Effect of an armed conflict on relative socioeconomic position of rural households: case study from western Côte d'Ivoire

How Poor Is Your Sample? A Simple Approach for Estimating the Relative Economic Status of Small and Nonrepresentative Samples

BACKGROUND

Asset-based indices of living standards, or wealth indices, are widely used proxies for economic status; however, such indices are not readily available for small and nonrepresentative samples.

METHODS

We describe a simple out-of-sample prediction approach that uses estimates from large and representative "reference" samples to calculate measures of relative economic status (e.g., wealth index scores) for small and/or nonrepresentative "target" samples. The method relies on the availability of common variables and assumptions about comparable associations between these variables and the underlying construct of interest (e.g., household wealth). We provide 2 sample applications that use Demographic and Health Surveys (DHS) from 5 countries as reference samples. Using ordinary least squares regression, we estimate associations between household characteristics and the DHS wealth index. We use parameter estimates to predict wealth index scores for small nonrepresentative target samples. Comparisons of wealth distributions in the reference and target samples highlight selection effects.

RESULTS

Applications of the approach to diverse populations, including populations at high risk of HIV infection and households with orphaned and separated children, demonstrate its usefulness for characterizing the economic status of small and nonrepresentative samples relative to existing reference samples. Women and men in northern Tanzania at high risk of HIV infection were concentrated in the upper half of the wealth distribution. By contrast, the relative distribution of household wealth among households with orphaned and separated children varied greatly across countries and rural versus urban settings.

CONCLUSIONS

Public health professionals who implement, manage, and evaluate programs in low- and middle-income countries may find this approach applicable because of the simplicity of the estimation methods, low marginal cost of primary data acquisition, and availability of established measures of relative economic status in many publicly available household surveys (e.g., those administered by the DHS Program, World Bank, International Labour Organization, and UNICEF).

Promising trends and influencing factors of complementary feeding practices in Côte d'Ivoire: An analysis of nationally representative survey data between 1994 and 2016

Poor complementary feeding (CF) challenges early childhood growth. We examined the trends and influencing factors of CF practices among children aged 6-23 months in Côte d'Ivoire. Using data from Demographic and Health Surveys (DHS, 1994-2011) and Multiple Indicator Cluster Surveys (MICS, 2000-2016), the trends and predictors of World Health Organization-United Nations International Children's Emergency Fund CF indicators including the timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD) and minimum acceptable diet (MAD) were determined. Using 2016 MICS data, we applied multivariate logistic regression models to identify factors associated with CF indicators. Between 1994 and 2016, the mean proportion of children aged 6-8 months achieving INTRO was 56.9% and increased by about 25% points since 2006. Over 2011-2016, the proportion of children aged 6-23 months meeting MMF, MDD and MAD increased from 40.2% to 47.7%, 11.3% to 26.0% and 4.6% to 12.5%, respectively. Older children and those from urban households had higher odds of meeting MDD and MAD. Maternal TV watching was associated with higher odds of meeting MDD. The secondary or higher education levels of mothers significantly predicted higher odds of meeting INTRO and MDD. Currently, breastfeeding was also positively associated with odds of meeting MMF and MAD. Children from poorer households had lower odds of meeting MMF, MDD and MAD. Despite the improvements, CF practices remain suboptimal in Côte d'Ivoire. Influencing factors associated with CF were distributed across individual, household and community levels, calling for future programmes and policies to implement multi-level strategies to improve young children's diet in Côte d'Ivoire.

Research productivity and main publishing institutions in Côte d'Ivoire, 2000-2016

BACKGROUND

The research productivity of countries commonly grouped within sub-Saharan Africa is as diverse as their cultural, economic, linguistic, political, and social profiles. While South Africa has been the science hub on the subcontinent for decades, publishing original research articles in the thousands, Mauritania struggles to have a single publication in international indexed journals in any given year. Detailed country-specific accounts on the co-evolution of research productivity and demographic and economic indicators from sub-Saharan Africa are lacking and render an accurate evaluation and cross-country comparison of internal research progress challenging.

