Decomposing Educational Inequalities in Child Mortality: A Temporal Trend Analysis of Access to Water and Sanitation in Peru

Tasneem Bohra Master of Public Health, School of Public Health, Ecole des Hautes Études en Santé Publique (EHESP), Rennes, France.

Search for other papers by Tasneem Bohra in
Current site
Google Scholar
PubMed
Close
,
Tarik Benmarhnia Institute for Health and Social Policy, McGill University, Montreal, Canada.

Search for other papers by Tarik Benmarhnia in
Current site
Google Scholar
PubMed
Close
,
Britt McKinnon Institute for Health and Social Policy, McGill University, Montreal, Canada.

Search for other papers by Britt McKinnon in
Current site
Google Scholar
PubMed
Close
, and
Jay S. Kaufman Institute for Health and Social Policy, McGill University, Montreal, Canada.
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.

Search for other papers by Jay S. Kaufman in
Current site
Google Scholar
PubMed
Close
Restricted access

Previous studies of inequality in health and mortality have largely focused on income-based inequality. Maternal education plays an important role in determining access to water and sanitation, and inequalities in child mortality arising due to differential access, especially in low- and middle-income countries such as Peru. This article aims to explain education-related inequalities in child mortality in Peru using a regression-based decomposition of the concentration index of child mortality. The analysis combines a concentration index created along a cumulative distribution of the Demographic and Health Surveys sample ranked according to maternal education, and decomposition measures the contribution of water and sanitation to educational inequalities in child mortality. We observed a large education-related inequality in child mortality and access to water and sanitation. There is a need for programs and policies in child health to focus on ensuring equity and to consider the educational stratification of the population to target the most disadvantaged segments of the population.

Author Notes

* Address correspondence to Tarik Benmarhnia, Institute for Health and Social Policy, McGill University, Meredith, Charles, House, 1130 Pine Avenue West, Montreal H3A 1A3, Canada. E-mail: tarik.benmarhnia@mcgill.ca

Authors' addresses: Tasneem Bohra, Master of Public Health, School of Public Health, Ecole des Hautes Études en Santé Publique (EHESP), Rennes, France, E-mail: turbulent.tas@gmail.com. Tarik Benmarhnia and Britt McKinnon, Institute for Health and Social Policy, McGill University, Montreal, Canada, E-mails: tarik.benmarhnia@mcgill.ca and britt.mckinnon@mcgill.ca. Jay S. Kaufman, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada, and Institute for Health and Social Policy, McGill University, Montreal, Canada, E-mail: jay.kaufman@mcgill.ca.

  • 1.

    Wagstaff A, 2002. Poverty and health sector inequalities. Bull World Health Organ 80: 97105.

  • 2.

    Makinen M, Waters HR, Rauch M, Almagambetova N, Bitran R, Gilson L, McIntyre D, Pannarunithai S, Prieto AL, Ubilla G, Ram S, 2000. Inequalities in health care use and expenditure: empirical data from eight developing countries and countries in transition. Bull World Health Organ 78: 5565.

    • Search Google Scholar
    • Export Citation
  • 3.

    Gwatkin DR, 2000. Health inequalities and the health of the poor. Bull World Health Organ 78: 16.

  • 4.

    Karlsson M, Nilsson T, Lyttkens CH, Leeson G, 2010. Income inequality and health: importance of a cross-country perspective. Soc Sci Med 70: 875885.

    • Search Google Scholar
    • Export Citation
  • 5.

    Houweling TA, Kunst AE, 2010. Socio-economic inequalities in childhood mortality in low- and middle-income countries: a review of the international evidence. Br Med Bull 93: 726.

    • Search Google Scholar
    • Export Citation
  • 6.

    Braveman P, Tarimo E, 2002. Social inequalities in health within countries: not only an issue for affluent nations. Soc Sci Med 54: 16211635.

    • Search Google Scholar
    • Export Citation
  • 7.

    Bhutta ZA, Das JK, Walker N, Rizvi A, Campbell H, Rudan I, Black RE, 2013. Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost? Lancet 381: 14171429.

    • Search Google Scholar
    • Export Citation
  • 8.

    Halvorson SJ, Williams AL, Ba S, Dunkel FV, 2011. Water quality and waterborne disease in the Niger River Inland Delta, Mali: a study of local knowledge and response. Health Place 17: 449457.

