Determinants of Child Mortality and Morbidity in China

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: Determinants of Child Mortality and Morbidity in China
: 6/12/2002
: 52
: English
/ : World
: Environment
Health, Nutrition and Population

: Limin Wang
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This study examines the linkages between child mortality and morbidity, and the quality of the household and community environment in rural and urban China. The data source is the 1992 China National Survey for Children which resembles the demographic and health surveys (DHS). The methodologies used for the analysis are based on models widely employed in epidemiological studies. The findings from this study both confirm evidence from studies in other countries and add new information in the area of environmental health.

The key findings include (1) use of unclean cooking fuels (wood and coal) significantly reduces the neonatal survival probability in rural areas - an outcome that is also confirmed in two other studies (India and Guatemala); (2) access to safe water or sanitation reduces child mortality risks by about 34% in rural areas; (3) higher maternal education levels reduce child mortality and female education has strong health externalities (i.e. controlling for other factors, a child living in a neighborhood with more educated mothers has about 50% lower mortality risk); (4) access to safe water/sanitation, and immunization reduce diarrhea incidence in rural areas, while access to modern sanitation facilities (flush toilets) reduces diarrhea prevalence in urban areas; (5) significant linkages between ARI incidence and use of unclean cooking fuels are found using the city level data constructed from the survey.

This study indicates that effective policy interventions for improving health outcomes often lie both within and outside the health sector. Cross-sectoral approaches can potentially produce large health benefits.

Limin Wang of the Bank s Environment Department led the study. She noted that previous studies have shown developed countries have reduced incidences of diseases, and better case management in these countries also accounts for reduced child mortality. These studies imply there is a lack of integrated approach on health interventions in the developing world. Lack of access to safe drinking water, indoor and outdoor air pollution, poor nutrition are all well known factors. Policy interventions can be helpful in this area, because they can seek to prevent rather than cure problems, and often have a strong poverty focus. Global studies by the Bank and the UN suggest 20% of global diseases are linked to the environment. Other studies have linked environmental quality with child morbidity and mortality.

Wang said her study on China s data used household survey data, which had not been used in previous studies. Province level information was reviewed, as well as more disaggregated data in rural and urban areas. Most data is from 1992 and Wang said her study used more household data than previous studies. Key variables include housing characteristics and socioeconomic indicators such as education and health. She said she conducted a comparison of China s data with India and other countries. She looked at mortality, acute respiratory infections, and diarrhea and found China had lower mortality rates, but higher rates for respiratory infections, particularly in urban areas. Mortality rates also differed sharply between urban and rural areas. Respiratory problems in urban areas and diarrhea problems in rural areas varied little between income groups.

Based on the data, Wang projected that air quality in the cities and lack of access to clean water in the countryside are the key factors for children s health. She then looked at water, sanitation and cooking fuels as health indicators to verify this projection. She noted there is a great deal of literature identifying the key determinants of child morbidity. Mortality, on the other hand, is difficult to establish because information is often lacking, multiple causes are at play, and deaths often occur in the home. Wang looked at the age of death for children and found most death occurred in the first nine months. In rural areas, her results suggest unclean cooking fuel is a key factor in rural mortality rates for babies. These results are similar to evidence from India and Guatemala. Additional results include children born in hospitals and living in better neighborhoods are more likely to survive. Access to safe drinking water is another critical variable. The mother s education also plays a role in the survival rate for children under five years of age. Results in urban areas found male children had higher mortality rates than female children, a result Wang said is inconsistent with data from other countries. Access to flush toilets is also a significant factor in mortality rates.