METHODS

We assessed the research productivity of Côte d'Ivoire, a francophone West African country that has gone through considerable socio-political unrest, for the period 2000-2016, and determined the main publishing institutions. We considered original research articles extracted from PubMed and Web of Science Core Collection, emphasizing life sciences and biomedical sciences.

RESULTS

We found the quantity of publications doubling from 4.1 to 8.5 per million population and the 'total product' - a measure for quantity and quality of published articles - rising from 0.8 to 22.1 per million population between 2000 and 2016. Since 2010 there was a marked increase in the proportion of English publications and a concomitant drop in the proportion of articles with Ivorian first and last authors. The percentage of foreign author contribution increased from 38.7% in 2000 to 71.6% in 2016, suggesting an 'internationalization' of the country's research production and output. Mixed authorship compared with 'Ivorian only' showed higher representation in journals with an official impact factor by Web of Science with proportions of 73% versus 28% for 2008 and 91% versus 45% for 2016. Two universities and university hospitals and three autonomous research institutions were consistently among the top 10 institutions publishing peer-reviewed material in three selected years (2000, 2008, and 2016). The main features of the most successful publishing institutions were research staff size, diversification of research portfolio and funding, multiple research bases across the country, and established and productive partnerships with foreign institutions.

CONCLUSION

Since the turn of the millennium, research productivity in Côte d'Ivoire has steadily grown at an above regional and global rate despite recurring economic pressures and sociopolitical unrest. We have observed benefits of internationalization throughout this current analysis reaching from improved publishing standards to increasing resilience of research institutions in times of crisis.

Infectious Diseases and Livelihoods

Agriculture has been the most common form of livelihood for rural communities in developing countries for centuries. Apart from providing a livelihood, rural communities find food and nutrients necessary for their survival and well-being from their farms. Agriculture also brings risks to health through infectious diseases. Poor health leads to reduction in productivity, where individuals are not able to carry out their livelihoods due to ill health. This could lead to reduction in income through excess expenditure on treatments, thereby inhibiting economic development of the affected communities. Infectious diseases have both direct and indirect impact on livelihoods. The direct impact includes poor health and loss of lives, which leads to partial and complete loss of livelihoods. Indirectly, infectious diseases lead to loss of income through poor performance of livelihoods as well as diversion of resources that could have been used to improve livelihood to seek medical treatment. Due to the effects of disease, individuals become marginalized, socially affecting their businesses and ways of earning a livelihood.

Improved Socio-Economic Status of a Community Population Following Schistosomiasis and Intestinal Worm Control Interventions on Kome Island, North-Western Tanzania

Research on micro-level assessment of the changes of socio-economic status following health interventions is very scarce. The use of household asset data to determine wealth indices is a common procedure for estimating socio-economic position in resource poor settings. In such settings information about income is usually lacking, and the collection of individual consumption or expenditure data would require in-depth interviews, posing a considerable risk of bias. In this study, we determined the socio-economic status of 213 households in a community population in an island in the north-western Tanzania before and 3 year after implementation of a participatory hygiene and sanitation transformation (PHAST) intervention to control schistosomiasis and intestinal worm infections. We constructed a household 'wealth index' based housing construction features (e.g., type of roof, walls, and floor) and durable assets ownership (e.g., bicycle, radio, etc.). We employed principal components analysis and classified households into wealth quintiles. The study revealed that asset variables with positive factor scores were associated with higher socio-economic status, whereas asset variables with negative factor scores were associated with lower socio-economic status. Overall, households which were rated as the poorest and very poor were on the decrease, whereas those rated as poor, less poor, and the least poor were on the increase after PHAST intervention. This decrease/increase was significant. The median shifted from -0.4376677 to 0.5001073, and the mean from -0.2605787 (SD; 2.005688) to 0.2605787 (SD; 1.831199). The difference in socio-economic status of the people between the 2 phases was highly statistically significant (P<0.001). We argue that finding of this study should be treated with caution as there were other interventions to control schistosomiasis and intestinal worm infections which were running concurrently on Kome Island apart from PHAST intervention.