    • Search Google Scholar
    • Export Citation
  • 9.

    Fuchs R, Pamuk E, Lutz W, 2010. Education or wealth: which matters more for reducing child mortality in developing countries? Vienna Yearb Popul Res 8: 175199.

    • Search Google Scholar
    • Export Citation
  • 10.

    Chou S-Y, Liu J-T, Grossman M, Joyce T, 2010. Parental education and child health: evidence from a natural experiment in Taiwan. Am Econ J Appl Econ 2: 6391.

    • Search Google Scholar
    • Export Citation
  • 11.

    Greenaway ES, Leon J, Baker DP, 2012. Understanding the association between maternal education and use of health services in Ghana: exploring the role of health knowledge. J Biosoc Sci 44: 733747.

    • Search Google Scholar
    • Export Citation
  • 12.

    LeVine RA, Rowe ML, 2009. Maternal literacy and child health in less-developed countries: evidence, processes, and limitations. J Dev Behav Pediatr 30: 340349.

    • Search Google Scholar
    • Export Citation
  • 13.

    Basu AM, Stephenson R, 2005. Low levels of maternal education and the proximate determinants of childhood mortality: a little learning is not a dangerous thing. Soc Sci Med 60: 20112023.

    • Search Google Scholar
    • Export Citation
  • 14.

    Jalan J, Ravallion M, 2003. Does piped water reduce diarrhea for children in rural India? J Econom 112: 153173.

  • 15.

    Tucker J, MacDonald A, Coulter L, Calow RC, 2014. Household water use, poverty and seasonality: wealth effects, labour constraints, and minimal consumption in Ethiopia. Water Resour Rural Dev 3: 2747.

    • Search Google Scholar
    • Export Citation
  • 16.

    Bolaane B, Ikgopoleng H, 2011. Towards improved sanitation: constraints and opportunities in accessing waterborne sewerage in major villages of Botswana. Habitat Int 35: 486493.

    • Search Google Scholar
    • Export Citation
  • 17.

    Mosley WH, Chen LC, 2003. An analytical framework for the study of child survival in developing countries. 1984. Bull World Health Organ 81: 140145.

    • Search Google Scholar
    • Export Citation
  • 18.

    Walsh B, Cullinan J, 2015. Decomposing socioeconomic inequalities in childhood obesity: evidence from Ireland. Econ Hum Biol 16: 6072.

  • 19.

    Christiani Y, Byles J, Tavener M, Dugdale P, 2015. Socioeconomic related inequality in depression among young and middle-adult women in Indonesia's major cities. J Affect Disord 182: 7681.

    • Search Google Scholar
    • Export Citation
  • 20.

    Doherty E, Walsh B, O'Neill C, 2014. Decomposing socioeconomic inequality in child vaccination: results from Ireland. Vaccine 32: 34383444.

    • Search Google Scholar
    • Export Citation
  • 21.

    Abu-Zaineh M, Mataria A, Moatti J-P, Ventelou B, 2011. Measuring and decomposing socioeconomic inequality in healthcare delivery: a microsimulation approach with application to the Palestinian conflict-affected fragile setting. Soc Sci Med 72: 133141.

    • Search Google Scholar
    • Export Citation
  • 22.

    Solmi F, Von Wagner C, Kobayashi LC, Raine R, Wardle J, Morris S, 2015. Decomposing socio-economic inequality in colorectal cancer screening uptake in England. Soc Sci Med 134: 7686.

    • Search Google Scholar
    • Export Citation
  • 23.

    Rama M, Li Y, Mitra PK, Newman JL, 2015. Addressing Inequality in South Asia. Washington, DC: The World Bank, 197.

  • 24.

    United Nations Organization, 2014. The Millennium Development Goals Report 2014. New York, NY: United Nations Organization.

  • 25.

    Urke HB, Bull T, Mittelmark MB, 2011. Socioeconomic status and chronic child malnutrition: wealth and maternal education matter more in the Peruvian Andes than nationally. Nutr Res 31: 741747.

    • Search Google Scholar
    • Export Citation
  • 26.

    Peru Support Group, 2008. The Great Water Debate: Cause and Effect in Peru. London, United Kingdom: Peru Support Group.

  • 27.

    Ioris AAR, 2012. The geography of multiple scarcities: urban development and water problems in Lima, Peru. Geoforum 43: 612622.

  • 28.

