Socio Economic Status- Assessment of Population

Title of Project: Socio Economic Status assessment of population for understanding health equity in HDSS Vadu

Investigator (s):

Dr Sanjay Juvekar (Co Investigator), Vadu Rural Health Program, KEM Hospital Research Centre, Pune and seven other co investigators from participating sites.

Collaborating/Participating Institutes (s):

INDEPTH Network, Accra, Ghana

Vadu Rural Health Program, KEM Hospital Research Centre, Rasta Peth, Pune 411 011,

Seven other member INDEPTH sites.

Funding Agency:

INDEPTH Network, Accra, Ghana

Project Start Date: August 2004

Project End Date: March 2005

Total Project Duration: 8 months.

Objectives:

  1. 1)To assess the socio economic status of the HDSS Vadu population by deploying the INDEPTH SES tool.
  2. 2)To identify relationship between SES and immunization & child and adult mortality.

Methodology:

Training of VLWDC

Training workshop for Village Level Women Data Collectors (VLWDC) was conducted in two sessions. First session was orientation session, which was conducted by Dr.Sanjeevani Muley, a demographer. As reported by the VLWDC, the session was very educative for them to understand importance of SES assessment in any study. Dr.Sanjeevani Muley had given elaborate account of SES schedule and discussed intricacies of the tool.  Mr. Mukhekar, a behavior and communication change expert provided guidance on the communication skills and importance of effective communication during fieldwork.  The second training session was conducted on the field at Vadu. The session was conducted by social scientists including Anthropologists and a Sociologist for imparting practical field experience to the VLWDC for SES schedule data collection.

Data collection:

Sixty Village level women data collectors (VLWDC) who have passed 12th grade were recruited for SES data collection. In some villages, village   level men data collectors were included due to non-availability of qualified women.

Immunization details of 5768 were collected during the study period through outreach program.

Every death in the population of 66417 (Round 2 populations) in the 22 villages in HDSS Vadu is scrutinized by a verbal autopsy of the death.  The mortality data is available for the years 2002, 2003 and 2004 to date. Mortality data gets collected every following month from the occurrence and reporting of death event. A total of 456 verbal autopsies were conducted during the study period. Following Table 2 gives details of the collected from both, intervention as also the comparison area. SES data collection started in August 04 along with the 3rd round of HDSS, Vadu. Household lists were provided to the VLWDC for updating and data collection. By end of the study, a total of 12487 households were interviewed in intervention area. In the comparison area 789 of 1309 households were interviewed, which were sampled from HDSS population.

Table 2: Data collection.

 

Intervention Area

Comparison Area

SES schedules

12487

789

Verbal Autopsy

456

Not applicable

Immunization data*

684

Not applicable

*Only children between age group12-24 months were included for analysis as this age group is anticipated to have completed all the primary vaccination up to Booster 1 vaccine.

Supervision and Cross checking

HDSS, Vadu Field Supervisors played crucial role in this survey starting from identifying VLWDc to collection of forms from the VLWDCs and verification.

Each Supervisor was responsible for four to five villages. Supervisors paid weekly visit to each VLWDC. They did physical verification and on the field cross checking of around 10% of the forms filled in by VLWDCs in order to validate the collected data.  Then the supervisors checked every form and signed with green pen in the right hand side top corner indicating, “ready for data entry”. Incomplete forms were sent back to the field for correction. These forms were brought back after correction for further processing.

Data Entry and Analysis:

Data entry of SES schedule, immunization schedule and verbal autopsy schedules was done in customized software using Visual fox pro 6.0 and Access. Data entry was started simultaneously with data collection to avoid massive backlog of data entry. Two personnel were assigned responsibility of the data entry. Cleaned data are analyzed and presented here.  As the Indepth Network’s main objective of the study is to validate the SES tool developed, we are presenting only the analysis of the larger part of the study that was conducted in the HDSS intervention area.                

Additional comparison area data were collected for the site specific purpose of enabling us compare differences in the two areas, if any, as and when required at later stage for what so ever reasons that may be either for research purpose or for improving the service provision.

