Measuring a population's health: an exploration of women's health status in Accra, Ghana

Abstract

Measuring the health status of individuals or a population is an important first step for the assessment of healthcare needs and evaluation of health intervention programmes. Reliable statistics on the health status of whole populations are scarce especially in developing countries, including Ghana. Measures of self-assessed health obtained from the general population have been used in many health evaluation studies since the late 1970’s, but limited in the African context. This thesis contributes to the research debate by: 1) exploring empirically the viability and validity of using Short Form-36 health questions to evaluate health status among women in urban Ghana. 2) examining intra-urban health differentials using both compositional and contextual factors; 3) assessing the linkages between objective health outcomes and self-assessed health status among the study population and, finally 4) investigating changes in health status over a five-year period and the possible factors that help to explain the observed patterns over time.

The study draws on a representative sample of respondents aged 18 years and older from three districts in the Greater Accra Region, using the two waves of data from the Women’s Health Study of Accra conducted in 2003 and 2008, and the 2000 Population and Housing Census to address the set objectives. The study employed various statistical methods, such as descriptive statistics, bivariate, multivariate and multilevel ordinal models in the research processes of this thesis.

The results of the study provide viable and valid evidence that SF-36 is suitable for the assessment of health status among women in Accra and, by extension, to urban women in Ghana. The results evinced that there are variations in health status among women in Accra using the eight SF-36 health scales. Educational level, age, disease symptoms, wealth status and social networking were the most significant factors at the individual level. The results further showed that living in an unhygienic neighbourhood negatively influence one’s overall physical health status. Surprisingly, residents in low housing quality residence and unhygienic neighbourhoods perceived their mental health higher than among women resident in the most hygienic and high quality housing neighbourhoods. The study results confirmed linkages between objective health outcomes and self-assessed health status, but with varied results. The results showed that perceived mental health status had no significant association with hypertension status among respondents without any prior knowledge. The results revealed that 34% of respondents’ health declined over the five-year study period. Age of respondents, wealth status, employment and diseases experienced were the significant factors influencing change in health status, but followed different pathways.

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ORCID for Allan G. Hill: orcid.org/0000-0002-4418-0379

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