Socio-economic status by rapid appraisal is highly correlated with mortality risks in rural Africa

Abstract

Socio-economic status is an important determinant of health and survival in rural Africa and necessitates a practical and valid instrument to implement in health studies. Our objective was to investigate the validity of the rapid appraisal method to assess socio-economic status and its ability to identify individuals at risk. Among 1573 households in rural northern Ghana, we calculated the Demographic Health Survey (DHS) wealth index and conducted two rapid appraisal methods: self-reported wealth and interviewer-reported wealth. In addition we followed the 25,184 participants from these households for survival with a mean follow-up of 3.9 years, during which 885 participants died. The DHS wealth index was moderately correlated to self-reported wealth (Spearman's rho 0.59, P<0.001) and interviewer-reported wealth (Spearman's rho 0.75, P<0.001). Mortality risks were significantly higher for people with lower than average self-reported wealth [hazard ratio (HR) 1.30 (95% CI 1.11-1.51)] and lower interviewer-reported wealth [HR 1.40 (95% CI 1.21-1.62)]. Mortality risks were lower for people with higher self-reported wealth [HR 0.81 (95% CI 0.32-2.03)] and higher interviewer-reported wealth [HR 0.84 (95% CI 0.58-1.21)]. Similar discriminative mortality risks were assessed when using tertiles of the DHS wealth index (Ptrend<0.001).

Determinants of epidemiologic transition in rural Africa: the role of socioeconomic status and drinking water source

“…Risk of mortality is increased for those with a low socioeconomic status and those who drink from unimproved water sources. 9,10,25 Although socioeconomic status and water source determine survival, they did not relate to the declines of mortality and fertility during the epidemiologic transition. Possibly, these declines have started earlier in groups with a relatively high socioeconomic status or access to an improved water source, so that the absolute levels of mortality differ, but the declines in mortality do not differ.…”

“…11,12 The majority of the population are farmers, whose agricultural practices are performed manually and without proper means of transportation, irrigation and electricity. 9,13 The local economy partly uses the barter system, in which goods are directly exchanged for other goods or services. 11,12 Up to half of the population has not received any formal education.…”

“…1,2,5 In addition, factors that have played an essential role in the classical epidemiologic transition, such as improvements in hygiene, access to improved drinking water and socioeconomic status, 1 have been shown to determine the survival probability in rural Africa. 9,10 However, it is unclear whether these factors drive the decline in mortality and fertility during the current protracted epidemiologic transition. 2,6,7 In one of the least developed areas of Ghana, we followed a cohort of almost 30 000 inhabitants for a period of 9 years and studied the ongoing epidemiologic transition.…”

Polymorphisms in TLR4 and TLR2 genes, cytokine production and survival in rural Ghana

“…The area is poor and mortality rates are high, with the main causes of death being malaria, diarrhea and poor nutrition. 14,15 Inhabitants belong to different ethnic groups such as Bimoba, Fulani, Busanga, Kusasi and Maprusi. Surveys on demographics were held annually from June to August, starting from 2002, 16 in which population information including births, deaths and migration was updated.…”

“…All analyses were adjusted for possible confounders such as age, sex and tribe. Additional confounder in this population is compound wealth, as it has been shown to affect mortality, 15 and possibly disease pathogen exposure. In all analyses, an additive model was used, assuming a linear association of each additional SNP allele with the outcome.…”