Influence of Ethnic Differentials in Socioeconomic Status and Health Care on Childhood Mortality

Kuniko Chijiwa, University of Florida

The general objective of this research is to examine ethnic differentials in infant/childhood mortality in Trinidad and Tobago (TT). Infant/childhood mortality is considered as an outcome of quality of mother’s health care, and as a variable to ascertain the economic and cultural differences between the two major ethnic groups: African and East Indian. The infant/childhood mortality rate has served as an important indicator of the well-being of a population. A number of researchers have examined race/ethnic differentials in infant/childhood mortality using risk factors in the structure of relationships with socio-demographic, socio-economic, and intervening factors: maternal health and health behavior. Theses studies stressed that efforts for eliminating social inequalities between racial/ethnic groups correspond to efforts for narrowing the gaps in infant/childhood mortality between them. Researchers have indicated ‘race/ethnicity’ as a socially defined and meaningful construct and as a reflection of socio-economic, political, cultural, behavioral, and health differences between groups. The race/ethnicity is associated with mother’s absolute health status during the perinatal period, which directly/indirectly affects fetuses, neonates, infants, and children through nutrition, housing, education, and health care accessibility . Hence, the association between racial/ethnic values and quality-of-life is a summary measure accumulated by an array of individual socio-economic characteristics We can assume that the results of statistical analysis on ethnic differences in infant/childhood mortality with efficient socio-economic indicators can provide valuable insights into an ethnically polarized society’s stratification system. Given the numerous issues associated with ethnic strife/competition over socio-economic and political allocations (health care should be considered as limited resources in a nation), in the multi-ethnic communities within a nation like TT, it is important to improve/renovate health care systems and interventions in a manner appropriate to each ethnic group. Since no comparative study on ethnic differences in infant/childhood mortality in TT has ever been conducted, this study aims to advance our awareness of ethnic differences in terms of health as an accumulation of and confounding effects of socioeconomic and cultural factors in TT. The Demographic and Health Survey in Trinidad and Tobago (TTDHS) is employed to determine whether ethnicity differentiates infant/childhood mortality among women in TT by contrasting socio-economic factors and socio-cultural factors with consideration of health care practices. The analysis of TTDHS is organized in order to empirically test hypotheses that are derived from theoretical perspectives of social stratification and the conceptual framework for child survivorship. Regarding influences of socio-economic status on infant/childhood mortality and the quality-of-health care, the stratification theory would be appropriate to assess the TT society. Since the major interest of this study is the relationship between ethnic background and infant/childhood mortality in the presence of other social factors, this study needs analytical guidance sustained by the conceptual framework for child survivorship with inclusions of socio-cultural factors based on the limitations and structure of TTDHS (Figure 1). Socio-cultural factors act as key covariates somehow influencing/operating on a mother and child’s health care. Stated as hypotheses; H1: After controlling for other socio-economic and demographic factors, ethnicity maintains its influence on infant/childhood mortality and its statistical significance. H2: Poor health care is associated with a higher incidence of infant/childhood mortality and the inclusion of health care variables narrows the ethnic differences in infant/childhood mortality. The data analysis consists of an examination of multivariate logistic regression models using ten explanatory variables; the analysis is divided into two phases. The first phase presents a set of logistic regression models using a whole sample population and the second phase analyzes each ethnic group separately. The second phase attempts to indicate the potential variables playing a significant role in determining infant/childhood mortality and the best model for each ethnic group in TT. This study uses the following dependent and independent variables: Dependent variable; Infant/Child Mortality 0 All children alive 1 Lost at least one child Independent variables; Age 20–34 Years of Education 0–17 Quality-of-Life 0–3.759 Quality of Preventive Health Care 0–4.861 Ethnicity 0 East Indian 1 African Type of Place of Residence 0 Rural 1 Urban Marital Status 0 Married 1 Other type of union Job Situation 0 Not working 1 Working Type of Place Child Born 0 Government hospital 1 Private hospital Prenatal Care 0 Not received from medical doctors 1 Received from medical doctors. Logistic regression analyses on child mortality using a whole data of TTDHS indicate that after controlling for all socio-economic, socio-demographic, and health related factors; ethnicity is statistically significant, and African women have 1.8 times higher probability of having lost at least one child in their past than East Indian women, and the three health related factors have positive impacts on mortality. The inclusion of these factors, however, widens the infant/child mortality gap between African and East Indian. In the models estimated separately by ethnicity, explanatory variables, which remain in the fitted model for each ethnic group, are different in combination and their magnitudes on mortality. This shows that a different dynamic and mechanism may function in each ethnic division. The variable of quality-of-life cannot maintain its strength in the model for East Indian while it remains in the model for African. These results imply that the population differences in the risk of infant/childhood mortality by ethnicity in TT cannot be explained by social class based on the social stratification theory. The results indicate that investigators studying infant/childhood mortality should continue to consider ethnicity and socio-cultural determinants, and to refine the measure of indices and to collect data for satisfying the child survival model for increasing our understanding of the associations among ethnicity, health practices/orientation, and infant/childhood mortality in TT.