Contextual and family factors associated with negative assessment of children's health

Background: The health and well-being of children are intimately linked to their families' physical, emotional and social circumstances. Evaluation of children's health has most often been based on parental responses. This work investigates whether proxy health, family context and household factors are associated with child's poor health reported by parental figures. Methods: Data of 32 688 children of three age-strata (0-5; 6-11; 12-17 years) were obtained from a representative survey in Brazil in 2003. The analyses used generalized estimation equations to examine the association between having a bad health evaluation and the following factors grouped as: children/adolescents characteristics, history of child's health care use, proxy characteristics and family and household factors. Results: Over 60% of the questionnaires were answered by the child's mother, with no significant difference among age groups. The proportion of children who had their health rated as bad decreased with age and was greater among males in all age groups (9.7%; 7.5%; 6.7% vs. 6.8%; 6.6%; 6.3%). The final model shows that household income per capita is inversely related to child's bad health in all age groups. Additionally, parent/proxy bad self-rated health is strongly and directly associated with child's bad health and is not explained by measures of the child's health or by the proxy's lack of education or a family's low income. The number of medical visits by the child in past year is also inversely associated with bad health. Conclusion: Results reinforce the importance of the household context to child's health and the association between parental figures and child health.