Understanding the Linkages of Household Environmental Deprivation, Asset Index and Child Survival in India

doi:10.4236/aasoci.2013.37037

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Advances in Applied Sociology

2013. Vol.3, No.7, 289-300

Published Online November 2013 in SciRes (http://www.scirp.org/journal/aasoci) http://dx.doi.org/10.4236/aasoci.2013.37037

Open Access 289

Understanding the Linkages of Household Environmental

Deprivation, Asset Index and Child Survival in India

Bidyadhar Dehury

International Institute for Population Sciences, Mumbai, India

Email: [email protected]

Received October 2nd, 2013; revised November 2nd, 2013; accepted November 9th, 2013

Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the

original work is properly cited.

Often the household environmental factors are combined with the household assets in explaining the eco-

nomic differentials in population and health parameters of developing countries. Though the utility of

wealth index (that combines household environment with assets) in explaining health and health care

utilization is established, its utility as a proxy of economic measures is contested. In this paper we at-

tempted to differentiate the role of household environmental factors and the household assets in explain-

ing the infant mortality (IMR) and the under-five mortality (U5MR) in India. We hypothesize that there

are no significant differences in IMR and U5MR among those households residing in poor household en-

vironmental condition and those who are poor in asset in India. We have used the data from the National

Family Health Survey (NFHS-3), 2005-06, India, a population based large scale representative survey.

Bi-variate analyses, principal component analysis, life-table technique and hazard model are used in the

analyses. Two composite indices namely, an asset index based on consumer durables of the households

and household environmental deprivation index based on the household environmental factors are con-

structed. The indices are categorized as poor and non-poor based on the 50% of the median composite

score. Result shows that the correlation coefficient of asset index and household environmental depriva-

tion index is weak. Further, there are no significant differences of IMR and U5MR among households

living in poor household environment and those are poor in asset cutting across the states. Results of

cox-proportional hazard model indicate that the household environmental factors have significant impact

on child survival. It calls for improving the household environmental conditions of the household in pro-

moting child survival in India.

Keywords: Household Environmental Deprivation; Asset Index; Child Survival; IMR;

U5MR; Urban India

Introduction

To improve child survival, measurement by reduction of in-

fant and under-five mortality are two monitoring indicators of

the Millennium Development Goals (MDGs). Empirical evi-

dences across the globe suggest that the progresses in these

indicators are slow and uneven across and within the countries

(Lawn et al., 2006). Though the millennium declaration aimed

to reduce the infant and under-five mortality by two-thirds by

2015 from the base year (1990), many developing countries

including India are lagging behind. According to UNICEF

(2009) though the progress in under-five mortality (U5MR) has

been made in many countries, the global rate of progress is still

insufficient to achieve the MDGs. Africa and Asia combined

account for 93 per cent of all under-five deaths that occur each

year in the developing world and India accounts about one-fifth

of global under-five mortality, which is more than any other

country (Black et al., 2010). During 1992-93 and 2005-06, the

infant mortality rate (IMR) in India had declined from 79 to 57

per 1000 live births while the under-five mortality rate had de-

clined from 109 to 74 per 1000 live births (IIPS and Macro In-

ternational, 2007). However, the actual rate of progress in re-

duction of infant and under-five mortality is lower than the

required rate of progress for the country (Ram et al., 2008). The

MDG target to reduce the IMR by 27 and U5MR by 41 seems

unattainable for the country by 2015 and the global effort in

achieving the MDGs is largely contingent on India’s success

(You et al., 2010).

The child survival, particularly during infancy is broadly af-

fected by a set of endogenous and exogenous factors. Endoge-

nous factors are mainly biological and arise from genetic causes

such as congenital disorders, premature births, birth injuries etc.

On the other hand, the exogenous factors are mainly environ-

mental or external factors that cause infections and accidents. It

is evident that in developing countries most of the deaths among

under-five years are associated with the infectious diseases

mainly caused by the poor household environmental conditions

(Sastry, 1996; Muhuri, 1996; Ayad et al., 1997; Hoque et al.,

1999; Folasade, 2000; Anderson et al., 2002; Mutunga, 2007;

Kembo & Ginneken, 2009; Fink et al., 2011; Cheng et al., 2012).

