Comparison of household socioeconomic status classification methods and effects on risk estimation: Lessons from a natural experimental study, Kisumu, Western Kenya

IntroductionLow household socioeconomic status is associated with unhealthy behaviours including poor diet and adverse health outcomes. Different methods leading to variations in SES classification has the potential to generate spurious research findings or misinform policy. In low and middle-income countries, there are additional complexities in defining household SES, a need for fieldwork to be conducted efficiently, and a dearth of information on how [1]classification could impact estimation of disease risk. MethodsUsing cross-sectional data from 200 households in Kisumu County, Western Kenya, we compared three approaches of classifying households into low, middle, or high SES: fieldworkers (FWs), Community Health Volunteers (CHVs), and a Multiple Correspondence Analysis econometric model (MCA). We estimated the sensitivity, specificity, and inter-rater reliability and misclassification of the three methods using MCA as a comparator. We applied an unadjusted generalized linear model to determine prevalence ratios to assess the association of household SES status with a self-reported diagnosis of diabetes or hypertension for one household member. Results Compared with MCA, FWs successfully classified 21.7% (95%CI=14.4%-31.4%) of low SES households, 32.8% (95%CI=23.2-44.3) of middle SES households, and no high SES households. CHVs successfully classified 22.5% (95%CI=14.5%-33.1%) of low SES households, 32.8% (95%CI=23.2%-44.3%) of middle SES households, and no high SES households. The level of agreement in SES classification was similar between FWs and CHVs but poor compared to MCA, particularly for high SES. None of the three methods differed in estimating the risk of hypertension or diabetes. ConclusionsFW and CHV assessments are community-driven methods for SES classification. Compared to MCA, these approaches appeared biased towards low or middle household SES and not sensitive to high household SES. The three methods did not differ in risk estimation for diabetes and hypertension. A mix of approaches and further evaluation to refine SES classification methodology is recommended.

Export-Driven, Extensive Coastal Aquaculture Can Benefit Nutritionally Vulnerable People

Export-orientated shrimp and prawn farming in coastal ghers has been associated with negative environmental, social, and nutritional impacts. This study challenges these perceptions based on field observations from four communities in South West Bangladesh. Most households observed (>60%) were either directly involved in seafood farming or engaged elsewhere in the seafood value chain. Our study set out to establish how the type and location of aquaculture impacted on access to and consumption of aquatic animals. Additionally, we assessed the effects of both household socioeconomic status and intra-household food allocation on individual diet and nutritional outcomes. We used a blended approach, including a 24-h consumption recall on two occasions, analysis of the proximate composition of aquatic animals and biomarkers from whole blood from a sample of the target population. The diverse polyculture systems generated broad social benefits, where “export-oriented” production actually supplied more food locally than to global markets. Key findings: (1) worse-off households achieved higher productivity of farmed aquatic animals on smaller landholding than better-off households with larger landholdings; (2) vegetable production on gher dikes was a significant source of nutrition and income in lower saline gradients; (3) more fish was eaten in lower saline gradients although fish consumption was highly variable within and between households; (4) intra-household allocation of specific foods within diets were similar across communities; (5) recommended nutrient intakes of protein and zinc exceeded daily requirements for adolescent females, but energy, calcium, and iron were below recommended intake levels; (6) n-3 LC-PUFA, expressed as percentage of total fatty acids, in whole blood samples of adolescent females declined with ambient salinity level regardless of household socioeconomic status; (7) analysis of aquatic animals consumed found that mangrove species and tilapia harvested from higher saline ghers contained high levels of desirable PUFAs. These findings suggest that export-driven, extensive coastal aquaculture can be nutrition sensitive when co-products are retained for local consumption.

