The Effect of Wealth & Inequality on Infant and Child Mortality Risk in Botswana

Abstract

Background: Botswana has experienced rapid economic and social development over the past few decades. However this has coincided with growing social inequalities in health and wealth. Botswanas GINI coefficient ranks it as one of the most unequal societies in the world and health indicators on under-five mortality are lower in comparison to other development indices. Furthermore there is considerable variance in wealth composition in the 29 administrative districts in the country. This study aims to look specifically at wealth and inequality and their association with infant and child mortality risk. The author expects that child health outcomes will be better for mothers in higher wealth levels and living in more societies where wealth is distributed more equally. Methods: Using data from the 2011 Botswana Population and Housing census a cross-sectional multilevel logistic regression analysis was conducted to analyze the effects of wealth at the individual- and district levels, as well as to identify whether infant and child mortality risk varies by district. The sample sizes included 40461 and 219584 mothers for the infant and child mortality risk analyses respectively. Conclusion: Although there was variation in infant and child mortality risk across districts, this could not be attributed to inequality. In addition, socioeconomic determinants were not associated with infant mortality risk. However, increasing wealth and education were positively associated with child mortality and in most cases with a social gradient. The importance of this study is in contributing to the literature on wealth and health in developing countries. Furthermore it provides recommendations on opportunities to improve health for the under-five subpopulation. As wealth disparities continue to rise in sub-Saharan Africa an awareness of their potential impact on population health should provide more encouragement for a systematic approach to the socioeconomic determinants of health.