Effect of deworming on school-aged children's physical fitness, cognition and clinical parameters in a malaria-helminth co-endemic area of Côte d'Ivoire

Background

Malaria and helminth infections are thought to negatively affect children’s nutritional status and to impair their physical and cognitive development. Yet, the current evidence-base is weak. The purpose of this study was to determine the effect of deworming against soil-transmitted helminthiasis and schistosomiasis on children’s physical fitness, cognition and clinical parameters in a malaria-helminth co-endemic setting of Côte d’Ivoire.

Methods

We designed an intervention study with a 5-month follow-up among schoolchildren aged 5–14 years from Niablé, eastern Côte d’Ivoire. In late 2012, a baseline cross-sectional survey was conducted. Finger-prick blood, stool and urine samples were subjected to standardised, quality-controlled techniques for the diagnosis of Plasmodium spp., Schistosoma spp., soil-transmitted helminths and intestinal protozoa infections. Haemoglobin level was determined and anthropometric measurements were taken for appraisal of anaemia and nutritional status. Children underwent memory (digit span) and attention (code transmission) cognitive testing, and their physical fitness and strength were determined (20 m shuttle run, standing broad jump and grip strength test). All children were treated with albendazole (against soil-transmitted helminthiasis) and praziquantel (against schistosomiasis) after the baseline cross-sectional survey and again 2 months later. Five months after the initial deworming, the same battery of clinical, cognitive and physical fitness tests was performed on the same children.

Results

Lower scores in strength tests were significantly associated with children with harbouring nutritional deficiencies. Surprisingly, boys infected with Schistosoma mansoni achieved longer jumping distances than their non-infected counterparts. Light-intensity infection with S. mansoni was associated with slightly better aerobic capacity. Deworming showed no effect on haemoglobin levels and anaemia, but children with moderate- to heavy-intensity Schistosoma infection at baseline gained weight more pronouncedly than non-infected children. Interestingly, children with soil-transmitted helminth or Schistosoma infection at baseline performed significantly better in the sustained attention test than their non-infected counterparts at the 5-month follow-up.

Conclusions

This study revealed conflicting results regarding clinical parameters and cognitive behaviour of children after two rounds of deworming. We speculate that potential beneficial effects of deworming are likely to be undermined in areas where malaria is co-endemic and nutritional deficiencies are widespread.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2334-14-411) contains supplementary material, which is available to authorized users.

Dynamics of people's socio-economic status in the face of schistosomiasis control interventions in Ukerewe district, Tanzania

There is a paucity of research on micro-level assessment of the dynamics of socio-economic status following health interventions. The use of household asset data to determine wealth indices is a common procedure for estimating socio-economic position in low-income countries. Indeed, in such settings information about income is usually lacking and the collection of individual consumption or expenditure data would require in-depth interviews, posing a considerable risk of bias. In this study, we determined the socio-economic status of 159 households in a village in north-western Tanzania before and 1 year after participatory hygiene and sanitation transformation (PHAST) intervention to control schistosomiasis. We constructed a household 'wealth index' based on durable assets ownership (e.g. bicycle and radio) and household characteristics dealing with ownership of land and house construction features (e.g. type of walls and roof). We employed principal components analysis and classified households into wealth quintiles. The study revealed that asset variables with positive factor scores were associated with higher socio-economic status, whereas asset variables with negative factor scores were associated with lower socio-economic status. Overall, households which were rated as the poorest and very poor were on the decrease, whereas those rated as poor, less poor and the least poor were on the increase after PHAST intervention. This decrease/increase was significant. The median shifted from -0.761 to -0.448, and the mean from -0.204 (standard deviation (SD) 1.924) to 0.193 (SD 2.079) between pre- and post-intervention phases. The difference in socio-economic status of the people comparing the pre- and post-intervention phases was highly statistically significant (p<0.001). This observation was confirmed by a multinomial model with a random effect on the households. We argue that significant changes in the socio-economic status observed in our study are attributable to the PHAST intervention, despite other sporadic interventions against schistosomiasis.