    Checkley W, Gilman RH, Black RE, Epstein LD, Cabrera L, Sterling CR, Moulton LH, 2004. Effect of water and sanitation on childhood health in a poor Peruvian peri-urban community. Lancet 363: 112118.

    • Search Google Scholar
    • Export Citation
  • 29.

    Fink G, Günther I, Hill K, 2011. The effect of water and sanitation on child health: evidence from the demographic and health surveys 1986–2007. Int J Epidemiol 40: 11961204.

    • Search Google Scholar
    • Export Citation
  • 30.

    Hill K, Amouzou A, 2006. Chapter 3: Trends in child mortality, 1960 to 2000. Jamison DT, Feachem RG, Makgoba MW, Bos ER, Baingana FK, Hofman KJ, Rogo KO, eds. Disease and Mortality in Sub-Saharan Africa, 2nd edition. Washington, DC: World Bank, 1530.

    • Search Google Scholar
    • Export Citation
  • 31.

    Pradhan J, Arokiasamy P, 2010. Socio-economic inequalities in child survival in India: a decomposition analysis. Health Policy 98: 114120.

    • Search Google Scholar
    • Export Citation
  • 32.

    World Health Organization (WHO) and United Nations Children's Emergency Fund (UNICEF), 2014. Progress on Drinking Water and Sanitation. Geneva, Switzerland: WHO and UNICEF.

    • Search Google Scholar
    • Export Citation
  • 33.

    Traissac P, Martin-Prevel Y, 2012. Alternatives to principal components analysis to derive asset-based indices to measure socio-economic position in low- and middle-income countries: the case for multiple correspondence analysis. Int J Epidemiol 41: 12071210.

    • Search Google Scholar
    • Export Citation
  • 34.

    Balk D, Pullum T, Storeygard A, Greenwell F, Neuman M, 2003. Spatial Analysis of Childhood Mortality in West Africa. Calverton, MD: ORC Macro.

  • 35.

    O'Donnell O, Van Doorslaer E, Wagstaff A, Lindelow M, 2008. Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation, 1st edition. Washington, DC: The Word Bank.

    • Search Google Scholar
    • Export Citation
  • 36.

    Morasae EK, Forouzan AS, Majdzadeh R, Asadi-Lari M, Noorbala AA, Hosseinpoor AR, 2012. Understanding determinants of socioeconomic inequality in mental health in Iran's capital, Tehran: a concentration index decomposition approach. Int J Equity Health 11: 18.

    • Search Google Scholar
    • Export Citation
  • 37.

    Freeman MC, Clasen T, Dreibelbis R, Saboori S, Greene LE, Brumback B, Muga R, Rheingans R, 2014. The impact of a school-based water supply and treatment, hygiene, and sanitation programme on pupil diarrhoea: a cluster-randomized trial. Epidemiol Infect 142: 340351.

    • Search Google Scholar
    • Export Citation
  • 38.

    Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM, 2005. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 5: 4252.

    • Search Google Scholar
    • Export Citation
  • 39.

    Stark J, Guillén S, Brady C, 2012. Follow the Water: Emerging Issues of Climate Change and Conflict in Peru. Lima, Peru: U.S. Agency for International Development, 5.

    • Search Google Scholar
    • Export Citation
  • 40.

    Huicho L, Trelles M, Gonzales F, 2006. National and sub-national under-five mortality profiles in Peru: a basis for informed policy decisions. BMC Public Health 6: 173.

    • Search Google Scholar
    • Export Citation
  • 41.

    United Nations Children's Emergency Fund (UNICEF), 2009. The State of the World's Children 2009: Maternal and Newborn Health. New York, NY: UNICEF.

    • Search Google Scholar
    • Export Citation
  • 42.

    Muñoz I, Paredes M, Thorp R, 2007. Group inequalities and the nature and power of collective action: case studies from Peru. World Dev 35: 19291946.

    • Search Google Scholar
    • Export Citation
  • 43.

    Perova E, Vakis R, 2012. 5 years in Juntos: new evidence on the program's short and long-term impacts. Economía 35: 5382.

  • 44.

    Günther I, Fink G, 2010. Water, Sanitation and Children's Health Evidence from 172 DHS Surveys. World Bank Policy Research Paper 5275. Zurich, Switzerland: Prospects Group.

    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 33 33 15
Full Text Views 403 120 2
PDF Downloads 217 63 1
 
Membership Banner
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save