FAMILY HEALTH AND WEALTH STUDY INSIGHTS ON WEALTH MEASUREMENT AND - - PowerPoint PPT Presentation

February 20, 2013

FAMILY HEALTH AND WEALTH STUDY

INSIGHTS ON WEALTH MEASUREMENT AND CHANGE

To assess the effect of childbearing patterns

• n family health and wealth outcomes
• Number and timing of births
• Role of contraception
• Family wealth and health outcomes
• Household income, employment
• Child schooling, nutrition
• Maternal health

To assess using a longitudinal design

STUDY AIMS

Addis Ababa University Assefa Seme Meselech Roro Assiut University Omaima El Gibaly Ghada Al-Attar Kwame Nkrumah University of Science and Technology Easmon Otupiri Denis Yar Makerere University Fred Makumbi Vivian Zalwango Obafemi Awolowo University Peter Ogunjuyigbe Abimbola Phillips University of Ibadan Michael Okunlola Imran Morhason-Bello Nathanael Afolabi University of Malawi Frank Taulo Eddie Malunga Wanangwa Chimwaza

FHWS SITE LEADS/DATA COORDINATORS

Andreea Creanga Alain Koffi Funmi OlaOlorun Nadia Diamond Smith Qingfeng Li Adel Takruri Linnea Zimmerman Timothee Fruhauf And the rest of the FHWS team Saifuddin Ahmed Michelle Hindin Stan Becker David Bishai Julia Driessen William Pan

FHWS ACKNOWLEDGEMENTS (US)

Three rounds of observation Probability sample of families in peri-urban area

• Wife of childbearing age (15-49 years)
• Husband of childbearing age (20-54 years)

GPS mapping of area (waypoints, households)

Data collection began by Ghana site January 2010

• Round 2 approximately 2 years later

STUDY DESIGN

 Household roster on occupants and their characteristics, GPS  Focal woman questionnaire

• Background characteristics
• Childbearing history, fertility preferences and contraceptive calendar
• Child schooling (5 to 24 years) and health history (births in <5 years)
• Marital relationship quality, decision-making autonomy
• Self-reported health

 Focal man questionnaire

• Background characteristics
• Parity, fertility preferences and contraceptive use
• Marital relationship quality, decision-making autonomy
• Adult morbidity and self-reported health

 Wealth module

• Housing construction quality, asset ownership, expenditures in <1 year

 Physical assessment

• Height, weight of household members
• Blood pressure, pulse
• Anemia (Ghana, Uganda)

MEASUREMENT STRUCTURE AND CONTENT

Coun Country Site Sampl ample si e size ze

Egypt Waldeya 548 Ethiopia Sebeta 998 Ghana Asawasa 800 Malawi Lunzu 605 Nigeria Ipetumodu 787 Nigeria Akinyele 502 Uganda Wakiso 505 Total 4745

PERI-URBAN FHWS SITES

SITES VARIED IN ‘PERI-URBAN-NESS’

TRAINING IS EVERYTHING

FHWS Round 2 training for Sebeta site

LEARNING TO TAKE BLOOD PRESSURE, MAPPING AND COMMUNITY SENSITIZATION

July 2011 workshop Blantyre, Malawi

PRECISION AND ENTHUSIASM

KNUST FHWS Team and some of equipment field staff transported during interviews

 Analysis workshops in July 2011 and July 2012  Data sharing and authorship agreements

• Gates Institute role is facilitating comparative analyses on pre-defined

set of topics

• Panel at International FP Conference 2011, Dakar
• Each site has autonomy to share data with analysts within and outside
• Ghana: Two dissertations
• Ethiopia: One dissertation

 One year spent on data cleaning and linking rounds

• Follow-up rates and who is missed

 Analyses underway

• Comparative description of 4745 families’ health and wealth
• Childbearing patterns and child schooling and nutrition
• Childbearing and family wealth
• Couple concordance in fertility preferences and contraceptive use
• Parity and self-rated health (and gender differences)

PROGRESS TO DATE

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Ibadan Ife Kumasi Lunzu Wakiso Sebeta