An estimated 1.87 million children aged below five years in de-

veloping countries died in 2004 due to diarrhea (Boschi-Pinto,

2008). Pruss et al. (2002) estimated that 4% of all deaths (in-

cluding children) and 5.7% of total disability-adjusted life years

can be attributed to water, sanitation, and hygiene. Cheng et al.

B. DEHURY

(2012) found that increase in access to water and sanitation

leads to significant decrease in IMR and U5MR. The world

health organization (WHO) estimated about 3.5 million deaths

and one tenth of global disease burden could be prevented

worldwide annually by improving water supply, sanitation, hy-

giene and management of water resources (Pruss-Ustun et al.,

2008). The use of biomass as cooking fuel results in air dense

with particulates and gases which affect the lungs and lives. In

developing countries, the indoor air pollution leads to a higher

chance of respiratory diseases and causes about 2 million deaths

annually to children under-five years of age (WHO, 2007). It

was estimated that the indoor air pollution caused by traditional

cooking fuel is responsible for 3.7% of the loss of disability

adjusted life years in developing world (WHO, 2007). However,

the deaths due to environmental factors are viewed as relatively

preventable and treatable (Pruss-Ustun et al., 2008).

Often the household environmental factors are combined

with the household assets in explaining the economic differen-

tials in population and health parameters of developing coun-

tries. Though the utility of asset index (that combines house-

hold environment with assets) in explaining health and health

care utilization is established, its utility as a proxy of economic

measures is contested. Theoretically, the households which are

economically stronger are likely to have better household envi-

ronmental condition. But this may not be always true. We be-

lieve that the economic proxies (consumer durables) of the

household are necessary but not sufficient condition in promot-

ing child survival. Also, little is known on the association of

household environmental conditions and economic conditions

of the households at disaggregated level. Moreover, the econo-

mic conditions measured by economic proxies (also refereed as

household asset) are basic necessities of life and often inherited

from parents or relatives.

In this paper we attempted to differentiate the role of house-

hold environmental factors and the household assets in ex-

plaining the infant mortality (IMR) and the under-five mortality

(U5MR) in India. We hypothesize that there are no significant

differences in child survival among the households residing in

poor household environmental condition and they are proof in

asset. This is primarily because 1) a sizeable proportion of po-

pulation residing in poor household environmental condition

such as slums have many of the household assets 2) the vari-

ables used in the asset index do not adequately measure the

household wealth 3) the child health is very sensitive to the

environmental condition of the households, such as water con-

tamination, cooking fuel, sanitary facilities etc. The present

study aims to understand the role of household environmental

deprivations on child survival in India.

The paper has three specific objectives. The first objective is

to examine the association of household environmental depri-

vations and household asset, the second objective is to estimate

the infant and under five mortality rate by household environ-

mental conditions and household asset index, and the third ob-

jective is to examine the factors associated with child survival

(IMR and under five mortality).

Data and Methods

Data

The unit data from National Family Health Survey (NFHS-3),

conducted in 2005-06 is used in the analyses. The NFHS-3 is a

nationally representative population based survey that success-

fully interviewed 109,414 households and 124,385 women. Two

sets of questionnaires, namely, the household questionnaire and

women questionnaire were used in the survey. The household

questionnaire collected information of household environmen-

tal conditions such as drinking water, dwelling conditions (ma-

terial used for wall, floor and roof), electrification, cooking fuel,

cooking arrangement, window in the house and ownership of

consumer durables. This information is used to construct the

household environmental deprivation index and an asset index

for the household. The women questionnaire collected informa-

tion on fertility, contraception, nutrition etc from the selected

women. From the birth histories of women, kids file and birth

history file are prepared. We have used the births of last five

years to estimate the IMR and births of last 10 years to estimate

the under-five mortality.

Methods

The Principal Component Analysis (PCA) is used to con-

struct the household environmental deprivation index and an

asset index of the households, separately for rural and urban

areas. This is because the health estimates differ significantly

when separate wealth index for rural and urban areas are used

against single wealth index (Mohanty, 2009). PCA assigns

weight to each of the variables in constructing composite index.

A positive weight indicates the better economic status and a

negative weight indicates relatively lower economic status. In

construction of composite indices, the variables are re-coded in

a binary form (0 and 1). In construction of asset index for rural

areas, ownership of house is not included and for the urban

asset index, the ownership of land is not included. The compos-

ite indices are categorized into two, namely, the poor and non-

poor. The cut-off point of poor is based on 50% of the median

composite score and all other were classified as non-poor.

