Child Mortality Rates in Africa: Exploring the Relationship between Poverty and Health

ASU

ECN 355 - Economics of Health Care

Date

Abstract (250 Words)

It is stated that a prosperous country is one that is healthy. However, the majority of Sub-

Saharan African (SSA) nations have poor health outcomes as a result of their poverty levels.

Poverty and health have been proven to be causally linked in both directions. Several studies

have found a relationship between poverty and health, and vice versa. However, there are few

studies in Africa that look at the relationship between poverty and poor health, and the results are

equivocal. The relationship between ill-health and poverty in Africa is investigated in this study,

which uses infant mortality rates as a proxy for health and the household income indices as a

substitute for poverty. We estimate the connection between health and poverty using data from

the WHO 2008-09 using two-stage least - square quintile regression approaches (mortality). The

findings reveal that infant mortality in Africa are influenced by, home type, mothers' education,

fresh water accessibility, sanitation, and cooking fuel, as well as the gender of the household

head. The goal of this project is to establish and execute programs and policies including

economic opportunities and parental education targeted at lowering child mortality and poverty,

especially in rural areas. Furthermore, it intends to inform African governments that they should

raise public knowledge about the need of sanitation and enhance basic health education

promotion in educational institutions. Most notably, it proposes that the authorities and other

development organizations boost the provision of clean water in rural regions and promote the

use of low-polluting fuels.

Keywords: Health, Poverty, Child Mortality, Millennium Development Goals, World Health

Organization, Sub-Saharan Africa, Empirical Data

JEL Classification: O13; O17; Q43; Q54

Child Mortality Rates in Africa: Exploring the Relationship between Poverty and Health

Introduction and Background (603 words)

Poverty and health are key indicators of human well-being, and their interactions are

intimately linked (Adams et al., 2003). Understanding the factors that influence health and

poverty, as well as how they change over time, has crucial policy implications. Numerous studies

have found a strong link between health and socioeconomic status (SES), which is frequently

assessed by income (Adams et al., 2003). Theoretically, there might be a positive or negative

relationship between socioeconomic level and health. On the one hand, low socioeconomic

position (for example, income poverty) can result in poor health owing to hunger and a lack of

access to healthcare. On the other side, when illness decreases one's capacity to work, it can lead

to poor income and consequently poverty

Poverty

Poverty is defined as a lack of adequate resources to sustain some normative functions

(Ravallion 2010). These include both basic survival requirements and the expenses of social

inclusion for engaging in economic and social activities (Ravallion 2010). Absolute poverty

refers to the cost of the bare essentials for human survival, whereas relative poverty refers to the

cost of the bare economic, social, political, and economic commodities necessary to maintain an

acceptable level of living in a particular community (World Bank, 2000). Food insecurity refers

to a person's inability to fulfill the minimal nutritional (calorie) needs for healthy growth as well

as human body maintenance. The amount of money needed to fulfill the suggested daily average

calorie allotment of 2,200 in accordance to the agreed-upon food basket is known as the food

poverty line. Poverty is defined as a lack of both non-food and food fundamental needs. Extreme

poverty happens when a person cannot satisfy her or his minimum calorie need even if she or he

spends all of her or his money on food (World Bank, 2000). Since colonial times, poverty has

become a big concern in Africa, as the number of countries have stayed relatively poor, with a

large number of unemployed and low-income individuals in their populations.

Africa's Healthcare Situation

Sub-Saharan Africa remains to have world's worst health care, with few countries capable

of spending between $35 and $40 each person for each year considered by World Health

Organization considers as the minimum for adequate treatment (World Bank, 2000).

Furthermore, despite rampant poverty, people's out-of-pocket healthcare costs accounts for half

of a region's total health spending. Significant progress has been made against HIV/AIDS,

tuberculosis, and malaria thanks to the generosity of donors. However, the bulk of the area lacks

adequate health-care infrastructure, and competent medical personnel are in short supply (World

Bank, 2000). As Africa's economies expand, the demand for better health care will only increase.