Parity Composition among Married Women Aged 15‐44 in Six FHWS Sites

6+ 4‐5 2‐3 0‐1

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 15-19 20-24 25-29 30-34 35-39 40-44 % % using modern contraceptiv using modern contraceptive me e method thod Ag Age g group

Modern Contraceptiv Modern Contraceptive Pre e Prevalence among Married W alence among Married Women A men Ages 15- es 15- 44 b 44 by A Age Gr e Group acr

• up across Six Africa-based FHW

ss Six Africa-based FHWS Sit S Sites es

Ibadan Ife Kumasi Lunzu Wakiso Sebeta

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 0‐1 2‐3 4‐5 6+ % using modern contraceptive method Parity group

Modern Contraceptive Prevalence among Married Women Ages 15‐ 44 by Parity across Six Africa‐based FHWS Sites

Ibadan Ife Kumasi Lunzu Wakiso Sebeta

CAPTURING HOUSEHOLD TRANSITORY WEALTH THROUGH AN INDEX ON EXPENDITURES AND NON-DURABLES

• J. Driessen, P. Ogunjuyigbe, A. Phillips, Q. Li, FHWS Study Team, A. Fatusi, A. Tsui

Common use of wealth quintiles from assets assessed in surveys (EDHS) Wealth measure can be broken down into

• Permanent wealth (house, housing quality,

vehicle, ownership of durable goods)

• Transitory wealth (expenditures on entertainment,

eating out, other consumption reflective of ‘middle class’ lifestyle)

Such data are challenging to collect

• Proxied with asset ownership of durables and non-

durables, expenditures, income, household quality

ANALYSIS OF PERMANENT AND TRANSITORY WEALTH MEASURES

 Address overlapping measurement of wealth  Deconstruct household wealth into permanent and transitory components  Create a summative index

• Selection of index items
• Weights for each item

 Dichotomous versus continuous measures

• DHS wealth quintiles based on PCA with dichotomous

measures  Used principal components analysis

RATIONALE FOR INDEX CONSTRUCTION

 Self-rated wealth

• 9-step ladder of perceived relative economic status

 Satisfaction with current income

• 4-step rating scale

 Aspirational wealth

• 5-step rating scale of relative well-being in one year

OUTCOMES OF INTEREST

PERCENT DISTRIBUTION FOR SATISFACTION WITH CURRENT INCOME

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Fully satisfied Rather satisfied Less than satisfied Not at all satisfied

 Regress self-reported economic wellbeing measures

• n
• Permanent wealth index (Fixed Asset Index)
• Transitory wealth index (Middle Class Index)

 Covariates

• Male years of schooling
• Number of persons in HH under age 5
• Number of persons in HH age 5-14

ANALYTIC APPROACH

Sites Ethiopia Ghana MalawiNigeria/Ife Nigeria/ Ibadan Uganda Eigenvalue of component 1 4.89 3.27 4.67 2.87 3.40 4.28 % variance explained by component 1 10.4 7.4 14.1 6.2 8.5 10.4 Cronbach's alpha 0.774 0.638 0.758 0.575 0.604 0.710 Range of predicted score (min max) (-3.92 9.78) (-4.22 6.14) (-2.67 17.44) (-5.13 6.12) (-4.10 11.06) (-3.20 9.99) % variance explained by component 1 with all fixed asset and middle class index items 9.0 5.9 12.9 6.1 8.2 13.7

PCA RESULTS FOR FIXED ASSETS

EXAMPLE OF FACTOR LOADINGS FOR FIXED ASSET INDEX

Ethiopia Ghana Malawi Nigeria/ Ife Nigeria/ Ibadan Uganda Furnishings Has bed 0.12 0.00 0.21 0.21 0.24 0.14 Has table 0.08

