This sub-theme aims to study the issues around NTD-related health inequalities with a focus on the bi-directional relationship between poverty and health using both primary and secondary data. This theme will look at:
- the socio-economic determinants of NTDs at the community level,
- the bi-directional relationship between poverty and NTDs,
- the issue of accessibility and adherence to MDAs, and
- an exploration of the relationship between NTDs and disability.
The study will be carried out in Cameroon, Liberia and Ghana.
DESIGN
The Socio-Economic Determinants of NTDs at the Community Level
This study will use nationally representative data for the three countries, namely, the 4th Cameroonian Household Survey (ECAM 4) collected in 2014, the Liberian Household Income and Expenditure Survey (LHIES) collected in 2014/2015 and the 6th Ghana Living Standards Survey (GLSS6) collected in 2012/2013. Separate Ordinary Least Squares regressions will be carried out to look at the factors that determine NTD prevalence. To account for co-endemicity, multivariate regressions will also be run. Finally, to control for reverse causality, we will be carrying out Instrumental Variable estimations.
The Bi-Directional Relationship between Poverty and NTDs
Primary survey data collected by the COUNTDOWN team in the three countries of study will be used to analyse the relationship between poverty and NTDs. The survey will collect information on socio-demographic characteristics, education, general health, health spending, disability and MDA access. In Ghana and Cameroon, individuals in selected communities will be tested for the schistosomiasis and Onchocerciasis. In Liberia however, a symptoms list will be used to determine potential infection.
Individuals will be matched based on their infection or non-infection status. At the household level, an asset index will be created using principal component analysis. In addition to asset index, household incomes and expenditures will be used to create a poverty indicator for the households. Individuals will be matched based on age, gender and location.
We will look at the incidence of NTDs among households facing catastrophic spending and those not facing such spending. Using concentration indices and regression analysis we will study the relationship between household poverty and NTD infections.
Accessibility and Adherence to MDAs
Primary data will be collected in the three countries to study the accessibility and adherence of individuals to MDAs. Households will be randomly selected for data collection. They will answer questions on how accessible MDAs are and whether they adhere to the treatments they receive during the MDA process. Questions on why they do not have access or adhere to the MDA will also be explored. Nested/Sequential regression analysis and the two-step Heckman model will be used for the analysis.
An Exploration of the Relationship between NTDs and Disability
Case-control data will be used to study the potential relationship between NTDs and disability. Given the difficulty in establishing a causal relationship where disability is involved, we will focus on correlations. We will also use bivariate profit models to examine the potential relationship.