Household composition and child health in Botswana

Background: there is a general lack of research on children’s household experiences and child health outcomes in low- and middle-income countries (LMICs). This study examines the relationship between household composition and stunting and diarrhoea prevalence among children younger than five years of age in Botswana. Methods: the analysis uses data from the 2007 Botswana Family Health Survey (BFHS) and multilevel logistic regression models. Results: the findings indicate that stunting varies by whom the child lives with. Stunting is higher among children living with no parents compared to those living with both parents. Stunting is also high among children living with non-related household members. Conversely, living with an aunt and living with other relatives protects against stunting. Similarly, children living in mother-only households and with a grandparent present have a higher level of stunting compared to those living with both parents. The findings on diarrhoea prevalence show that children living in mother-only households and those living with no parents are less likely to have the condition than those living with both parents. Also, across all households, those who are more affluent, regardless of who is in the household, have lower rates of stunting and diarrhoea prevalence than those who are poorer. Finally, the findings show a clustering effect at household level for both stunting and diarrhoea prevalence. Conclusions: these findings suggest that policies and programs aimed at reducing stunting and diarrhoea may work best if they target households and other adults in a household besides biological parents. Further, programs should take into account the nature of the child’s health condition, whether it is an indicator of long-term or short-term health