Determinants of Child Health: An Empirical Analysis

Infant and child mortality rates in India have fallen by almost half from the time of adoption of millennium development goals to 2012 but there has not been a concurrent decrease in morbidity and under-nutrition rates. This may be due to a greater focus on treatment interventions vis-à-vis preventive interventions that reduce child deaths; the latter helps in overall child wellbeing by reducing under-nourishment and number of days lost due to illness. This study seeks to identify the mechanisms through which household and community-level socioeconomic factors affect child health and thereby identify preventive interventions that are of greatest consequence. We use the longitudinal data of Young Lives project that tracks the lives of two birth cohorts: 2000 children born in 2001-02 and 1000 children in 1994-95 and has information on multiple indicators of child health: morbidity episodes, health status as perceived by the caregiver, and nutritional status. Using multi-level analysis and structural equation modeling, we simultaneously analyse the effect of socioeconomic factors on multiple proximate factors like drinking water, sanitation and breastfeeding and, the effect of these factors on child health and nutrition. We find that household wealth, mother’s education and community level factors determine the socioeconomic status (SES) of the household. Low SES is in turn associated with high exposure (through crowding, open defecation, mud flooring), and low resistance (through inappropriate complementary feeding practices and partial immunization care) to diseases. However, we find that children belonging to households of low SES are more likely to be breastfed for longer duration. Among the proximate factors, open defecation, and inappropriate feeding practices and birth characteristics like low gestational age and birth weight significantly increase infant morbidity rates. These factors combined with drinking unsafe water, receiving partial or no immunization care and poor living conditions lead to high under-nutrition rates in infants.