Bivariate analyses and correlation coefficient are used to un-

derstand the association of asset index and the household envi-

ronmental deprivation index. The alpha test is used to check the

reliability of the estimates and Z test is used to test the signifi-

cance difference in estimates. The life table technique is used to

derive the estimates of IMR and U5MR among poor and non-

poor, for both household environmental deprivation index and

asset index. The cox-proportional hazard model is used to un-

derstand the significant predictor of child survival. The com-

bined estimates are derived from rural and urban estimates and

the analyses are carried out for India and major states. The in-

fant mortality rate is estimated from the kid’s file that depicts

the birth history of the women in five years preceding the sur-

vey. The under-five mortality rate is estimated from ten years

birth history of women preceding the survey from the birth file.

Results

Household Environmental Deprivation Index

and Asset Index

Table 1 describes the mean, standard deviation and factor

score of household environmental deprivations, separately for

rural and urban India. The distribution of variables on house-

hold environmental conditions is skewed, both in rural and ur-

ban areas. For example, the distribution of households on

drinking water showed that 72% of household in urban India

used piped water followed by tube well, dug well and other

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Table 1.

Mean, standard deviation and factor score of variables used in computation of household environmental deprivation index in urban India, 2005-06.

Urban Rural

Household Variable s Mean Standard DeviationFactor Scor e Mean Standard Deviation Factor Score

Sources of Drinking Water

Piped water .719 .449 .145 .281 .450 .196

Tube well .213 .409 −.133 .532 .499 −.176

Dug well .048 .213 −.041 .155 .361 .011

Other sources .020 .140 −.011 .033 .178 −.022

Electricity .931 .254 .242 .558 .497 .280

Type of Toilet

Flush toilet .787 .410 .336 .200 .400 .337

Pit toilet .040 .196 −.077 .059 .236 .029

No toilet/open field .172 .378 −.325 .740 .439 −.323

Type of Cooking Fuel

Electricity/biogas .601 .490 .340 .088 .283 .316

Biomass .261 .439 −.328 .891 .311 −.328

Kerosene/charcoal .138 .345 −.066 .021 .142 .088

Has Window .847 .360 .269 .586 .493 .279

Material Used in the House

Finished material used for wall .889 .314 .268 .534 .499 .268

Finished material used for floor .807 .395 .275 .305 .460 .323

Finished material used for roof .924 .265 .231 .714 .452 .216

Persons Per Sleeping Room

<2 persons .377 .485 .102 .325 .468 .110

2 - 5 persons .534 .499 −.038 .543 .498 −.034

>5 persons .089 .285 −.106 .132 .338 −.102

Cooking Arrangement

No separate kitchen .272 .445 −.183 .339 .474 −.183

Separate kitchen .590 .492 .288 .341 .474 .235

Separate building .043 .204 −.026 .099 .298 .012

Outdoor .093 .291 −.188 .220 .414 −.069

ALPHA .784 .762

sources. Similarly, 79% of urban households used flush toilet

and 17% didn’t had any toilet. About three-fifths of urban

households used electricity and biogas as cooking fuel. The

standard deviation varies substantially indicating the variability

within the urban areas. The factor score of the variables are in

expected ways both in rural and urban areas. For example, the

factor score of electricity/biogas is .34 and that of biomass is

−.33 in urban areas. The alpha value of household environmen-

tal deprivation index is .784 in urban and .762 in rural India

indicating that the estimates are reliable. Figures 1 and 2 shows

the distributions of household environmental deprivation index

for urban and rural India respectively. While the distribution of

household environmental deprivation score is less skewed in

rural areas, it is more skewed in urban areas.

Table 2 describes the mean, standard deviation and factor

score of asset index separately for urban and rural India. It may

be mentioned that the variables used in the asset index are eco-

nomic proxies and not the direct measure of economic status of

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Figure 1.

Distribution of household environmental deprivation index in ur-

ban India, 2005-06.

Figure 2.

