Chart trends in childhood mortality from 1993- 2003 Estimate effect of household structure on child survival Examine variations of household structure and child survival across rural and urban areas Objectives

4. 4 Ghana; population of 20 million in West Africa Economy stable; estimated poverty rate at 35% of population 25% Urban and 75% rural Young population with 46.9% 0-14 Overall life expectancy of 59.6 for females and 55.4 for males Setting

5. 5 Three major theoretical perspectives: ‘New household economic models’ Becker, 1981; Schultz, 1974  Critically examine household as a single entity  Resource pooling within the family  Household boundaries and resource availability Literature on socioeconomic influences on child survival Biological proximate determinants of child survival Theoretical framework

6. 6 Hypotheses Children in nuclear households have health advantage if constraints to resource pooling exist Effects of nuclear households depend on mother’s education and socio-economic status Effects mediated by bio-demographics of mother and utilization of maternal services Effects of household structure stronger in rural than in urban areas

7. 7 Ghana Demographic Health Surveys (GDHS), cross- sectional; 1993, 1998 & 2003 Sample size: 6351 last born children Statistical Model Discrete-time logistics models  5 Age intervals specified  Each child contributes 1-5 observations depending on age at death or censoring Data and Methods

8. 8 Outcome Variable:  Childhood mortality: probability of dying from birth to age 5 Main predictor: Household structure: two broad forms:  (1) Elementary: nuclear & single-parent Households  (2) Extended:three generational & lateral households Control variables: person months lived, socio- economic, bio-demographic, maternal health factors

9. 9 Analytical Strategies  Model 1: Household structure, 2: socio- economic, 3: biological and maternal utilization  Urban and Rural Areas: Same model specification

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13. 13 Figure 4: Child Survival Estimates by Household Structure

14. 14 Multivariate Results *= <.05, ** = <.01 + = <.1

15. 15 Extended households seem to have negative impact on child mortality Household structure important for rural areas does not appear so in urban areas Cost of health care, social inequalities may explain effects of household structure in rural and urban areas Education and standard of living more important in urban areas Summary of findings

16. 16 Conclusion and Implications  Community level health interventions need to adjust to specific needs of household forms More research is needed to identify vulnerable children in changing household situations Comprehensive sociological models needed to account for household effects

17. 17 THANK YOU