The Child Mortality Rate in Africa

Wright and Yogo (2012) says that Africa accounted for almost 14% of the global child

mortality burden in 1960. Despite having just 11% of the global population, Sub-Saharan Africa

currently accounts for more than half of all child mortality (Younger, 2011). Africa must seek to

bridge the gap as rapidly as possible if egvelopment goals are met, which is to reduce child

mortality by two-thirds, is to be realized. In 2003, the death rate for children as young of five

was 172 fatalities per 1000 live births, down from 188 in 1990. (Wolfson et al., 2010). The

Sustainable development goals ask for a 7.8% annual average rate of decline, whereas this

translates to a 9.5% total drop. A number of challenges must be overcome in order to reduce

child mortality in Africa (Wichman, 2016). Child mortality in Africa are thought to be linked to

caregivers' diminishing caring abilities, as well as increased food and poverty insecurity.

Review of the Literature (909 words)

Mutunga (2004) performed research on the impact of socioeconomic and environmental

factors (mother's education, source of water, cooking fuel, sanitation, and electricity on

childhood mortality at various ages. The modified health production conceptual foundation

Shultz (1984) has been used in conjunction with the hazard rate model. The findings revealed

that environmental and socio - economic factors influenced child mortality significantly.

However, the study did not look at the impact of poverty on infant mortality rates or the causal

mechanism that leads to it.

Using data from, Elmahdi (208) investigated the socioeconomic factors of child mortality

in Africa. In this study, a logistic regression analysis was used. Other than the mother's

employment and wealth indices, there was no significant relationship between other

socioeconomic characteristics and child mortality in both wealthy and poor regions, according to

the data. Breastfeeding was also shown to be the most important indicator of infant mortality,

followed by ethnicity, reproductive characteristics (birth order and interval), and gender, with

gender having the least impact. However, the study did not look at the link between Infant

mortality and poverty.

In light of Africa's poverty levels, Amina (2008) investigated the levels, trends, and

differences in childhood mortality. The Africa Comprehensive Household and Budget Study

2005/06 was used in the research. The Trussel (1974) variation of the Brass technologies were

used to calculate the likelihood of a kid dying between birth and a specific age. Child mortality

rates rose in tandem with poverty levels, according to the research. In North Northern and

Central Africa, on the other hand, non-poor families had greater mortality rates than poor

household’s health. Unlike the study discussed above, which used the Africa Comprehensive

Household and Expenditure Survey to investigate the association between health and poverty

using infant mortality rates as a health indicator, this study uses the Africa Demographic And

health Survey 2009/10. Amina (2008) did not look at the direction of the poverty-child mortality

link. This research also aims to determine the impact of poverty on infant mortality rates by

identifying the processes involved.

Mariara et al. (2012) looked at the factors that influence African child survival. Survival

models were employed to study child poverty, and an asset index was utilized as a measure of

well-being. The study used primary micro-level data on the Gross National Product, health

spending, and geographical levels of health services for the year of a child's birth supplemented

with Demographic health Survey from 1993 to 2003. Child survival was studied using the

proximal determinant approach. According to the study's findings, there was a substantial link

between child survival and poverty (asset index). Furthermore, children in rural areas were more

likely to be poor and, as a result, to die than their urban counterparts. The researchers did not

look at the potential of a coincidental link between child survival and poverty. This study looks

at the link between impoverishment and ill-health by using a model that allows for the evaluation

of the connection between the two, even if they are both possibly endogenous.

Ngigi (2013) investigated the factors that influence child mortality in Africa. The study

goals were met using the logit model and the Schultz (1984) framework. Mother's age, total

number of children born by a mother, family wealth, newborn birth size, mother's education, and

religion were all found to be significant factors of infant mortality. However, the study did not

look at the impact of poverty on child mortality. The model used in this study evaluates the

genuine effect of poverty on child mortality. Ahmed et al. (2012), on the other hand, looked at

the causal relationship between health and poverty in Nigeria, using HIV/AIDS as a health

indicator. Data from the Annual time series from 1990 to 2009 were used in the study. The

Granger causality test was used to meet the study's goals. According to the data, there was no

clear relationship between HIV and poverty in Nigeria, meaning that poverty had no impact on

the country's HIV rates. HIV, on the other hand, has been linked to an increase in poverty rates.

One criticism of the research is that it did not look at the short-term link between poverty and

HIV. This study, on the other hand, investigates the association between poverty and poor health

in Africa utilizing instrumental methodology and cross-sectional data.