Distribution of household environmental deprivation index in

rural India, 2005-06.

the households. The distribution of households on ownership of

consumer durables in urban India showed that it was maximum

for watch (91%) followed by cot (86%), fan (85%) and chair

(76%) and minimum for agricultural accessories, probably be-

cause large proportion of households in urban areas worked in

non-agricultural activities. The standard deviation varies from .5

for bicycle and color television to a minimum for thresher (.065)

and tractor (.068). Similarly in rural India about 81% of house-

holds own a cot followed by own a watch (71%), own a bicycle

(51.5%) and own mattress (48.6%). The standard deviation of

variables is maximum in mattress and bicycle (.5) followed by

marginal land, no land holdings and chair (.49). The factor

scores of the variables are positive except no land and marginal

land. These groups are poorest as compared to medium and

large land holdings. The distribution of asset index for urban

and rural India is given in Figures 3 and 4 respectively. It is ne-

gatively skewed in rural areas and normal in urban areas. The

alpha value of asset index is .85 in urban and .82 in rural India.

Table 3 provides the cross classification of households in

asset index and household environmental deprivation index by

place of residence in India. Our interest is to examine the extent

of association of household environmental deprivation index

and asset index. We have hypothesized that people possessing

asset measured by economic proxies not necessarily reside in

good household environmental condition. Moreover, studies

Figure 3.

Distribution of asset index in urban India, 2005-06.

Figure 4.

Distribution of asset index in rural India, 2005-06.

indicate that the agreement of consumption expenditure and

economic proxies in India are not strong in Indian context

(Srivastava & Mohanty, 2010). Because many of the variables

used in asset index are necessity of life and often inherited. The

results indicate that in India about 79.2% households who are

asset poor, resides in poor household environmental condition

but 27.7% of non-poor also resides in poor household environ-

mental conditions. This is higher in rural areas than urban areas.

The correlation coefficient of asset index and household envi-

ronmental deprivation index is .51; .61 for urban and .48 for

rural India indicating weak association of asset index and house-

hold environmental deprivation index.

Table 4 provides the correlation coefficient of household de-

privation index and asset index by place of residence in the

states of India. The correlation coefficient of asset index and

household environmental deprivation index varies from .60 in

the state of Odisha to .33 in the state of Jammu & Kashmiri. In

urban India the correlation coefficient varies from .71 in Chhat-

tisgarh to .34 in Sikkim. Likewise, in rural India the maximum

correlation is found in Odisha (.57) and minimum in Delhi (.22).

It shows that the association of two indices is generally low and

lower in the rural areas than the urban areas, in most of the

states.

Estimate of Infant and Under- Five M ort al ity Rate by

Household Environmental Deprivation Index

and Asset Index

Table 5 provides the estimates of IMR and U5MR for each

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Table 2.

Mean, Standard Deviation (SD) and factor score of variables used in computation of asset index in India, 2005-06.

Urban Rural

Wealth Variables Mean Standard De viationFactor Scor eMeanStandard De viation Factor Score

Own a house .783 .413 .074 - - -

Bank/post office account .574 .495 .250 .327 .469 .226

Mattress .753 .432 .248 .486 .500 .207

Pressure cooker .698 .459 .276 .220 .414 .289

Chair .760 .427 .255 .438 .496 .269

Cot .863 .344 .183 .812 .391 .132

Table .649 .477 .284 .329 .470 .285

Fan .847 .360 .204 .386 .487 .269

Radio .389 .488 .156 .269 .444 .171

B & W Television .256 .436 −.060 .186 .390 .135

Color Television .514 .500 .294 .125 .331 .258

Sewing .308 .462 .200 .126 .332 .221

Mobile .362 .481 .265 .073 .261 .231

Telephone .266 .442 .270 .080 .271 .246

Computer .081 .272 .177 .006 .076 .091

Refrigerator .334 .472 .300 .066 .248 .232

Watch .910 .286 .160 .713 .453 .200

Bicycle .501 .500 .084 .515 .500 .112

Scooter .303 .460 .263 .107 .309 .257

Cart .010 .099 .014 .074 .262 .086

Car .061 .239 .169 .010 .099 .124

Pump .110 .313 .152 .099 .298 .169

Thresher .004 .065 .029 .022 .147 .099

Tractor .005 .068 .034 .023 .150 .137

No land - - - .416 .493 −.091

Marginal land holdings (0 - 2.5 acres) - - - .392 .488 −.020

Small land holdings (2.5 - 5 acres) - - - .082 .274 .130

Medium and large land holdings (>5 acres) - - .110 .313 .060

Irrigated land .380 .485 .115

ALPHA .847 .820

Note: Not used in analysis.

of the variables which are used in construction of household en-

vironmental deprivation index and the asset index. The esti-

mates of child survival by source of drinking water showed that

the estimated IMR among households access to pipe water is 40

compared to 64 for tube well and 55 for dug well. Similar dif-

ferences are observed for U5MR and by place of residence. The

IMR and U5MR are estimated higher among those households

does not have electricity in the household and it is true in rural

and urban areas. The mortality rates are much lower among

those households access to flush toilet followed by pit toilet

households and higher among those households does not have

toilet facility or use open field for defecation. In case of cook-

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Table 3.

