title: Does child gender determine household decision for health care in rural Thatta, Pakistan?
abstract: BACKGROUND
  In South Asia, gender disparity in child mortality is highest in Pakistan. We examined the influence of child gender on household decision regarding health care.
  
  
  METHODS
  Prevalence ratios were calculated for 3740 children aged 1-59 months from 92 randomly selected villages of rural Pakistan using a cluster-adjusted log-binomial model. Level 1 variables included child and household characteristics and level 2 included village characteristics.
  
  
  RESULTS
  There were 25 more girl deaths than boys per 1000 live births (95% CI: 13.9, 48.6) among post-neonates and 38 more among children aged 12-59 months (95% CI: 10.5, 65.5). However, in adjusted analysis, gender was not a significant predictor of illness reporting, visit to health facilities, choice of provider, hospitalization and health expenditure. Significant predictors of health care were child's age, illness characteristics, number of children in the family, household socio-economic status and absence of girls' school in the village.
  
  
  CONCLUSIONS
  Differential care seeking for boys and girls is not seen in Thatta despite clear differences in mortality ratios. This calls for more creative research to identify pathways for gender differential in child mortality. Factors identified as influencing child health care and amenable to modification include poverty alleviation and girls' education.
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan. rozina.nuruddin@aku.edu
authors.forename: R
authors.initials: R
authors.lastname: Nuruddin
authors.forename: W C
authors.initials: WC
authors.lastname: Hadden
authors.forename: M R
authors.initials: MR
authors.lastname: Petersen
authors.forename: M K
authors.initials: MK
authors.lastname: Lim
mesh_terms: D000367:Age Factors; D046688:Child Mortality; D002669:Child Welfare / Q000706:statistics & numerical data; D002675:Child, Preschool; D016000:Cluster Analysis; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005191:Family Characteristics; D005260:Female; D006304:Health Status; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D015999:Multivariate Analysis; D010154:Pakistan / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D012424:Rural Population; D012737:Sex Factors; D012959:Socioeconomic Factors