Poster session on Health, mortality and longevity (1)

This paper uses data from a maternal health study carried out in 2006 in two slums of Nairobi, Kenya, to: describe perceptions of access to and quality of care among women living in informal settlements of Nairobi, Kenya; quantify the effects of women’s perceived quality of, and access to, care on the utilization of delivery services; and draw policy implications regarding the delivery of maternal health services to the urban poor. Results show a pattern of women’s good perceptions in terms of access to, and quality of, health care provided by the privately owned, sub-standard and often unlicensed clinics and maternity homes located within their communities.In the multivariate model, the association between women’s perceptions of access to and quality of care, and delivery at these ‘inappropriate’ facilities remained strong, graded and in the expected direction. Women from the study area are seldom able to reach not-for-profit private providers of maternal health care services like missionary and non-governmental organization (NGO) clinics and hospitals. Against the backdrop of challenges faced by the public sector in health care provision, we recommend that the government should harness the potential of private clinics operating in urban, resource-deprived settings.

There is a long standing debate on whether measures of subjective wellbeing are an adequate reflection of objectively assessed health states among a population. This question has not previously been empirically examined in Ghana. Using a representative sample of women aged 20 through 85 years from the second wave of the Women’s Health Study of Accra (WHSA II) conducted in 2008/2009, the study seeks to address this issue by investigating the strengths of a woman assessing her own subjective health as poor compared with her objectively assessed health outcomes after controlling for other covariates. The study employs descriptive, bivariate and multivariate analysis to describe the general health situation among urban women in Accra. The results show that 31.7% and nearly one-fifth of women in Accra are living with a chronic condition or hypertensive. The bivariate analysis also showed that a higher proportion who assessed their subjective health as poor were having a medical condition.
Although, subjective health measures can be employed to supplement objectively assessed health outcomes as surveys cover a wider population; its influence is mixed. Subjective health measures are not substitute for medical examination; they provide simple and inexpensive ways of identifying people at risk of chronic morbidity and mortality.

Using the New Immigrant Survey and the National Health Interview Survey, this paper examines whether Asian immigrants in the United States, especially those who are less-educated, are selected on positive health compared to non-migrants in their sending countries and to their U.S.-born counterparts. If positive health selection is most prevalent for less educated Asian immigrants, it can help to explain why Asian immigrants in the U.S. have a weaker education gradient in health. Results show that most Asian immigrants are healthier compared to people in their home countries and to their U.S.-born counterparts. More-educated immigrants are more likely to have better health than people in their sending countries. Yet, the effect of nativity on health does not significantly vary by education level. Other possible reasons for the weaker education gradient in health for Asian immigrants are acculturation, different education and health relationship in sending countries and lower returns to education.

Male out-migration leads to modification in the structure of family life and also transforms women’s social and economic position. A significant effect of migration on the family is the conjugal separation. The need for assistance with child care also may motivate a restructuring of household composition. Data Source: National Family Health Survey (NFHS)-3 (2005-2006). Objective: The broad objective of the study is to understand the household structure of left behind women and use of maternal health services in the place of origin due to male out-migration. Findings: male out-migration in non-nuclear households has better in use of maternal health services compared to those in nuclear households. This may be explained on the basis of the fact that the economic status of women in non-nuclear households is better than their counterparts. May be due to low standard of living, the affordability for health care among women in nuclear households is overshadowed.

Emile Durkheim’s scientific study on suicide (1897) is considered the pioneering work on the epidemiological impact of religion, a topic which then became the subject of intense inquiry in the West, before, during and after the epidemiologic transition. In developing countries in general, there is a dearth of scientific studies on the matter, even though the influence of religion may be more greater due the generally low levels of education among the population. Reluctance to vaccinate based on religious grounds, for example, have been reported in northern Nigeria where in 2003, Muslim leaders called on parents to refuse to vaccinate children against polio, on the grounds that the vaccine may contain HIV or cause infertility (Jegede, 2007). Such ideological barriers stand in the way of the Expanded Programme on Immunization’s goal to vaccinate all children, and of consequently achieving the fourth MDG (to reduce under 5 mortality by two thirds between 1990 and 2015). In order to improve the effectiveness of immunization programs, it is important to measure disparities in childhood immunization and understand the causes of these disparities. Using data collected in a Demographic and Health Surveillance System, this paper aim to examine the religious differences in child vaccination in Ouagadougou, the capital of Burkina Faso.

