Reproductive and Overall Health Outcomes and Their Economic Consequences for Households in Accra, Gh...
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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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Allan hill and g nther fink harvard center for population development studies

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

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

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

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

Original Sampling Framework


Findings from 2003

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

Health topics covered in the home interview


Physical examination

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

Microeconomic Study 2008/2009


Study design

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


Allan hill and g nther fink harvard center for population development studies

  • 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

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

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

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

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

Daily Diary Example


Discussion diary data

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

Data Collection: Status and Projection

More coming soon…


Thank you

Thank you!


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