Volume 49 - Article 11 | Pages 249–294  

The dynamic role of household structure on under-5 mortality in southern and eastern sub-Saharan Africa

By Ashira Menashe-Oren, Philippe Bocquier, Carren Ginsburg, Yacouba Compaoré, Mark Collinson


Background: Children are born and grow up in households, where they receive essential care, including time, socio-psychological support, and economic resources. Children’s immediate environment, captured by household structure, changes over time.

Objective: We evaluate the role of dynamic household structure in the risk of child death in southern and eastern Africa.

Methods: We use longitudinal data from 15 Health and Demographic Surveillance Systems between 1990 and 2016, covering almost 282,000 under-5 year olds. We analyse under-5 mortality using semi-parametric Cox models accounting for time-varying household structure (household size and household typology) and controlling for maternal characteristics.

Results: We find that children in smaller households have a higher risk of death than those in large households. In particular, children in households where they are the sole child with two adults of opposite sexes have the lowest chances of survival, reflecting a first-child effect. By contrast, nuclear-type households with more than one child are the most protective, while children in extended households are more vulnerable.

Contribution: Our findings suggest that the (in)stability of households is important in evaluating child survival, and that it is imperative to consider households as changing entities.

Author's Affiliation

Other articles by the same author/authors in Demographic Research

Human capital on the move: Education as a determinant of internal migration in selected INDEPTH surveillance populations in Africa
Volume 34 - Article 30

Migration’s contribution to the urban transition: Direct census estimates from Africa and Asia
Volume 48 - Article 24

Migrant-based youth bulges and social conflict in urban sub-Saharan Africa
Volume 42 - Article 3

Urban–rural disparities in adult mortality in sub-Saharan Africa
Volume 39 - Article 5

A regional perspective on the economic determinants of urban transition in 19th-century France
Volume 38 - Article 50

Household structure vs. composition: Understanding gendered effects on educational progress in rural South Africa
Volume 37 - Article 59

Decomposing changes in household measures: Household size and services in South Africa, 1994–2012
Volume 37 - Article 39

Which transition comes first? Urban and demographic transitions in Belgium and Sweden
Volume 33 - Article 48

The age pattern of increases in mortality affected by HIV: Bayesian fit of the Heligman-Pollard Model to data from the Agincourt HDSS field site in rural northeast South Africa
Volume 29 - Article 39

Circular migration patterns and determinants in Nairobi slum settlements
Volume 23 - Article 20

The implications of long term community involvement for the production and circulation of population knowledge
Volume 17 - Article 13

World Urbanization Prospects: an alternative to the UN model of projection compatible with the mobility transition theory
Volume 12 - Article 9

Most recent similar articles in Demographic Research

Comparative evidence of years lived with reproductive-age morbidity in sub-Saharan Africa (2010‒2019)
Volume 49 - Article 6    | Keywords: life expectancy, maternal morbidities, reproductive age, sub-Saharan Africa

Women's economic empowerment in sub-Saharan Africa: Evidence from cross-national population data
Volume 47 - Article 15    | Keywords: agency, Demographic and Health Surveys (DHS), economic growth, education, employment, sub-Saharan Africa, women's economic independence

Household structure across childhood in four lower- and middle-income countries
Volume 47 - Article 6    | Keywords: children, cross-national comparison, developing countries, household structure, sequence analysis

“One hand does not bring up a child:” Child fostering among single mothers in Nairobi slums
Volume 46 - Article 30    | Keywords: child fostering, informal settlements, Kenya, kinship, single motherhood, sub-Saharan Africa

Fertility among better-off women in sub-Saharan Africa: Nearing late transition levels across the region
Volume 46 - Article 29    | Keywords: education, fertility, fertility differentials, international comparison, socioeconomic status, sub-Saharan Africa