PhD: Social determinants of health and health inequalities in Malawi

PhD: An economic perspective of the social determinants of health and health inequalities in Malawi

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The project, implemented as a PhD study, was organised as follows. The first chapter of the thesis outlined the research questions, rationale and background to the study. Chapter 2 examined two research hypotheses. Focusing on the effect of household and mother’s education, it tested whether a socio-economic gradient in child malnutrition exists, focusing on stunting and under-weight in children aged below 5 years using a linear regression model. This chapter also tested whether the socio-economic determinants of child malnutrition have similar effects across the stunting and under-weight distributions using a quantile regression framework. Chapter 3 examined whether a socio-economic gradient in infant mortality exists. Using count regression models, chapter 4 examined whether a socio-economic gradient in healthcare utilisation exists, focussing on outpatient visits for children aged 5 years and below in Malawi. Chapter 5 revisited the hypothesis of the existence of a socio-economic gradient in child malnutrition addressed by decomposing the socio-economic inequalities in child stunting and under-weight.

The results show evidence of a socio-economic gradient in child health in Malawi. The thesis also finds a positive and significant effect of wealth and a negative effect of mother’s education on infant mortality. Furthermore, the findings show no significant effect of wealth but a positive effect of mother’s education on outpatient utilisation.

Additionally, the thesis finds significant and substantial effects of child-, household- and community-level factors on child health and outpatient care. Policy-wise, the results point to an urgent need for clearly specifying the distributional goals for the Malawi health sector in the next health sector strategic plan.

Outcome and Translation

This research is of interest as its findings will substantially inform the development of policies aimed at tackling inequalities and which are based on a secure evidence base linking socio-economic factors to health, thus indicating where resources should be applied most effectively.

PhD student: Dominic Nkhoma

Supervisors: Ramses Abul Naga and Barbara Eberth (HERU)

Publications

Nkhoma, D. (2014) 'An economic perspective of the determinants of and inequalities in child health and health care in Malawi', PhD Thesis, HERU, University of Aberdeen.

Presentations

Nkhoma, D. (2011) 'Social determinants of child mortality in Malawi', Presented at the Health Econometrics Working Group, HERU, Aberdeen, November 2011.

Nkhoma, D. (2011) 'Determinants of child malnutrition in Malawi: a family perspective', Presented at the HERU Internal Seminar Series, Aberdeen, December 2011.

Nkhoma, D. (2013) 'Measuring and explaining inequality and change in inequality, in infant mortality in Malawi', Presented at the Health Econometrics Working Group, HERU, Aberdeen, February 2013.