Cross classification of household environmental deprivation index and

asset index by type of place of residence in India, 2005-06.

Asset Index

Household environmental

deprivation index Poor Non poor

Urban

Poor (%) 73.6 13.4

Non-poor (%) 26.4 86.6

N 25,475 23,785

Rural

Poor (%) 81.8 34.7

Non-poor (%) 18.2 65.3

N 30,306 27,463

Combined

Poor (%) 79.2 27.7

Non-poor (%) 2.8 72.3

N 55,888 51,141

ing fuel, the estimated IMR among households using biomass

and kerosene/charcoal is almost double of those households us-

ing biogas. This becomes three times higher in rural areas and

in urban areas it is little less than two times. Similar differ-

entials are observed for U5MR. In case of cooking arrangement,

the estimated IMR among households cooking food within the

household is 49 compared to 53 among those households cook

food in separate house and 64 among those households cook

food outside house. Having window in the households also

show significant differential in IMR and U5MR estimates with

higher among those households do not have window in house.

After examining the individual component, we attempted to

understand the differentials in the estimates of IMR and U5MR

rate separately for urban and rural India by household environ-

mental deprivation index and asset index. From the graphs

(Figures 5 and 6) it is clearly seen that there are no significant

differences in the proportion of child surviving under age five

for both household environmental deprivation index and asset

index. But there are significant differences in child survival be-

tween poor and non-poor households either by household envi-

ronmental poor or asset poor (z test). The proportion of child

survival has decreased rapidly from the birth to age five in case

of either in poor household environmental condition or asset poor

than the non-poor households.

Table 6 describes the differentials in estimated IMR and

U5MR among households reside in poor household environ-

mental condition and asset poor by place of residence. For ex-

ample, the estimated IMR among asset poor and households re-

siding in poor household environmental condition is 62 per

1000 live birth each. Similarly, the U5MR among asset poor is

87 compared to 89 among those residing in poor household en-

vironmental condition. The pattern is similar for rural and urban

areas. However, the poor and non-poor differentials are large

by both household environmental deprivation index and asset

index. For example, the estimated IMR among households

Table 4.

State level correlation of household environmental deprivation index

and asset index by place of residence in India, 2005-06.

Correlation Coefficient

States Urban Rural Combined

Andhra Pradesh .58 .41 .46

Arunachal Pradesh .60 .52 .54

Assam .66 .48 .51

Bihar .63 .48 .50

Chhattisgarh .71 .40 .49

Delhi .63 .22 .62

Goa .58 .48 .55

Gujarat .54 .45 .47

Haryana .55 .37 .43

Himachal Pradesh .46 .35 .36

Jammu & Kashmiri.48 .26 .33

Jharkhand .66 .47 .58

Karnataka .54 .39 .45

Kerala .48 .38 .47

Madhya Pradesh .67 .47 .54

Maharashtra .58 .46 .51

Manipur .51 .45 .52

Meghalaya .42 .51 .47

Mizoram .42 .52 .49

Nagaland .41 .44 .47

Odisha .69 .57 .60

Punjab .65 .38 .52

Rajasthan .63 .46 .52

Sikkim .34 .49 .44

Tamil Nadu .58 .37 .48

Tripura .62 .53 .58

Uttar Pradesh .64 .43 .47

Uttaranchal .65 .45 .49

West Bengal .66 .51 .56

India .61 .48 .52

residing in poor household environmental condition is 62 per

1000 live births compared to 38 among non-poor. The differ-

ences are large in rural areas compared to urban areas. This dif-

ference indicates that the household environmental condition

have significant influence on IMR and U5MR. From the z test

it is found that the calculated values of z test are smaller than

the tabulated value in 95% confidence interval by place of re-

sidence and states in India. We infer that there is not much

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Table 5.

Estimated IMR and U5MR of household environmental conditions by place of residence in India, 2005-06.

