Abstract
Ouagadougou, the capital of Burkina Faso, is currently experiencing rapid population growth, mainly concentrated in the outskirts of the city. Since 2008, the Ouagadougou Health and Demographic Surveillance System (Ouaga HDSS) has followed 80,000 people living in five neighbourhoods on the periphery of the city, half of them living in poor, informal settlements. This urban population faces a complex burden of disease: children under five die mainly from infectious diseases, while the main causes of deaths among adults aged 15–59 are AIDS, cardiovascular diseases and accidents. In this analysis, we explore whether poverty is associated with greater mortality among small children and among adults and we examine how the risk factors associated with the main causes of death in these two age groups vary by socio-economic status. We find that children who are born to uneducated and poor parents are twice as likely to die as their counterparts likely because they have worse access to both preventive and curative health care. Young children living in informal areas are also twice as likely to die compared to others because, everything else being equal, they are more often ill, more often malnourished, and less likely to receive medical care; these outcomes can be related to the unsanitary environment. In contrast, adult mortality is higher in formal neighbourhoods. Since adult health behaviours are similar regardless of neighbourhood (everything else being constant), this excess mortality seems attributable to the relatively higher wealth of households in formal neighbourhoods: affluent adults are more often overweight and more likely to be HIV positive. Better educated adults have a lower risk of dying than others because, despite their higher rates of accidents and HIV infection, they are more likely to seek medical care.
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Notes
- 1.
At 26 per 1000, the infant mortality rate in the Ouaga HDSS is lower compared to the four HDSS located in rural Burkina Faso: Nouna, Kaya, Nanoro, Sapone (First comparative workshop for the Burkinane HDSS, April 2–7 2012, Ouagadougou, Institut Supérieur des Sciences de la Population, Université de Ouagadougou).
- 2.
Almost half (46 %) of residents 15 and older in the Ouaga HDSS neighbourhoods have never been to school, and the proportion is lower in the formal neighbourhoods (36 %) than in the formal neighbourhoods (59 %). While educational level and wealth are associated, the relation is far from systematic, since an important part of the economy remains informal; rich illiterates are common, as are jobless graduates.
- 3.
We tested two additional poverty indicators, but did not keep them in the final analyses. An indicator of household food insecurity (questions provided by J. M. Prevel and his team at the Institut de Recherche pour le Développement) proved not sensitive enough, with 70 % of households reporting severe food insecurity. Second, households headed by widowed/separated/divorced women were not associated with poorer health outcomes, even though women in general have less ability to generate revenue; economically successful women are probably over-represented in these households.
- 4.
Useable vaccination data were collected for children only at the third re-enumeration.
- 5.
During the two first years of data collection we report on here, causes of death were defined by a group of local doctors. Later, the Ouaga HDSS used a software to determine the causes of death: using that approach, over the 2009–2012 period and for adults aged 35 and over, AIDS is only the 7th causes of death (Rossier et al. 2014).
- 6.
Reporting of children’s deaths, while a problem during the first years of surveillance, appears to have become complete later on (Lankoande et al. 2016).
- 7.
Data on children’s vaccination in the Ouaga HDSS are available only from the third enumeration on.
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Rossier, C., Soura, A.B., Lankoande, B., Millogo, R.M. (2016). Health Disparities on the Periphery of Ouagadougou. In: Ramiro Fariñas, D., Oris, M. (eds) New Approaches to Death in Cities during the Health Transition. International Studies in Population, vol 12. Springer, Cham. https://doi.org/10.1007/978-3-319-43002-7_12
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