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Reproductive and Overall Health Outcomes and Their Economic Consequences for Households in Accra, Ghana. Allan Hill and Günther Fink Harvard Center for Population & Development Studies Ernest Aryeetey and Isaac Osei-Akoto Institute for Statistical, Social and Economic Research

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Reproductive and Overall Health Outcomes and Their Economic Consequences for Households in Accra, Ghana

Allan Hill and Günther Fink

Harvard Center for Population & Development Studies

Ernest Aryeetey and Isaac Osei-Akoto

Institute for Statistical, Social and Economic Research

Third Annual Research Conference on Population, Reproductive Health and Economic Development

Dublin, Jan 16-18, 2009


Research Questions

Broad question:

What are the economic consequences of ill health?

Original Research Questions:

  • How do spells of ill health affect household income and consumption in urban Sub-Saharan Africa?

  • How does household composition affect the coping mechanisms chosen by the household in the short run?

  • How does ill health affect household composition in the short and medium run?


Empirical challenges…

  • Identifying the causal effect of ill health on economic outcomes in the presence of unobserved heterogeneity

  • Distinguishing “reproductive” morbidity from general ill-health

  • Measuring the indirect effects of women’s RH morbidity

    • Childhood illness and women’s work

    • Other adult illnesses in the household

    • “Openness” of household support (e.g. Ga non-residence of spouses; extended family transfers; national health insurance)

  • Capturing the co-incidence of a set of individually “minor” RH conditions which are nonetheless additive….


Baseline Sample

Women’s Health Study of Accra 2003:

  • Representative sample of 3200 women aged 18+ from the Accra Metropolitan Area

  • Over-sampling of elderly

  • Stratification by social class based on census data

  • Detailed home interview with focus on general and reproductive health

  • Blood tests and hospital visit for a sub-sample of the women (Korle Bu Teaching Hospital)


Original Sampling Framework


Findings from 2003

  • Heavy burden of non-communicable diseases – strong association with age

    • Obesity

    • Cholesterol levels

    • Diabetes

    • Depression and mental illness

  • Women of reproductive age in good general health

    • TFR=2.1

    • Clustering of minor reproductive health conditions (co-morbidities c.f. Giza Study)

    • RH conditions additive…


Health topics covered in the home interview


Physical examination

  • Measurement of height, weight and girth

  • Measurement of visual acuity

  • Measurement of blood pressure, heart rate and temperature

  • Complete physical examination: head to toe


Microeconomic Study 2008/2009


Study Design

  • Sub-sample of 1000 households indexed to women interviewed both in 2003 and 2008 (in progress)

  • Each households is followed over 12 weeks with at least one visit per week

  • Rolling sample to guarantee regional coverage of all four socioeconomic residence types in each season


  • Accra Metropolitan Area

  • Total population estimate 1.6-2.9 Millions (about 10% of total population)

  • 1741 enumeration areas (EA) in 6 sub-metros – 200 randomly selected


Rolling Sample Time Line

12 weeks

Week 1

IV 1 round 1

Week 2

IV 2 round 1

Week 3

IV 3 round 1

  • Each “cohort” consists of

  • 20-25 households

  • 3-5 different EAs

IV 11: round 4

IV 12: round 4

Week 52

IV 13: round 4

December 09

October 08


Background Information Collected

  • Householdstructure and arrangements (week 1)

  • Detailed schooling information for all children in the houshold (week 7)

  • Detailed job information for all adult household members (week 10)

  • Detailed health history of index woman and her family (WHSA II)


Main Health Information Collected

  • Health Module: During each of the 12 weekly visits, a log about sickness spells in the household is kept. If any acute sickness occurred in previous 6 days, the following information is collected:uration of sickness

    • Health facility name and location

    • Medication used

    • Direct cost to the household: prescriptions & doctor fees

    • Indirect private cost: number of hours/days not able to work

    • Indirect HH cost: number of hours other HH members stayed home to take care of sick person


Additional Health Information Collected

  • Daily time use and health diaries: selected household members are trained to fill out daily diaries containing:

    • Principal activity for each 30 minute time block

    • Overall self-health assessment each day


Daily Diary Example


Discussion Diary Data

Main benefits:

  • allows to verify household response from health modules: how does daily routine change for individuals during health problems of any HH member?

  • Provides interesting picture of everyday life in an modern African urban environment – how do individuals spend their time?

  • Allows limited risk factor analysis: work distance, commuting and health; work/leisure balance and health

    Concerns:

  • Large potential error in self-reports

  • Major sample selection problem: literacy!


Data Collection: Status and Projection

More coming soon…


Thank you!


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