Parental investment in child health in sub-Saharan Africa: a cross-national study of health-seeking behaviour.

Parents face trade-offs between investing in child health and other fitness enhancing activities. In humans, parental investment theory has mostly been examined through the analysis of differential child outcomes, with less emphasis on the actions parents take to further a particular offspring's condition. Here, we make use of household data on health-seeking for children in a high mortality context where such behaviours are crucial for offspring survival. Using Demographic and Health Survey (DHS) data from 17 sub-Saharan African countries, we examine whether maternal factors (age, health, marital status) and child factors (birth order, health, sex, age) independently influence parental investment in health-seeking behaviours: two preventative behaviours (malaria net use and immunization) and two curative ones (treating fever and diarrhoea). Results indicate that children with lower birth order, older mothers and mothers with better health status have higher odds of investment. The effects of a child's sex and health status and whether the mother is polygynously married vary depending on the type of health-seeking behaviour (preventative versus curative). We discuss how these results square with predictions from parental investment theory pertaining to the state of mothers and children, and reflect on some potential mechanisms and directions for future research.