Foloko (2009) used the Lesotho DHS datasets for 2004/05 to study the factors of infant

mortality rates in Lesotho. In order to analyze child mortality, the researchers used Rosenzweig

and Schultz's (1983) approach and hazard model. Household income, mother's education, and

sanitary facilities were all shown to be major drivers of child mortality. However, the study did

not look at the direct influence of poverty on infant mortality rates or the mechanism that causes

it. In Bangladesh, Gwatkin et al. (2000) investigated socioeconomic inequalities in health,

nutrition, and population. They looked at differences in baby and under-5 mortality, malnutrition

levels, diarrhea incidence, and respiratory infections using DHS data from 40 underdeveloped

nations. According to the data, a kid born in a home belonging to the poorest quintile is almost

twice as likely as a baby conceived in a household from to the highest income quintiles. Another

conclusion from the study seemed to be that nations with lower child rates of morbidity and

mortality had bigger socioeconomic inequality. The study made no effort to describe the

relationship between poverty and illness. The impact of impoverishment on child mortality is

investigated in this study.

Aims, Objectives and Research Questions

Aim of the study

The aim of this is to determine the impact of poverty on human health and more

specifically regarding how it influences child mortality in Africa. This study’s topic is a medical

and economics study topic. It also aims to influence the ways in which policies are formulated.

These formulated policies targeted at reducing health disparities, policymakers must understand

the magnitude of the relationship between health and poverty. Medical academics and public

health specialists believe there is a link between poverty and illness (Smith, 1999).

The other aim of this study is changing from therapies and healthcare to social and

economic factors such as income, job status, environment, and income distribution which

Wilkinson and Marmot (1998) deems very important is determining the level of poverty in a

country and consequently determining the mortality rates among children. However, economists

appear more concerned in the impact of health on socioeconomic position, notably on labor

supply and salaries.

Newborn and child mortality rates are strongly connected to incomes, but the

distributional characteristics of child mortality seem to be much more susceptible to the

wellbeing of the poor (Younger, 2011). The health of the poor is argued by Spencer (2005). The

sharp decline in income due to macroeconomic crises or other circumstances may negatively

impact health (Paxton and Shady, 2004). Therefore, with such information available in the public

domain, those concerned with public health matters will help in steering programs that will push

for the achievement of decreased poverty which have the ability to influence poverty and

mortality rates among children in Africa.

Others contend that health is not always linked to money and spending, opening the door

to studying health in connection to impoverishment (Younger, 2001). There are few research on

the link between ill-health and poverty in Africa. The effects of poverty on infant mortality rates

in Africa has not been extensively studied. The study investigates the relationship between infant

mortality and poverty. It is important to understand if there is a positive or negative relationship

between socioeconomic level and health.

Previous research in Africa on infant mortality and poverty used WHO data from 2003

and UNCEF data from 2007/08. For example, Amina (2008) studied child mortality trends,

patterns, and disparities in poverty. In their study, Mariara et al. Mutunga (2004) studied how

family socioeconomic and environmental factors affect baby and child mortality. These

empirical research in Africa have not examined the link between poverty and ill-health, assuming

that the relationship runs both ways. More importantly, the previous research did not fully focus

on the influence of poverty on infant mortality rates and the processes involved. This study also

aims at filling up certain information gaps that were left by other studies.

Research Objective

This study's goal is to research the link between poverty and illness in Africa. These

objectives are: t

I. To assess the impact of poverty on infant mortality rates in Africa.

II. To determine the link between poverty and child mortality in Africa

III. To make policy suggestions for addressing the health needs of Africa children.

Research Question

This study seeks to answer the questions below in the process of trying to explore the

relationship that exist between poverty and health in influencing the child mortality rates in the

continent of Africa.

The first, question that his study seeks to answer is:

I. How does poverty affect child mortality in Africa?

II. How strong is the relationship that exist between poverty and infant mortality in Africa?

III. What influences the relationship between poverty and child mortality in Africa?

Methodology (596 words)

Analytical Framework

Rosenzweig and Schulltz (1983) model is used as refined by Schultz (1984). The

framework's primary premise is that households devote time and resources to produce

commodities, some of which are marketed and others that are consumed at home. The utility

function U, which would be a function of the composite consumer good X, composite

environment quality Y, and H the health condition of n household children, H represents

household health choices. It is written as:

U= U(X Y H)….1

Child health is represented by a child specified health input (I), that does not impact

parental utilities directly, and infant health endowment (Rosenzweig and Schultz, 1983.

Then child health production:

H= F(Y, I, K, µ)…2

Such that

K is household's health knowledge, while Y, I, and µ remain as stated above.

Y is influenced by the infant's health endowment identified as (MC), household choice

(PR), market pricing, and restrictions from household's physical environment identified as (P) as

well as wealth (W).