Household Socioeconomic Status and Antenatal Care Utilization Among Women in the Reproductive-Age

The study examined the effect of household socioeconomic status and other socio-demographic characteristics on antenatal care (ANC) utilization among 819 women within the reproductive ages across eight rural communities in Delta State, Southern part of Nigeria. Characteristics of the women were described using simple proportion and frequency. The chi-square test was used to examine factors that were significantly associated with a minimum of four (≥4) and eight (≥8) antenatal care contacts, which were respectively in line with the focused ANC and WHO's new guideline. The multivariable logistic regression was used to examine the determinants of a minimum of four and eight ANC. Statistical analyses were set at 5%. The results showed that 31.4% (257/819) and 2.2% (18/819) of mothers, respectively, made ≥ 4 and ≥ 8 ANC contacts in the course of their last pregnancies. According to the results, the odds for reporting 4≥ and ≥ 8 ANC improved with both wealth and educational attainment. Distance to the health center and cost are barriers to maternal care utilization and they reduce the odds for undertaking ≥ 4 and ≥8 ANC contacts. Women on higher media exposure were more likely to undertake ≥ 4 and ≥8 ANC contacts, and those on the highest media exposure were more likely to undertake ≥8 ANC contacts. Financing maternal care through health insurance and free maternal care significantly improves the odds to undertake ≥ 4 and ≥ 8 ANC contacts. Intervention programs should be designed to improve access to maternal care services and should expand education opportunities for mothers, improve household socioeconomic conditions, and encourage enrolment in health insurance and free maternal care in the study area.

The Association of Household Socioeconomic Status and Neighborhood Support System With Adherence to Cardiovascular Fitness Among Persons With Diabetes Mellitus in Ghana a Hospital-based Cross Sectional Study.

Background: Diabetes mellitus (DM) is an independent risk-factor for cardiovascular diseases. Physical activities (PAs) could reverse this risk factor. However some factors could influence adherence to PAs. Our study investigates the association of household socioeconomic status and neighborhood support system with adherence to cardiovascular fitness among persons with diabetes mellitus (DM) in Ghana.Methods: Facility-based cross-sectional-study was conducted among 530 T2DM patients in Ghana. Structured-questionnaires were used to collect demographic, anthropometric, and clinical variables. Household socioeconomic status (SES) was assessed using wealth-composite index and adherence to PAs measured using WHO PA-short form questionnaires. SPSS version-22 was used in data analysis.Results: There were significant mean difference in low (P = 0.010) and high (P = 0.0001) social/neighborhood supports according to place of residence. After adjusting for age and diabetes duration, high SES (quintile 3) Adjusted Odd Ratio (AOR) =0.68, 95% confidence interval (95%CI) (0.22, 0.07), moderate SES (quintile 3), AOR=3.16, 95%CI (1.01, 9.89) and high social support system (quintile 2) AOR =3.29, 95%CI (1.02, 10.58) were significant for adherence to cardiovascular fitness. Furthermore Low SES (quintile 3) AOR= 3.52, 95%CI (1.44, 8.59) and low social support system (quintile 1) AOR=1.05, 95%CI (1.05, 1.09) were significant for adherence to sedentary lifestyle among persons with diabetes mellitus. Conclusion: SES, and Social/neighborhood support systems are associated with adherence to cardiovascular fitness. Health care workers should prioritized these variables as modifiable factors in diseases preventions and health promotion

Adolescent Obesity Modeling: A Framework of Socio-Economic Analysis on Public Health

Bayesian Structural Equation Modeling (SEM-Bayesian) was applied across different research areas to model the correlation between manifest and latent variables. The primary purpose of this study is to introduce a new framework of complexity to adolescent obesity modeling based on adolescent lifestyle through the application of SEM-Bayesian. The introduced model was designed based on the relationships among several factors: household socioeconomic status, healthy food intake, unhealthy food intake, lifestyle, body mass index (BMI) and body fat. One of the main contributions of this study is from considering both BMI and body fat as dependent variables. To demonstrate the reliability of the model, especially in terms of its fitting and accuracy, real-time data were extracted and analyzed across 881 adolescents from secondary schools in Tehran, Iran. The output of this study may be helpful for researchers who are interested in adolescent obesity modeling based on the lifestyle and household socioeconomic status of adolescents.

