Bidzha Mashudu Lucas, Ngepah Nicholas, Greyling Talita
School of Economics, University of Johannesburg, Corner Kingsway and University Road, Auckland Park, 2006, South Africa.
SSM Popul Health. 2024 Apr 16;26:101671. doi: 10.1016/j.ssmph.2024.101671. eCollection 2024 Jun.
Although there is sufficient evidence in the epidemiological literature that antiretroviral treatment (ART) reduces child mortality, there is limited evidence of its effect in the socio-economic determinants of child mortality literature. Furthermore, evidence on the effect of child focused unconditional cash transfers (UCTs) on child mortality is limited, especially in the African context. Using South Africa's provincial level data over the period 2001 to 2019, we evaluate the effect of ART and child focused UCTs on child mortality. We use the two-stage instrumental variable mean group estimator. We find that ART reduces child mortality. Moreover, we find an inverted U-shaped non-linear relationship between UCTs and child mortality that is contingent to the level of cash transfer coverage. Our analyses also reveal that UCTs improve the effect of ART on child mortality by enhancing access and adherence to treatment. While the focus of our analyses was on the child mortality effects of ART and UCTs, our findings reaffirm the well-documented impacts of factors such as public health expenditure, HIV/AIDS, female education, and health worker density on child mortality. Collectively, the combination of high ART and UCTs coverage, increased public health expenditure, enhanced female education, and improved health worker density, represents value for money for policymakers and funders. These areas should be prioritised to improve child well-being.
尽管流行病学文献中有充分证据表明抗逆转录病毒治疗(ART)可降低儿童死亡率,但在儿童死亡率的社会经济决定因素文献中,其效果的证据有限。此外,关于以儿童为重点的无条件现金转移(UCTs)对儿童死亡率影响的证据也很有限,尤其是在非洲背景下。利用南非2001年至2019年的省级数据,我们评估了ART和以儿童为重点的UCTs对儿童死亡率的影响。我们使用两阶段工具变量均值组估计器。我们发现ART可降低儿童死亡率。此外,我们发现UCTs与儿童死亡率之间存在倒U形非线性关系,这取决于现金转移覆盖水平。我们的分析还表明,UCTs通过增加治疗的可及性和依从性,提高了ART对儿童死亡率的影响。虽然我们分析的重点是ART和UCTs对儿童死亡率的影响,但我们的研究结果再次证实了公共卫生支出、艾滋病毒/艾滋病、女性教育和卫生工作者密度等因素对儿童死亡率的影响,这已得到充分记录。总体而言,高ART和UCTs覆盖率、增加公共卫生支出、提高女性教育水平以及改善卫生工作者密度的综合作用,对政策制定者和资助者来说具有成本效益。这些领域应被优先考虑以改善儿童福祉。