SOCIAL DETERMINANTS OF HEALTH STATUS IN UGANDA
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Date
2019-12-06
Authors
ATUGONZA, RASHID
Journal Title
Journal ISSN
Volume Title
Publisher
Makerere University
Abstract
Health status of individuals of great significance both because of the direct utility that health
can provide and the productivity gain as a result of good health. The purpose of the study was
to empirically establish the key factors influencing health status in Uganda. Specifically,
examining the relationship between health status and socio-demographic, economic, lifestyle
and environmental factors. Government of Uganda has been investing in health through
acting on key Social Determinants of Health (SDH) such as household income and
infrastructure as marked in the HSDP 2015/16-2019/20. However, evidence shows heavy
burden of disease. The relationship between health status and the above SDH is not clear.
Therefore, this necessitated the need to investigate the SDH. The study used Uganda National
Household Survey (UNHS) 2016/17 data. The study was based on the SDH framework to
examine SDH Status. Four logistic regressions models were estimated i.e. model I, II, III and
IV focusing on individuals aged 0-5, 6-14,15-59 and 60+ years respectively. The study used
adjusted Wald test to test for individual Statistical significance of the regression coefficients
and Hosmer-Lemeshow (HL) test, to assess the goodness of fit.
In reference to demographic factors the study establishes that Females aged 6-14, 15-59 and
60+ years were 1.29, 1.25, and 1.4 times more likely to be in poor health when compared to
the males at P< 0.01 respectively. Individuals aged 6-14 from male headed household were
1.2 times more likely to be in poor health at P< 0.01 when compared to those from femaleheaded households. Rural residents aged 0-5, 6-14 and 15-59 were 1.5, 1.52, and 1.3 times
more likely to be in poor health when compared to urban residents at P< 0.01 respectively.
Likewise, the married aged 15-56 and 60+ years were 1.6 and 1.7 times more likely to be in
poor health when compared with individuals not married at P< 0.01 respectively. Concerning
economic factors, individuals with no formal education aged 6-14 years were 1.2 times more
likely to be in poor health at P< 0.01 when compared to individuals with secondary level of
education. Similarly, individuals aged 6-14 whose mothers have no formal education were
1.1 times more likely to be in poor when compared to those whose mothers have attained
secondary level of education at P< 0.01. At P< 0.05 the unemployed aged 60+ were 1.6 times
more likely to be in poor health when compared to those employed. Regarding lifestyle
factors, current and past alcohol consumers aged 15-59 were 1.3 and 1.9 times likely to be in
poor health at P< 0.01 when compared to individuals that do not consume alcohol
respectively. Current smokers above 15-59 and 60+years were 1.8 and 1.4 times more likely
to be in poor health when compared to the non-smokers at P< 0.01 respectively. As for
environmental factors, individuals aged 0-5- and 6-14 using water from unimproved sources
were 1.3 and 1.2 times more likely to be in poor health when compared to those that use
water from improved sources at P< 0.01 and P< 0.05 respectively. Individuals aged 0-5 using
poor and intermediate quality toilet facilities were 1.7 and 1.5 times more likely to be in poor health when compared to those that use high quality toilet facilities at P< 0.01 and P< 0.05
respectively. Individuals aged 6-14 residing in mad and poles houses and houses whose floor
material made of earth were 1.2 and 1.3 times more likely to be in poor health when
compared to those that reside in brick houses and houses whose floor material made of
cement at P< 0.01 respectively.
The study findings show that females above 6 years are more likely to be in poor health when
compared the males. Therefore, considerable emphasis should be put on health interventions
for women. Education of girls and employment opportunities for women will also promote
gender equality and more broadly improve upon their health. Interventions to prevent people
from smoking and alcohol consumption must also be undertaken or strengthened. More
efforts should also be put in promoting health lifestyles especially among the young people.
Also, policies should be aimed at closing the gap in health conditions between urban and
rural inhabitants through balanced economic and social development to increase the level of
income, education and decreasing unemployment amongst people living in the rural areas.
From the results, children aged 6 to 14 years whose mothers have no formal education are
more likely to be in poor health. Therefore, education especially for the girls should be a
priority to enable mothers gain knowledge and skills to be able to make better healthy
choices. To address the health problem among unemployed individuals aged 60+ years, it is
necessary to put in place insurance scheme for the elderly to ease their access to health care.
Regarding the environmental factors, there should be establishment of clear institutional
responsibility and specific budget lines for water & sanitation, and ensuring that public sector
agencies working in health, in water resources and other utility services work together better
to enhancing quality infrastructure (piped water to homes, toilets connected to sewers or
septic tanks).
Description
Keywords
Social Determinants of Health, , Health Status.