Discussion
This study examined the factors associated with childhood morbidity in sub-Saharan Africa. Results revealed that one-fifth of children in sub-Saharan Africa have suffered from fever and cough while 16% suffered from diarrhoea. Children of women aged 15–24 and 25–34 are more likely to experience morbidity compared with children of women aged 35 years and above. This implies that children of older women have lower tendency of experiencing morbidity compared with children of young and middle-aged women.18–20 This may be linked to the notion that older women are more experienced in child care practices than young and middle-aged women. Such experience may have contributed to the knowledge of these women in disease prevention measures.
Although results at a point in time indicated that children of uneducated women are less likely to experience fever and cough, other results showed that attaining higher education reduces the chances of experiencing morbidity.21 22 For instance, children whose mothers are uneducated and those with primary education are more likely to suffer from diarrhoea compared with children whose mothers have secondary or higher education. The possible explanation for these results may be that uneducated women at a point in time observed some measures which prevented their children from experiencing fever and cough but did not take measures to prevent their children from experiencing diarrhoea. Not maintaining personal hygiene and living in an unhygienic environment may contribute to childhood diarrhoea.
Contrarily, this may be an advantage on the part of educated women who place high priority on hygiene. Results also showed that children from poorest and poorer households are more likely to suffer from morbidity than children from richest households. This indicates that there is a significant relationship between household wealth and childhood morbidity.23 24 Poverty at household level contributes to poor feeding condition of children and forces households to live in poor environment. Poor feeding condition and living in unhygienic environment expose children to morbidity. Children of non-working women are less likely to suffer from any of the diseases compared with children of working women. This has also been reported in other studies.25 This may be linked to the fact that non-working women have more time to cater for their children than working women. Working women with young children, especially those in urban areas, tend to put their children under the care of day care providers, housemaids or guardians. In most cases, these children are not properly taken care of which negatively impacts on their health. It is further revealed that children who are within the age bracket of 12–23 months are more likely to suffer from fever and diarrhoea than children who are within the age bracket of 24–59 months. This indicates that younger children are more susceptible to diseases than older children.26 27 This may be premised on the fact that the older a child becomes, the stronger the immunity he or she builds. However, results showed that unvaccinated children are less likely to suffer from morbidity compared with vaccinated children. This may be linked to the fact that the routine vaccines being administered to children are not meant to prevent any of the diseases under review.
There seems to be a significant relationship between birth order and childhood morbidity as children of second-order birth and third or higher order birth are more likely to experience morbidity than children of first-order birth.28 Ordinarily, one would expect children of higher order birth to suffer less from any of the diseases based on mothers’ experience in child care. But previous studies found that mothers tend to allot less attention to children of higher order birth than children of first-order birth.29 This invariably exposes such children to morbidity. The size of child at birth is another important factor influencing childhood morbidity. Children who were small at birth are more likely to experience morbidity than children who were considered large or of average size.30 This indicates that the smaller a child becomes at birth, the more such child is exposed to morbidity. Environmental factors such as toilet facility also influence childhood morbidity.31–33 Children who are exposed to non-improved toilet facility are more likely to suffer from morbidity. Non-improved toilet facility exposes users to germs that are transmitted to utensils in households.
Policy implications
Efforts at reducing child mortality in sub-Saharan Africa may be jeopardised without a considerable reduction in childhood morbidity. With one-fifth of children suffering from fever and cough and 16% suffering from diarrhoea, childhood morbidity still poses a big challenge to child health in the region. Although it is on record that governments of the countries involved have taken steps at one time or the other to tackle morbidity among children, more measures need to be put in place in order to overcome this challenge. In the first instance, the programmes introduced and sponsored by international organisations in the region with the aim of addressing childhood morbidity should be sustained. It is evident that such programmes have helped in increasing awareness in disease prevention measures among mothers. In addition to this, efforts should be made at national and local levels to strengthen awareness programmes on child health among women.
Since morbidity is more pronounced among children of young and middle-aged women, the focus of such awareness programmes should be on these categories of women. At these programmes, women should be educated on causes of diseases, how children would be prevented from such diseases and, in the event of contracting any disease, what steps to be taken. Apart from this, a community-based forum should be organised on regular basis. At this forum, older women who have accumulated experience in child care should be invited to share their knowledge of child care with younger women. While efforts should be made to establish the factors that contributed to low incidence of fever and cough among children of uneducated women, efforts should be made to increase the percentage of educated women. Education policy that aims at bridging gender gap in enrolment should be promoted. In countries where such policy is already introduced, efforts should be made to ensure effective implementation of such policy. It is obvious that poverty alleviation programmes have been implemented at one time or the other in different countries in sub-Saharan Africa. Despite this, level of poverty in the region remains high at both individual and household levels. This has eventually contributed to childhood morbidity.
There is a need to review such programmes in order to assess their effectiveness and identify their shortcomings. It is also important to map out other ways by which financial pressure on households, especially in respect of child health, can be reduced. For instance, introduction of child health insurance scheme which offers a comprehensive free healthcare for children right from birth up to age 5. This type of scheme will promote child health and at the same time alleviate household poverty. Based on the findings that children of non-working women are less exposed to the risk of morbidity than children of working women, measures should be taken to ensure adequate child care practices on the part of working women. For instance, those who enrol their children in day care centres should ensure that such centres are located close to their place of work which would afford them the opportunity to check on their children at regular intervals before close of work. At the same time, it would be worthwhile if there is a policy that will mandate employers to make provision for day care facility within their premises. Such facility would enable working mothers to have their children under the care of day care providers within their place of work. Local authority in each country should ensure that toilet facility in each house meets the required standard in order to reduce the proportions of non-improved toilet facility.
Study strengths and weaknesses
This study shares some of the shortcomings inherent in the use of cross-sectional data sets. Since respondents were interviewed at a point in time, the opportunity to establish a cause-effect relationship between independent and outcome variables is lost. More so, analysis in this study would have been more robust and detailed information would have been provided if there had been variables measuring other childhood diseases. But the data sets were limited to the diseases considered in this study. It should also be noted that the surveys in the 31 countries were not conducted in the same year. There are economic and population disparities in the periods covered by the data sets which this study could not harmonise. In spite of these shortcomings, the study has provided valuable information on the factors that are associated with childhood morbidity in sub-Saharan Africa using the most recent data sets in the countries considered. This has provided this study with an edge over most previous studies on childhood morbidity which limited their findings to specific countries.
