Background: Botswana has experienced rapid economic and social development over
the past few decades. However this has coincided with growing social inequalities in
health and wealth. Botswana’s GINI coefficient ranks it as one of the most unequal
societies in the world and health indicators on under-five mortality are lower in
comparison to other development indices. Furthermore there is considerable variance in
wealth composition in the 29 administrative districts in the country. This study aims to
look specifically at wealth and inequality and their association with infant and child
mortality risk. The author expects that child health outcomes will be better for mothers in
higher wealth levels and living in more societies where wealth is distributed more
equally.
Methods: Using data from the 2011 Botswana Population and Housing census a crosssectional
multilevel logistic regression analysis was conducted to analyze the effects of
wealth at the individual- and district levels, as well as to identify whether infant and child
mortality risk varies by district. The sample sizes included 40461 and 219584 mothers for
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the infant and child mortality risk analyses respectively.
Conclusion: Although there was variation in infant and child mortality risk across
districts, this could not be attributed to inequality. In addition, socioeconomic
determinants were not associated with infant mortality risk. However, increasing wealth
and education were positively associated with child mortality and in most cases with a
social gradient. The importance of this study is in contributing to the literature on wealth
and health in developing countries. Furthermore it provides recommendations on
opportunities to improve health for the under-five subpopulation. As wealth disparities
continue to rise in sub-Saharan Africa an awareness of their potential impact on
population health should provide more encouragement for a systematic approach to the
socioeconomic determinants of health.