Growth and Survival : Child Health Disparities and Early Life Adversity in Sub-Saharan Africa

Abstract: Sound physical health is a critical component of the human development process, wherein early life and childhood are pivotal periods. Although child health in sub-Saharan Africa has been improving for the past few decades, the region still has the highest mortality rate for children under five as well as high levels of child morbidity. The most immediate causes of these poor health outcomes are infectious diseases and undernutrition, while more remote factors, such as resources available to parents, are also known to play a role in child health. Parents are further embedded in an economic, social and epidemiological environment, which commonly reflects the parent’s own resources, as well as aiding them in or inhibiting them from ensuring the healthy development of their children. The primary aim of this dissertation is to first study the consequences of an adverse environment in infancy, such as exposure to infectious diseases, on human development; and secondly, to explore disparities in child health as they relate to several parental factors ─ maternal health, parental education, and religious affiliation. Specifically, the dissertation examines the overlap and interaction between these parental factors and contextual factors in determining child health. The results show that adversity in infancy negatively impacts subsequent human development, which is not mitigated in households with higher socioeconomic status. Secondly, contextual factors explain some of the differences in child health between different groups but do so to a varying degree. The relationship between child health and parental education and, especially, maternal health, appears to be persistent and strong, even independent of contextual factors and other measures of living standards. On the other hand, the link between religious affiliation and child health mostly reflects geographic clustering of religious groups and heterogeneity in living standards. As the contextual environment has improved, the association between parental education and maternal health and child health appears to have decreased. Specifically, the persistence of the intergenerational transmission of health from mother to child has attenuated as government spending on health care has increased, and the association between parental education and child health has diminished over time as the contextual environment has improved. Parental resources, health, and socioeconomic status are all vital components of human development in sub-Saharan Africa and other low and middle-income countries. The intergenerational transmission of disadvantage from parents to children is, however, reduced with improving environments.