Association of household socioeconomic status, neighborhood support system and adherence to dietary recommendation among persons with T2DM, a facility-based cross-sectional study in Ghana

Background Dietary recommendation help persons with diabetes adopt to healthy eating habits to achieve optimal glycemic control. Socioeconomic-status and neighborhood support system can influence adherence to dietary recommendation. The purpose of our study is to assess the association of household-socioeconomic status and neighborhood-support system with adherence to dietary recommendation among persons with type 2 diabetes mellitus (T2DM). Methods Facility-based cross-sectional-survey was conducted in Brong Ahafo region, Ghana. Six hospitals were randomly selected and 530 individuals with T2DM consecutively recruited from the selected hospitals for the study. Structured-questionnaires were used to collect socio-demographic variables. Adherence to dietary-recommendation was the outcome-variable, and was assessed using perceived dietary-adherence questionnaire. Results Age (years) (P-value = 0.005), Physical-Activity level (P-value = 0.024) Receive-moderate Social-Support (P-value = 0.004) and High-Socioeconomic status (P-value = 0.046) were significantly correlated with adherence to dietary-recommendation. Age (years) regression coefficient (β) -0.089, 95%CI (− 0.12, − 0.001), Being married β0.103, 95%CI (0.002, 0.02), moderate and low-social support system β 0.309, 95%CI (0.17, 0.38) and β-0.192, 95%CI (− 0.26, − 0.06) respectively, and high-socioeconomic status β 0.197, 95%CI (0.06, 0.25) were significantly associated with adherence to dietary-recommendation. Conclusion Social-support system and socioeconomic-status could be associated with adherence to dietary-recommendation. Therefore, health workers should consider patients’ social support system and socioeconomic status as modifiable factors for optimum adherence.

Beyond Household Socioeconomic Status: Multilevel Modeling of Supply-Side Determinants of LPG Consumption among 5,500 Households in Sub-Saharan Africa

Household transition to cleaner cooking fuels (e.g. liquefied petroleum gas (LPG)) has historically been understood as an “energy ladder” with clean energy access resulting from improvements in household socioeconomic status (SES). Recent studies have demonstrated the importance of supply-side determinants in increasing clean cooking, yet few large-scale studies have assessed their significance quantitatively. As part of the CLEAN-Air(Africa) study, a population-based survey was conducted (N = 5,638) assessing cooking practices in peri-urban communities within Cameroon, Kenya and Ghana. Multilevel logistic and log-linear regression were used to assess socioeconomic and supply-side determinants of LPG usage (primary versus secondary fuel) and consumption (kilograms/capita/year), respectively. Supply-side factors (e.g. cylinder refill and transportation costs) and using single versus multi-burner stoves were better predictors of both the probability of primarily cooking with LPG and annual LPG consumption than household SES. These results suggest the need for policies promoting LPG access and stove equipment that meet household needs.

Association of Household Socioeconomic Status, Neighborhood Support System and Adherence to Dietary Recommendation among Persons with T2DM, a Facility-based Cross-sectional Study in Ghana

Background: Dietary recommendation help persons with diabetes adopt healthy eating habits to achieve optimal glycemic control. Socioeconomic-status and neighborhood support system could influence adherence to dietary recommendation. The purpose of our study is to assess the association of household-socioeconomic status and neighborhood-support system with adherence to dietary recommendation among persons with type 2 diabetes mellitus (T2DM). Methods: Facility-based cross-sectional-survey was conducted among 530 individuals with T2DM in Brong Ahafo region, Ghana. Six hospitals were randomly selected and persons with T2DM consecutively recruited from the selected hospitals into the study. Structured-questionnaires were used to collect socio-demographic variables. Adherence to dietary recommendation was the outcome -variable, and was assessed using perceived dietary adherence questionnaire. Results: Age (years) (P-value=0.01), place of residence (P-value =0.01), educational level (P-value =0.01) and occupation (P-value =0.01) were significantly correlated with socioeconomic status (P-value 0.01). Age (years) regression coefficient (β) -0.089, 95%CI (-0.12, -0.001), Being married β0.103, 95%CI (0.002, 0.02), moderate and low-social support system β 0.309, 95%CI(0.17, 0.38) and β-0.192, 95%CI(-0.26, -0.06) respectively, and high-socioeconomic status β 0.197, 95%CI(0.06, 0.25) were significantly associated with adherence to dietary recommendation.Conclusion: We found that social-support system and socioeconomic-status could be associated with adherence to dietary recommendation. Therefore, health workers should consider that patients’ social support system and socioeconomic status could be modifiable factors for optimum adherence.