Lartey Stella T, Khanam Rasheda, Takahashi Shingo
Ministry of Health, Accra, Ghana.
School of Commerce, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Queensland, 4350, Australia.
J Health Popul Nutr. 2016 Nov 22;35(1):38. doi: 10.1186/s41043-016-0074-9.
Improving child health is one of the major policy agendas for most of the governments, especially in the developing countries. These governments have been implementing various strategies such as improving healthcare financing, improving access to health, increasing educational level, and income level of the household to improve child health. Despite all these efforts, under-five and infant mortality rates remain high in many developing nations. Some previous studies examined how economic development or household's economic condition contributes to child survival in developing countries. In Ghana, the question as to what extent does economic circumstances of households reduces infant and child mortality still remain largely unanswered. Thus, the purpose of this study is to investigate the extent to which wealth affects the survival of under-five children, using data from the Demographic and Health Survey (DHS) of Ghana.
In this study, we use four waves of data from Demographic and Health Surveys (DHS) of Ghana from 1993 to 2008. The DHS is a detailed data set that provides comprehensive information on households and their demographic characteristics in Ghana. Data was obtained by distributing questionnaires to women (from 6000 households) of reproductive age between 15 and 49 years, which asked, among other things, their birth history information. The Weibull hazard model with gamma frailty was used to estimate wealth effect, as well as the trend of wealth effect on child's survival probability.
We find that household wealth status has a significant effect on the child survival in Ghana. A child is more likely to survive when he/she is from a household with high wealth status. Among other factors, birth spacing and parental education were found to be highly significant to increase a child's survival probability.
Our findings offer plausible mechanisms for the association of household wealth and child survival. We therefore suggest that the Government of Ghana strengthens and sustains improved livelihood programs, which reduce poverty. They should also take further initiatives that will increase adult education and improve health knowledge. To the best of our knowledge, this is the first study in Ghana that combines four cross sectional data sets from DHS to study a policy-relevant question. We extend Standard Weibull hazard model into Weibull hazard model with gamma frailty, which gives us a more accurate estimation. Finally, the findings of this study are of interest not only because they provide insights into the determinants of child health in Ghana and other developing countries, but they also suggest policies beyond the scope of health.
改善儿童健康是大多数政府的主要政策议程之一，尤其是在发展中国家。这些政府一直在实施各种战略，如改善医疗保健融资、增加获得医疗服务的机会、提高教育水平以及家庭收入水平，以改善儿童健康。尽管做出了所有这些努力，但许多发展中国家的五岁以下儿童和婴儿死亡率仍然很高。一些先前的研究探讨了经济发展或家庭经济状况如何影响发展中国家儿童的生存。在加纳，家庭经济状况在多大程度上降低婴儿和儿童死亡率的问题在很大程度上仍未得到解答。因此，本研究的目的是利用加纳人口与健康调查（DHS）的数据，调查财富对五岁以下儿童生存的影响程度。
在本研究中，我们使用了1993年至2008年加纳人口与健康调查（DHS）的四轮数据。DHS是一个详细的数据集，提供了加纳家庭及其人口特征的全面信息。数据是通过向15至49岁的育龄妇女（来自6000户家庭）发放问卷获得的，问卷除其他外还询问了她们的生育史信息。使用带有伽马脆弱性的威布尔风险模型来估计财富效应以及财富效应在儿童生存概率上的趋势。
我们发现家庭财富状况对加纳儿童的生存有显著影响。当一个孩子来自高财富家庭时，他/她更有可能存活。在其他因素中，生育间隔和父母教育被发现对提高儿童生存概率非常重要。
我们的研究结果为家庭财富与儿童生存之间的关联提供了合理的机制。因此，我们建议加纳政府加强并维持改善生计的项目，以减少贫困。他们还应采取进一步举措，增加成人教育并提高健康知识。据我们所知，这是加纳第一项结合来自DHS的四个横断面数据集来研究一个与政策相关问题的研究。我们将标准威布尔风险模型扩展为带有伽马脆弱性的威布尔风险模型，这使我们能够进行更准确的估计。最后，本研究的结果不仅因其提供了对加纳和其他发展中国家儿童健康决定因素的见解而受到关注，还因其提出了超出健康范围的政策建议。