Self-reported morbidity i.e. measure of incidence of disease based on reported sickness has an element of subjectivity. Unlike morbidity, mortality is an objective measure based on “external assessment of health”. In India, there are evidences of regions where the reported morbidity is higher, yet the mortality is low and vice versa. Motivated from this opposing observation in morbidity and mortality and from the fact that there is a dearth of literature on exploring the relation between morbidity and mortality in Indian context, this paper studies the difference between morbidity and mortality for Indian States. The study conceptualizes Mortality–Morbidity–Gap Index (MMGI) and justifies the measure through an axiomatic characterization. An empirical illustration is carried out ranking the States of India as per MMGI using data from National Sample Survey. The study also investigates the determinants of MMGI by considering State’s income, education, urbanization, health infrastructure, and policy variables.

In spite of significant gains in life expectancy at birth (e0) that both Arabs and Jews in Israel have experienced throughout the last 40 years, a gap ranging between 3 to 4 years has persisted between the two groups. Using decomposition methods, this paper estimates the contribution of specific age groups and causes of death to the total Arab-Jewish gap during 1970-08. Results show that trends in the total gap reflect two opposing processes. During 1970-80 modest declines in the total gap were driven by converging infant and child mortality rates. Thereafter, growing inequalities in older-age mortality resulted in widening the gap. Cancer mortality which was a major suppressor of the total Arab-Jewish gap for both sexes has recently turned to a small positive contributor. Faster increase in diabetes mortality rates among the Arab minority also positively contributed to enlarging the gap.

This paper re-examines the relationship between maternal employment and child survival in India. It examines differences in survival to age five between children of working and non-working mothers. Also, it examines which aspects of maternal employment (e.g. work location or occupational category) are more relevant to understanding child survival. Data come from India’s National Family Health Survey. Formation of comparison groups (e.g. non-working vs. working mothers) is aided by propensity score matching, and differences between matched groups in child survival are estimated through survival analysis. In urban areas, results show higher risk of dying for children of working mothers as compared to children of non-working mothers. No similar relationship was found in rural areas. Also, results show that some aspects of employment increase the risk of mortality more than other: working at home (but not away from home) or working in low-status occupation is associated with increased risk of child mortality.

Ouagadougou, the capital of Burkina Faso, is currently experiencing rapid population growth. Since 2008, the Ouaga HDSS following 80,000 people living in five neighborhoods on the periphery of the city, half of them living in poor, informal settlements. First analyses of the mortality data collected show that the main causes of deaths among adults aged 15 to 59 are AIDS, cardiovascular diseases and accidents; adult mortality (15 to 59) is higher in formal neighborhoods. This excess mortality seems attributable to the relatively higher wealth of households in formal neighborhoods: affluent adults are indeed more often overweight and more likely to be HIV positive; better educated adults are more likely to have accidents. In this analysis, we test (using Cox regression and data on mortality from 2008 to 2012) whether wealthier adults are more often victim of premature death, controlling for a variety of factors at the individual and household level.

With the global paradigm shift in disease burden, behavioural change has been identified as one the major drivers of effective disease management. This study examines risk and preventive health behaviour in Ghana controlling for chronic disease status and socio-demographic factors. Data from the Study on Global Ageing and Adult Health (SAGE) conducted in an adult population 18 years and older with significant focus on those aged 50 years plus were analysed. The study focuses on healthy lifestyle behaviour (HLB) estimated using factor analysis and regression modelling to investigate the association between chronic disease, socio-demographic factors and HLB. An overall higher level of HLB among chronic disease persons was found with age, sex education, employment and wealth still being significant predictors of HLB. The study argues that the significant differential in HLB in favour of chronic disease persons will chart a new pathway for the epidemiological transition with longevity.