Urban Rural Total

Household variabl e s IMR U5MR IMR U5MR IMR U5MR

Sources of drinking water

Piped water 37 53 46 64 40 57

Tube well 58 69 66 92 64 86

Dug well 43 50 57 83 55 77

Other sources 39 64 49 66 46 66

Electricity

No 61 82 70 102 69 99

Yes 40 54 49 65 45 59

Type of toilet

Flush toilet 39 49 35 47 38 49

Pit toilet 53 79 50 72 51 74

No toilet/open field 54 82 66 92 65 91

Type of cooking fuel

Electricity/biogas 33 40 25 34 32 39

Biomass 55 80 60 86 59 85

Kerosene/charcoal 52 70 72 55 55 68

Window in house

No 58 77 70 104 67 97

Yes 38 51 49 64 44 58

Material used in wall

Finished material 39 52 52 71 45 61

Rudimentary 55 75 62 89 61 86

Material used in floor

Finished material 39 53 43 49 41 52

Rudimentary 51 66 63 92 61 87

Material used in the roof

Finished material 40 53 53 74 48 64

Rudimentary 59 97 68 97 66 97

Cooking arrangement

Inside house (no separate kitchen) 53 70 67 90 62 87

Inside house (separate kitchen) 33 42 47 61 40 51

Separate building 42 40 56 75 53 68

Outdoor 65 94 63 89 64 90

difference in proportion dead among households with poor

household environmental condition and asset poor households

but significant and large differences in child survival among

poor and non-poor households.

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Figure 5.

Child Survival by Asset Index in India, 2005-06.

Figure 6.

Child Survival by Household Deprivation Index in Urban

India, 2005-06.

Table 6.

Estimated IMR and U5MR by household environmental deprivation

index and asset index by place of residence in India, 2005-06.

Household environmental

deprivation index Asset index

IMR and

U5MR

Poor Non-poor Poor Non-poor

IMR

Rural 69 42 68 48

Urban 50 33 53 29

India 62 38 62 42

U5MR

Rural 100 53 98 58

Urban 72 40 72 34

India 89 46 87 50

Table 7 provides the differential in estimated IMR and

U5MR by asset index and household environmental deprivation

index for states of India. In most of the states, the general pat-

tern holds true, that is, the estimated IMR and U5MR among

the poor are substantially higher than the non-poor, both by

household environmental deprivation index and asset index.

Among the states, the estimated IMR among those living in

poor household environmental condition is maximum in the

state of Uttar Pradesh (82) followed by Chhattisgarh, Rajasthan,

Madhya Pradesh, Arunachal Pradesh and Jharkhand where IMR

is more than 70 per thousand live birth. On the other hand, the

IMR among poor household environmental condition house-

holds is minimum in the state of Goa (8) followed by Kerala

and Tamil Nadu with IMR of 34 each, 37 in Manipur and 38 in

Andhra Pradesh. On the other hand, among asset poor house-

holds the IMR is higher in the state of Punjab where the IMR is

87 per thousand live birth and minimum in the state of Goa

with IMR of 22 per thousand live birth. On comparing the es-

timated IMR among asset poor and poor household environ-

mental condition we found that the states such as Andhra Pra-

desh, Haryana, Jammu and Kashmiri, Kerala, Mizoram, Odisha,

Rajasthan, Sikkim, Uttar Pradesh and Chhattisgarh have higher

IMR among those reside in poor household environmental con-

dition than that of asset poor. Among these states Jammu and

Kashmiri has the maximum difference with 21 points difference

of IMR between poor household environmental households and

asset poor households. Similarly the states like Bihar, Jhark-

hand and Tamil Nadu have no difference in IMR between asset

poor households and poor household environmental condition

households. From the table it is also found that most of the

states have higher U5MR rates among the households living in

poor household environmental condition compared to those are

asset poor. There are two states found; Madhya Pradesh and

Uttar Pradesh where there is no difference in U5MR between

those households living in poor household environmental con-

dition compared to asset poor households.