Results:

Socio Economic Status Assessment of families:

  • Most of the families in the study population were headed by males (94%), the percentage of women heading the households was higher among the migrants (7.4%) as compared to the residents (2.2%). 
  • Joint family is a striking feature of Indian traditional family. However, the figures in the present study show change in this trend. Percentage of nuclear families (55.7%) in the study area is more than joint families.
  • Overall average household size was 4.79 persons. Household size for natives was much more than migrants.
  • Hindu is the dominant religion in this area comprising 92.8 percent population proportion where as all remaining religions include only 7.2 percent. The dominant caste among Hindus was Maratha. However there was caste and religion wise difference among migrants and natives.
  • Overall median age of a household head was 40 years. Median age of natives was 43 where as median age of migrants was quite low which was about 30 years.  Almost 44 percent migrant household heads were below 30 yrs of age. However, around 40% native household heads were between 30-44 yrs age group. 
  • Housing characteristics like electricity, sanitation, source of drinking water, fuel for cooking may have direct influence on overall health status of the household.
  • The data revealed that more than 80 percent households had electricity. Proportion of migrant households having electricity in their houses; was more than natives.
  • More than 40 percent households have drinking water source in residence or yard which is an indirect indicator of time for fetching water where as more than 50 percent households use public water source.
  • More than 60 percent of households have no toilet facility. 23.3 % migrant households have own flush toilet whereas only 14.4 percent native households have own flush toilet. Could it be attributed to the fact that as the migrants stay in rented houses that are likely to have more amenities as against for ones own family? 
  • Regarding fuel for cooking more than 50 percent households use either LPG/Biogas/electricity as a fuel for cooking. However using dry wood at hearth is the traditional fuel for cooking which is still used in almost 20 % households. 
  • A little over 65 percent of households in study area live in pucca houses (made with good quality materials throughout, including the roof, wall, and floor), 30.1 % in semi-pucca (using partly low-quality and partly high quality materials) and 4.8 percent in kachha (made with mud, thatched roof or other poor quality material).
  • Garbage disposal directly reflects on the hygiene behavior of the household. Sixty one percent households use private pits, where as about 19 percent households use public pits for garbage disposal.
  • Proportion of low standard of living was higher for migrants (23.6) than natives (10.6) when compared based on Standard of Living Index using NFHS2-India (1998-99) methods for calculation.
  • The natives have more proportion of non irrigated agricultural (over 71 %) and irrigated (over 60 %) land ownership land ownership as compared to the migrants (31 % and 18 % respectively). Near about 70 percent migrants did not have any agricultural land anywhere whereas just about 28 % were without any agricultural land ownership.
  • Ownership of a house and livestock was more prominent among the natives as against migrants. About 88 % natives and 22 % migrants reported possessing their own house. Of these natives, 51 % reported possessing livestock whereas just about 11 % migrants reported thus.  

Food security:

  • A little proportion (0.27) of population reported experiencing food scarcity in the past 12 months, 0.24 percent natives and 0.34 percent migrants have experienced food scarcity in the previous 12 months.  However the figures for food security for next three months were quite high.  About 15.3 percent of native population and 42.3 percent of migrant population did not have food security for the next three months.

SES and Immunization:

  • Immunization coverage for BCG, oral Polio/DPT as well as for measles and Booster 1 showed sex wise differences. More male children were vaccinated than female children for all above-mentioned vaccines. 67.8 percent male children and 61.8 percent female children were vaccinated for measles. Education of mother also plays an important role in child immunization. Expected trend for immunization coverage is immunization coverage increases as educational level of mother increases. Similar trend was seen in immunization for measles and Booster 1. However different trend was found for BCG and Oral polio/DPT. It would probably be due to more fostered primary health care programmes for low socio-economic group people (considering illiteracy and low education assigned features of low socio-economic group). Immunization coverage also showed difference among resident status of the household. Immunization coverage was higher among natives than migrant children. Similarly immunization coverage increased as the SLI increased from lower SLI to high SLI. There was more coverage among households with higher SLI as compared to lower SLI.
  • Due to excessive mobility of the migrant population, there are limitations to health care services, both for migrants to access the services and for the service providers to reach this migrant population. This is evident from the lower Immunization coverage among migrants for BCG (72 %), OPV/ DPT (70 %) and measles (57 %) as compared to the natives with coverage of 86 %, 85 % and 67 % respectively.

SES and Mortality:

  • Age structure of migrants’ populations helps explain a high mortality rate among the natives than migrants. There is very little 60+ population (about 4 % against 20 % among natives) and a large number of <30 years population (about 44 % against 10 % among natives) in migrants. Crude death rate for natives was much higher (5.14) as against migrants (1.5). Highest CDR (6.25) was observed in medium SLI category followed by 4.95 among low SLI category and the lowest was 3.71 for high SLI category. 

Outcome of Indepth Health Equity Tool

Health Equity tool for data collection needs to be validated. Any tool could be validated either by pre testing the tool or by collecting the same data by using some other tool. Focused group discussions are often used for validation purpose. The present multi centric study envisages validation of Indepth tool for SES by testing it globally. Hence Indepth Network sites that have participated in this SES tool testing exercise would provide insight into the development of a more or less universally accepted SES tool that could be used anywhere in the world with area specific adaptations.


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