Household structure, composition and child mortality in the unfolding antiretroviral therapy era in rural South Africa: comparative evidence from population surveillance, 2000–2015

BMJ Open · 5 authors, 5 centres

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TL;DR

The central result was that children living in nuclear households with both parents had the lowest risk of dying compared to all other household types.

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The study used longitudinal demographic surveillance data from two rural South African sites (2000-2015) to examine how household structure and kin presence relate to under-5 child mortality during the rollout of antiretroviral therapy (ART). The primary finding was that children in nuclear households with both parents had the lowest mortality risk. Limitations include a focus on matrilineal kin only, reliance on household membership data rather than detailed caregiving roles, and potential unmeasured confounders.

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cohort

SPECIALTY

public health

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ORIGINAL PAPER

PMC10030929

Household structure, composition and child mortality in the unfolding antiretroviral therapy era in rural South Africa: comparative evidence from population surveillance, 2000–2015

BMJ Open

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ABSTRACT

Abstract Objectives The structure and composition of the household has important influences on child mortality. However, little is known about these factors in HIV-endemic areas and how associations may change with the introduction and widespread availability of antiretroviral treatment (ART). We use comparative, longitudinal data from two demographic surveillance sites in rural South Africa (2000–2015) on mortality of children younger than 5 years (n=101 105). Design We use multilevel discrete time event history analysis to estimate children’s probability of dying by their matrilineal residential arrangements. We also test if associations have changed over time with ART availability. Setting Rural South Africa. Participants Children younger than 5 years (n=101 105). Results 3603 children died between 2000 and 2015. Mortality risks differed by co-residence patterns along with different types of kin present in the household. Children in nuclear households with both parents had the lowest risk of dying compared with all other household types. Associations with kin and child mortality were moderated by parental status. Having older siblings lowered the probability of dying only for children in a household with both parents (relative risk ratio (RRR)=0.736, 95% CI (0.633 to 0.855)). Only in the later ART period was there evidence that older adult kin lowered the probability of dying for children in single parent households (RRR=0.753, 95% CI (0.664 to 0.853)). Conclusions Our findings provide comparative evidence of how differential household profiles may place children at higher mortality risk. Formative research is needed to understand the role of other household kin in promoting child well-being, particularly in one-parent households that are increasingly prevalent. Keywords: public health, epidemiology, HIV & AIDS

CITATION EXPORT

Brian Houle, Chodziwadziwa Kabudula, Dickman Gareta et al.. Household structure, composition and child mortality in the unfolding antiretroviral therapy era in rural South Africa: comparative evidence from population surveillance, 2000–2015. BMJ Open. (2023). https://doi.org/10.1136/bmjopen-2022-070388

AUTHORS

5 · 5 CENTRES

Brian Houle, Chodziwadziwa Kabudula, Dickman Gareta, Kobus Herbst, Samuel J Clark

1School of Demography, The Australian National University, Canberra, Australian Capital Territory, Australia
2MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Acornhoek, South Africa
3Africa Health Research Institute, Somkhele, South Africa
4DSI-MRC South African Population Research Infrastructure Network (SAPRIN), Durban, South Africa
5Department of Sociology, The Ohio State University, Columbus, Ohio, USA