Factors Affecting Child Survival

Table 8 presents the results of Cox Proportional Hazard mo-

del to understand the significant predictor of child survival se-

parately for rural and urban India. Time is the dependent vari-

able and death is the failure variable (0 for surviving and 1 for

dead). The independent variables are a set of demographic and

social variables, namely, age at birth, education of the mother,

preceding birth interval, place of delivery, type of birth (single

or multiple), duration of breastfeeding, working status of mo-

ther, body mass index of mother, sex of the child, caste of mo-

ther and place of residence. Additionally, the household envi-

ronmental deprivation index and the asset index are included in

the hazard model. Results indicate that mother’s education, sex

of the child, preceding birth interval, place of delivery, type of

birth, duration of breastfeeding are significant predictors of

child survival in India. Along with these confounders house-

hold environmental deprivation is also found a strong predictor

of child survival in India and also in both rural and urban India.

The relative hazard ratio is .687 [.566 - .835] for the non-poor

households compared to those who are poor in household envi-

ronmental condition. The hazard ratio is higher in rural areas

compared to the urban areas. On the other hand, the relative

hazard ratio among the asset non-poor is .854 [.717-1.017]

compared to those who are asset poor households. The relative

hazard ratio is not significant in both rural and urban areas. In

the level of education of mothers it is found that the relative

hazard ratio is less for the educated mothers than the unedu-

cated mothers. The relative risk is .46 for mothers with secon-

dary and higher education compared to mothers with no educa-

tion. The hazard ratio is significantly higher for female child

compared to male child. The preceding birth interval also has

greater influence on child survival. The relative risk of hazard

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Table 7.

State level estimated IMR and U5MR by household environmental deprivation index and asset index in India, 2005-06.

IMR U5MR

Household environmental

deprivation index Asset index Household environmental

deprivation index Asset index

STATES

Poor Non-poor PoorNon-poorDa Poor Non-poor Poor Non-poor Db

Andhra Pradesh 38 44 35 47 03 66 50 52 64 14

Arunachal Pradesh 73 45 84 40 −10141 78 157 69 −17

Assam 70 61 81 53 −1190 55 102 47 −13

Bihar 65 47 65 58 00 89 60 93 59 −04

Chhattisgarh 80 40 73 72 07 106 59 102 85 04

Delhi 57 38 60 32 −0374 33 69 34 05

Goa 8 18 22 13 −1466 25 86 16 −20

Gujarat 61 42 66 39 −0584 48 80 52 03

Haryana 67 31 49 41 17 79 42 64 54 15

Himachal Pradesh 42 29 50 29 −0860 38 54 41 05

Jammu and Kashmir 64 38 43 49 21 77 42 53 55 24

Jharkhand 71 51 71 60 00 101 67 102 72 −01

Karnataka 47 43 54 36 −0871 54 82 35 −11

Kerala 34 11 33 12 01 14 13 32 8 −18

Madhya Pradesh 73 44 80 40 −07112 50 112 49 00

Maharashtra 40 36 46 29 −0661 43 68 33 −06

Manipur 37 26 49 19 −1161 49 83 37 −21

Meghalaya 42 52 45 49 −0385 36 71 51 14

Mizoram 42 27 36 32 06 55 31 40 44 15

Nagaland 51 31 54 27 −0369 50 66 55 03

Odisha 61 65 60 68 01 90 64 96 58 −06

Punjab 59 38 87 31 −2873 49 77 51 −03

Rajasthan 77 51 76 58 01 104 66 107 66 −03

Sikkim 49 31 39 32 10 57 35 31 44 25

Tamil Nadu 34 30 34 27 00 57 38 59 22 −02

Tripura 53 51 56 47 −0278 58 91 43 −13

Uttar Pradesh 82 47 81 65 01 120 58 120 86 00

Uttarakhand 58 31 61 36 −0283 61 109 52 −25

West Bengal 50 45 53 39 −0460 46 62 39 −01

India 62 38 62 42 00 89 46 87 50 02

Note: aDifferences in IMR of household environmental deprivation index (poor) and asset index (poor); bDifferences in U5MR of household environmental deprivation

index (poor) and asset index (poor).

decreases with increase in the preceding birth interval. The

relative risk is significantly higher (3.1 times) for multiple birth

compared to the single birth. The duration of breastfeeding is

also a significant predictor of child survival. In urban India,

mother’s education for secondary and higher, preceding birth

interval, type of birth, duration of breastfeeding, working status

B. DEHURY

Table 8.

Hazard ratio and 95% confidence interval of mortality under ages five in India, 2005-06.