Considering that the production function (2) and the household finances restriction, the

utility function denoted by (1) is maximized.

The household finances limitation:

PX + PY + PI = Z

Where

Z -family income.

PX - Price of consumer items with direct impact on health.

PY -price of health-related items.

PI stands for the price of a child's individual health input.

Adopting Mwabu (2008) in the maximization formula (1) according to healthcare

production function denoted as (2) as well as the budget restriction (3).

Households demand function:

Dx = D(PY, PI, K, W,µ) ...4

DI = D(PY, PI, K, W,µ) ....6

Through the substitution of demand function (5) and (4) into the health production

function, the result obtained by Mwabu (2008) is indicated below.

H= F (DX (PY, PI , K,W ,µ), DY (PY, PI , K,W ,µ ),K, µ) … 7

H= F (PY, PI , K, W, µ) ...8

The relative prices (PI and PY), the household's health knowledge doted as (K), the

household wealth (W), and the infant's health endowments for all children (µ) may all be

described by expression (8).

The simplified input demand function become from formula (9). infant health is

described by determinative inputs to infant health (Y), infant health inputs (I), the household's

health knowledge (K), the household's wealth (W) as well as infant health endowment (µ),

(Mwabu, 2008).

Model Specification

Child mortality model:

CM= f(MED,BSIZ,G, MAGE, MREL, MMS,TNC, HHW, SCF, RT,AW, AS, PD, TTI, )........10

Where:

CM- based on the likelihood of a kid dying before their fifth birthday, with a value of (1)

if the child is believed to have died and (0) if the infant is reported alive. The variable names,

definitions, and apriori estimates of the parameters in (10)

Estimation of the Model

To achieve the study's goals, and in accordance with Mwabu and Ajakaiye (2009), a

structural model for quantifying the causal influence of poverty (as measured by family wealth)

on health is used. The model's formulation.

Y= ..........11

……..12

Where Y is the therapy variable and X is the health output variable (child mortality)

Gender, age, and residential location are all external control factors in Z.

K denotes a set of parameters that must be evaluated (Mwabu, 2009).

Through regression analysis, equation (11) is used to approximate the IV as the Two

Stage Least Square (12). The researcher regress X on K in the first step to get anticipated X

values

We regress Y on in the second stage, with the coefficient on being the Two Stage Least

Square estimator:

Y= α+ β + + …13

Significance (299)

The Importance of the Research is that being aware of the link between health and

poverty outcomes will aid in the development and implementation of effective interventions that

are tailored to the needs of the poor. The findings of the study have the capacity to help

policymakers on economic health designs and the implementers in developing intervention

programs that are bi-dimensional in their approach to addressing both poverty and ill health

outcomes. It will also serve as a reference point for action by nongovernmental organizations,

civil society organizations, and other health sector actors that wish to advocate for the

establishment of pro-poor health-care policies in their respective countries. Health and poverty

outcomes have been viewed as separate issues in the policy initiatives that have been

implemented. Because of this, the study serves as a signal to policymakers on the necessity for a

shift in strategy. To conclude, the study adds to the body of empirical research on poverty and

infant mortality that has already been conducted using data from censuses and health surveys,

and it provides a foundation for future research.

There is a pressing need for a societal commitment to spend more and effectively in

people on a more sustained basis. All of the Sustainable Development Goals (SDGs) related to

education are jeopardized if children are unable to read. Putting an end to severe financial

poverty, malnutrition, and malnutrition is just as crucial as putting an end to learning poverty. To

attain it in the conceivable future, we will need to make significantly more rapid development at

a far larger scale than what we have seen thus far. Lastly, the research of poverty helps us

understand a country's economic and social progress. By analyzing poverty, we can devise

strategies to reduce its effect on health and child mortality.

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Appendix

ACTIVITY

WEEK

Find a supervisor

Finalize research proposal

Detailed literature review

Finalize Aims, Objectives and

Research Questions

Finalize Analysis for Equation 1,

2, 3&4

Finalize Analysis for Equation

5&6

Finalize Analysis for Equation

7&8

Finalize Analysis for Equation 9,

10, 11, 12 &13

Draft research report after

incorporating supervisor's

feedback

Final consultation with

supervisor and draft revision

Proofreading, printing and

binding

Submit the report

Child Mortality Rates in Africa: Exploring the Relationship between Poverty and Health

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