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Journal of Public Health Advance Access originally published online on May 14, 2009
Journal of Public Health 2009 31(3):389-397; doi:10.1093/pubmed/fdp038
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© The Author 2009, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Does child gender determine household decision for health care in rural Thatta, Pakistan?



R. Nuruddin, Assistant Professor1,2

W. C. Hadden, Visiting Faculty1

M. R. Petersen, Independent Consultant3

M. K. Lim, Associate Professor2
1 Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan
2 Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore
3 Independent Consultant, Cincinnati, Ohio, USA

Address correspondence to Rozina Nuruddin, E-mail: rozina.nuruddin{at}aku.edu


  Abstract

Background In South Asia, gender disparity in child mortality is highest in Pakistan. We examined the influence of child gender on household decision regarding health care.

Methods Prevalence ratios were calculated for 3740 children aged 1–59 months from 92 randomly selected villages of rural Pakistan using a cluster-adjusted log-binomial model. Level 1 variables included child and household characteristics and level 2 included village characteristics.

Results There were 25 more girl deaths than boys per 1000 live births (95% CI: 13.9, 48.6) among post-neonates and 38 more among children aged 12–59 months (95% CI: 10.5, 65.5). However, in adjusted analysis, gender was not a significant predictor of illness reporting, visit to health facilities, choice of provider, hospitalization and health expenditure. Significant predictors of health care were child's age, illness characteristics, number of children in the family, household socio-economic status and absence of girls' school in the village.

Conclusions Differential care seeking for boys and girls is not seen in Thatta despite clear differences in mortality ratios. This calls for more creative research to identify pathways for gender differential in child mortality. Factors identified as influencing child health care and amenable to modification include poverty alleviation and girls' education.

Keywords: children, gender, health services


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