Child Gender and Parental Reporting of Illness Symptoms in Sub-Saharan Africa

Abstract

Abstract. 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 subsample 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.

Quantifying the contribution of Plasmodium falciparum malaria to febrile illness amongst African children

“…This modelling approach makes use of household survey datasets in a novel way; no previous attempts have been made to measure childhood fever prevalence (and the malaria/non-malaria causality of the fever) from surveys recording two-week fever history. This approach has some drawbacks: it relies on two-week recall of fever from the child’s caregiver, the accuracy of which can be subject to biases such as (i) length of time since the fever; (ii) the child’s frequency of febrile episodes, (iii) the economic status of the family, and (iv) even the child’s sex ( Das et al, 2012 ; Rockers and McConnell, 2017 ). We also include fever caused by P. vivax malaria as a NMFI by definition, as not all household surveys tested for P. vivax with RDT and thus only P. falciparum outcomes were used in this analysis.…”

Esophageal cancer male to female incidence ratios in Africa: A systematic review and meta-analysis of geographic, time and age trends

“…While etiological insights are of primary interest, gender inequalities in healthcare access giving rise to referral biases, may also affect sex-differentials in incidence in the African setting [ [58] , [59] ]. There is some indication of this in sub-Saharan Africa, with present-day male referral bias having been reported in children [ 60 ] and middle-aged women [ 61 ] as well as historical reports of barriers faced by elderly women in rural areas [ 62 ]. Such referral biases would be expected to affect other cancer sites too, but we are not aware of any studies examining this issue.…”

Sibling rivalry between twins in utero and childhood: Evidence from birthweight and survival of 95 919 twin pairs in 72 low‐ and middle‐income countries

“…Some studies address variance rather than averages, often finding greater variability in health among male children than female children under stressful circumstances (Ansar Ahmed et al, 1985; Drevenstedt et al, 2008; Kraemer, 2000; Sawyer, 2012). A variety of studies address sex‐specific differences and gender bias against girls (Gupta et al, 2017; Khera et al, 2014; Klasen, 1996; Rockers & McConnell, 2017; Treleaven et al, 2016), sometimes finding worse outcomes for male children (Marcoux, 2002; Sahn & Stifel, 2002; Svedberg, 1990; Wamani et al, 2007), including higher rates of a miscarriage of male fetuses at times of environmental stress (Valente, 2015).…”