Decomposing differences in self-rated health between adult men and women in sub-Saharan Africa: Results from the World Health Survey

While there is a widespread interest for gender health differences in public policy and scientific debates within developed countries, studies on this topic are scarce in developing countries, particularly in sub-Saharan Africa. However, gender differences in sub-Saharan Africa health status are important, with the few available studies showing that women report worse health than men. Nevertheless, the sources of these differences are rarely explored. We used an extension of Oaxaca-Blinder decomposition using logistic models with data from the 2002 World Health Survey to partition the women-men poor self-rated health (SRH) gaps into a component reflecting differential “exposure” to risk factors between women and men, and a component reflecting differential “vulnerability” to risk factors in sixteen sub-Saharan African countries. We found that women more often reported poor SRH than men in all the countries analyzed (apart from Kenya). Decomposition analyses showed that differential exposure largely explained the women-men gaps in poor SRH in all the countries studied, with an explained part ranging from a low of 64% in Zambia to a high of 122% in Malawi. Disability, arthritis, socio-economic, psychosocial and behavioral risk factors proved important contributors to the observed differences in men’s and women’s poor SRH.