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Stevanie Kumah
July 13, 2014

Income and Health in Accra, Ghana

The Harvard School of Public Health in Boston, Massachusetts, the Department of
Geography at the San Diego State University in San Diego, California, and the Center of
Population and Development Studies at Harvard University in Cambridge, Massachusetts
performed a study using the data collected by household surveys from Accra, Ghana. They
wanted to have documentation and a measurement of the urban burden of disease in Accra,
Ghana.
Introduction
The main finding of the surveys was that there was a high occurrence of chronic disease
but the connection between the poor health and the income of the household was weak. The
initial survey was conducted by the Womens Health Study of Accra (WHSA) and was focused
mainly on the womens health not the entire household. So another study was performed by the
Time-Use and Health Study of Accra (TUHS). Its purpose was to depict the short-term
differences in health and income statuses. The surveys were performed in rural areas of Accra,
Ghana so most of the data collected can not accurately summarize all areas of the country. For
this specific study, they used the data gathered by the surveys to first assess the occurrence of
poverty and then used the data to explore what the connection between poverty is to the health of
the people in these rural areas.
Methods
They used a Rolling-Sample Study. The TUHS had monitored 1,254 households. They
were monitoring to see what their daily health and financial activities were. They did this for a
three month period of time. They recorded the chronic and acute health problems as well as all
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the households spending and earnings. Because of the WHSAs involvement they also studied at
least one adult woman within the household. During this Rolling-Sample Study, it was
documented that 22 members died, 249 members left the household, and 421 new members came
to live at the households. All this data was calculated into the final count of 1,254 households.
Results
After the three month study period 1,193 health problems were recorded. Below shows a
table of the different causes of these acute health problems. As you can see, Malaria was the
most common health problem within the households at approximately 25%. Malaria is a very
common disease in this region and it is also used to diagnose a lot of different symptoms. So
because of this they carefully distinguished malaria from the other fevers.
Frequency and shares of most common acute health problems in
study population, Accra, Ghana
Health problem No. %
Malaria 301 25.3
General body pains 281 23.6
Fever 192 16.2
Diarrhea 147 12.3
Respiratory infection 92 7.8
Cardiovascular problem 20 1.7
Other 156 13.2
Chronic health problems depending on income are shown in the table below. As you can
see, the households that had a higher income level actually had more chronic health problems.
These results included hypertension and obesity among the women that participated in the
WHSA study. These rates were high. Obesity was at 39.2%. The gradient of wealth that was
recorded showed that wealthier women were more likely to be obese. The same goes for
hypertension among the wealthier households at 46.1%.
Income and poverty levels in study population, Accra, Ghana
Income per day and person No. %
< $1 1,123 20.48
$1 to < $2 1,587 28.94
$2 to < $4 1,834 33.44
$4 940 17.14
The study also showed that the higher income households were less likely to seek or
receive treatment (12%) for acute and chronic health problems and the lower income households
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were more likely to seek or receive treatment. However, both the higher and lower income
households were more likely to receive treatment at pharmacies. There were some smaller rural
areas that would only seek treatment from alternative means, such as through friends or
traditional healers within their tribes.
Discussion
When looking through the results from this study they found that the gradient in the
health by income level in Accra, Ghana was shallow. Most of the households within these rural
areas had low income levels. Although, the findings that most obesity comes from the
households that have higher income levels was interesting because it showed a consistency with
literature about these areas whereas women that are obese are better off. This and other
developing nations tend to have the thought that people that are obese must be rich and people
that are thin must be poor. Because of this men find women that are obese more attractive in
these areas.
Hypertension was also found to have a shallow gradient in the health by income levels in
Accra, Ghana. These weak connections between the income levels and the health problems
showed that on average all households, no matter their income level, are at risk to short term
health problems. The most common were malaria, diarrheal diseases, and respiratory infections.
Also found was that treatment in Accra, Ghana is low enough that everyone, no matter
their income level, should be able to seek and receive treatment for any of the known diseases.
This study did, however, show that those in the urban populations have high levels of treatable
illnesses but these treatable illnesses are consistent with the same diseases we see among the
poorest populations in the United States and other developed countries.


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References
Gunther Funk, John R. Weeks, and Allan G. Hill, Income and Health in Accra, Ghana: Results
from a Time Use and Health Study, The American Society of Tropical Medicine and
Hygiene, p. 608-615, 2012.