Child Gender and Parental Reporting of Illness Symptoms in Sub-Saharan Africa
Child Gender and Parental Reporting of Illness Symptoms in Sub-Saharan Africa
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DOI：
10.4269/ajtmh.16-0249
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发表时间：
2017-01-01
影响因子：
3.3
通讯作者：
McConnell, Margaret
中科院分区：
文献类型：
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作者：
Rockers, Peter C.;McConnell, Margaret
关于中低收入国家儿童健康的绝大多数证据都是基于父母的报告。关于这些报告是否存在系统性偏见，特别是与儿童性别有关的偏见，证据有限。我们调查了撒哈拉以南非洲国家样本中儿童性别的症状报告差异。对2005年以来进行的35次人口与健康调查和10次疟疾指标调查的数据进行了分析。父母报告的儿童症状进行了比较的女孩和男孩。在来自尼日利亚的子样本数据中，我们还比较了父母报告女孩和男孩发烧的准确性。然后，对观察到的报告差异的潜在解释进行了探索。最后，对症状报告的性别差异与儿童健康结果差异之间的国家级关系进行了估计。据父母报告，女孩发烧和腹泻的次数少于男孩。女孩较少报告症状似乎并不是因为减少了接触致病因子，也不是因为寻求治疗的人数增加。在国家一级，女孩发烧报告率低于男孩，与女孩婴儿死亡率相对较高有关，这与报告不足和健康结果之间的潜在联系一致。从计量的角度来看，根据父母的报告对儿童发病率和治疗方面的性别不平衡作出的估计可能不准确。从公共卫生的角度来看，父母对女孩症状的漏报可能表明未得到治疗的疾病未被注意。
The overwhelming majority of evidence about the health of children in low-and middle-income countries is based on reports by parents. There is limited evidence on whether these reports suffer from systematic bias, particularly related to the gender of the child. We investigate differences in symptom reporting by child gender in a sample of countries in sub-Saharan Africa. Data from 35 Demographic and Health Surveys and 10 Malaria Indicator Surveys conducted since 2005 were analyzed. Parental reports of child symptoms were compared for girls and boys. In a sub-sample of data from Nigeria, we also compared the accuracy of parental reports of fever between girls and boys. Then, potential explanations for observed reporting differences were explored. Finally, country-level relationships between gender differences in symptom reporting and differences in child health outcomes were estimated. Parents reported fewer episodes of fever and diarrhea for girls as compared with boys. Less frequent symptom reporting for girls does not appear to be due to reduced exposure to illness-causing agents nor increased treatment seeking. Lower fever reporting for girls relative to boys is associated with higher relative infant mortality for girls at the country level, consistent with a potential link between underreporting and health outcomes. From a measurement perspective, estimates of gender imbalances in child morbidity and treatment based on parental reports may be inaccurate. From a public health perspective, parental underreporting of symptoms in girls may indicate untreated illness that goes unnoticed.