Sub-Saharan Africa has the poorest overall health in the world-the estimated under-5-year death rate of 173 per thousand live births is almost twice that of south Asia and nearly 30 times higher than the rate in developed countries. Uniquely among world regions, child mortality rates in sub-Saharan Africa are increasing due to HIV/AIDS and other diseases including malaria and pneumonia. Few studies have investigated health inequities in African countries, even though any inequities would have important implications for health-care management.
Joanna Armstrong Schellenberg from Ifakara Health Research & Development Centre, Tanzania, and colleagues did a household survey in four regions of Tanzania (which included around 2000 children under five years of age) to establish the effects of relative household wealth on access to community health-care.
The prevalence of childhood illness was high-around half the children of the surveyed households had been ill in the two weeks before the survey. Wealthier families were more likely to bring their sick children to a health facility; their children were more likely than poorer children to have received antimalarials, and antibiotics for pneumonia
Joanna Armstrong Schellenberg comments: "We have shown that care-seeking behaviour is worse among poorer families than among the relatively rich, even within a rural Tanzanian society that might easily be assumed to be uniformly poor. Programmes aimed at reducing overall average burden of disease should include strategic components aimed specifically at simultaneously improving health equity."
See also accompanying Commentary (p 540)
Contact: Dr Joanna Armstrong Schellenberg, Ifakara Health Research & Development Centre, Ifakara, Tanzania; E) dajobelo@aol.com
The Lancet