Social determinants of child health in Yemen

Much of child illness in developing countries can be explained by what have been called, 'proximate determinants,' principally infant feeding practices and preventive and curative care. During previous field research in a small village in Yemen the author observed that despite the uniformly unhealthy environment, a minority of the families carried most of the burden of child illness and death. This study was carried out to document that observation, and to suggest an explanation. The study used quantitative techniques to map child health in the community and identify a sub-sample for subsequent in-depth questioning and observation. What distinguished women with healthy and unhealthy children was the level of resources under their control and the way they managed them; their social support or lack of it; and their passive or active attitudes toward life. Detailed stories are presented for five of the women. Although biological explanations for ill health can lead to useful interventions, the social and economic problems of the 'multi-problem family'--well-recognized in industrialized countries--must also be addressed to improve child health.