Hazard ratio 95% Confidence interval

Covariates

Urban Rural Total Urban Rural Total

Place of residence

Urban®

Rural - - 1.145 .963 - 1.361

Household e nvironmental depri va tion index

Poor®

Non-poor .687* .694*** .687*** .464 - 1.018 .554- .870 .566 - .835

Asset index

Poor®

Non-poor .830 .863 .854* .557 - 1.237 .709 - 1.050 .717 - 1.017

Age at birth

<19®

20 - 29 1.316 .796* .887 .743 - 2.330 .607 - 1.044 .695 - 1.132

30+ 1.559 1.052 1.141 .833- 2.916 .777 - 1.425 .870 - 1.497

Education of m ot her

No education® .973 .718** .797** .685 - 1.381 .556 - .928 .649 - .978

Primary .370*** .538*** .466*** .255 - .536 .411 - .703 .375 - .580

Secondary/higher

Sex of the child

Male®

Female 1.198 1.308*** 1.270*** .921 - 1.559 1.109 - 1.543 1.104 - 1.460

Preceding birth interval

<2 years® .684** .657*** .654*** .497 - .941 .543 - .795 .555 - .770

2 - 3 years .505*** .470*** .474*** .360 - .708 .378 - .584 .395 - .569

3+ years

Place of delivery

Home®

Hospital .733** .623*** .657*** .541 - .992 .479 - .811 .540 - .800

Caste

SCs® 1.246 1.011 1.020 .811 - 1.915 .795 - 1.286 .828 - 1.257

STs .840 .845 .837* .592 - 1.191 .673 - 1.060 .692 - 1.012

OBC .704** 1.022 .895 .479 - 1.035 .792 - 1.319 .723 - 1.106

Others

Type of birth

Single birth®

Multiple birth 2.979*** 3.065*** 3.110*** 1.425 - 6.227 2.088 - 4.498 2.222 - 4.377

Working status of mother

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B. DEHURY

Continued

No®

Yes 1.428** 1.009 1.085 1.060 - 1.922 .849 - 1.198 .934 - 1.261

BMI of mother

<18.5®

≥18.5 1.040 .901 .929 .768 - 1.408 .761 - 1.067 .802 - 1.077

Duration of breastfeeding

Never breastfeed®

<11 months 1.271 1.467** 1.383** .777 - 2.077 1.035 - 2.081 1.041 - 1.838

11 - 23 months .153*** .214*** .193*** .087 - .270 .147 - .312 .141 - .263

>23 months .043*** .064*** .055*** .019 - .095 .040 - .101 .039 - .085

Note: ***p < .01, **p < .05, *p < .10, ®Reference category.

of mother and household environmental condition are signifi-

cant predictors of child survival. In rural India, age at birth,

education of mother, sex of child, preceding birth interval,

place of delivery, type of birth, duration of breastfeeding and

household environmental conditions are the significant predic-

tors of child survival.

Discussion and Conclusion

The study attempts to understand the association of house-

hold environmental conditions and asset index. Furthermore, it

attempts to understand the state of child survival by household

environmental conditions and asset index in India. Result shows

that the association of household environmental deprivation in-

dex and asset index is weaker and lower in rural areas than in ur-

ban areas. The association also varies among the states. In most

of the states the association between household environmental

deprivation index and asset index is low. Theoretically it is true

that the asset households tend to reside in good household en-

vironmental condition. However, the association between these

two indices in this study does not support the theoretical argu-

ment. We further found that there is no significant difference in

the risk of infant and child mortality among the asset poor and

those poor in household environmental deprivation index. In

most of the states, households living in poor household envi-

ronmental condition experienced higher mortality than the

households with poor asset status. The rural areas have rela-

tively higher risk of infant and under-five mortality than the ur-

ban areas. By analyzing the chance of child survival by indivi-

dual variables of household environmental condition, it is found

that the risk of infant and under-five mortality is lower among

the households having access to improved sources of drinking

water, flush toilet, and household using biogases as cooking

fuel and electrification. Hence these are found critical determi-

nants of child survival. The multivariate results show that along

with the socio-economic and demographic covariates, the house-

hold environmental deprivation is found a stronger predictor of

child survival. However, interestingly the relative hazard ratio

is higher in asset index compared to household environmental

deprivation index. It is also found that the hazard ratio is not a

significant predictor of child survival in rural and urban India.

It calls for improving the household environmental conditions

of the households in promoting child survival in India.

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