• 0.03

0.21 0.24 0.27 0.21 Has chair 0.08 0.01 0.19 0.23 0.26 0.19 Has dresser 0.26 0.13 0.17 0.18 0.20 0.23 Has refrigerator 0.29 0.24 0.30 0.30 0.25 0.30 Has landline telephone 0.28 0.04 0.15 0.04 0.14 0.14 Has motorcycle 0.01 0.03 0.06 0.04 0.03 0.06 Has bicycle 0.09 0.01 0.05 0.02 0.07 0.13 Has car/truck 0.20 0.12 0.25 0.26 0.26 0.29 Has horse cart

• 0.01

0.00 ‐‐ 0.03 ‐‐ 0.15 Has generator 0.10 0.03 0.07 0.29 0.27 0.20

PCA RESULTS FOR MIDDLE CLASS INDEX

Sites Ethiopia Ghana Malawi Nigeria/ Ife Nigeria/ Ibadan Uganda Eigenvalue 3.79 3.60 4.83 3.20 3.30 7.67 % variance explained by component 1 11.2 10.6 15.1 9.4 9.7 22.6 Cronbach's alpha 0.671 0.660 0.755 0.677 0.668 0.522 Range of predicted score (min max) (-2.67 12.64) (-1.57 18.15) (-2.12 11.82) (-4.09 7.77) (-2.70 14.61) (-0.93 23.65)

EXAMPLE OF FACTOR LOADINGS FOR MIDDLE CLASS INDEX

Sites Ethiopia Ghana Malawi Nigeria/ Ife Nigeria/ Ibadan Uganda

Consumption/expenditure behaviors Spent >$2.5 eating out in last 7 days 0.19 0.30 0.14 0.21 0.10

• 0.02

Spent >$10 in last month on clothes/shoes 0.07 0.29 0.14 0.22 0.16

• 0.01

Spent >$10 in last month on daily household items 0.19 0.30 0.20 0.30 0.15

• 0.01

Spent >$5 in last month on medicines 0.07 0.30 0.14 0.23 0.09 0.01 Spent >$10 in last month on books, newspapers, school supplies and entertainment 0.18 0.22 0.23 0.22 0.16 0.00 Spent >$5 in last month on other products and services 0.12 0.24 0.05 0.22 0.13

• 0.01

Spent >$20 in last month on child care 0.13 0.26 0.24 0.20 0.10 0.00 Spent >$15 in last 7 days on food (less amount spent eating out) 0.23

• 0.25

0.20 0.07 0.13 0.00 Spent >$10 in last month on utilities 0.28

• 0.01

0.25 0.20 0.24 0.01 Paid any amount for taxes last year 0.23 0.26 0.20 0.17 0.15

• 0.02

Household has no debt 0.01

• 0.16

0.00

• 0.06
• 0.04

0.00 Household has lent any amount to others 0.05 0.11 0.07 0.11 0.14

• 0.01

Household currently has savings 0.18 0.08 0.22 0.14 0.18

• 0.01

Red frame indicates statistical significance at 5% level. Adjusted for male education, presence of children and youth in household

Red frame indicates statistical significance at 5% level. Adjusted for male education, presence of children and youth in household

Red frame indicates statistical significance at 5% level. Adjusted for male education, presence of children and youth in household

WHAT WE’VE LEARNED ABOUT WEALTH MEASUREMENT

 PCA can be applied to other non-asset variables and reduce reliance on reported expenditure data  Constructed Middle Class Index reflective of consumption and short-term well-being  MCI performs similarly to Fixed Asset Index in predicting self-reported wealth outcomes  Middle class index sensitive to

• Expenditure ‘shocks’ (e.g., unanticipated health expenses)
• Health expenditure shock likely associated with having

sick children

• Presence of children
• Children may drive expenses captured in transitory

wealth score

THE DISTRIBUTION OF THE PERMANENT WEALTH SCORES IN ROUND 1 AND 2 (ETHIOPIA)

.05 .1 .15 .2 .25 Density

• 5

5 10 Fixed Assets Scores Round 1 Round 2

THE DISTRIBUTION OF THE TRANSITORY WEALTH SCORES IN ROUND 1 AND 2 (ETHIOPIA)

.05 .1 .15 .2 .25 Density

• 5

5 10 15 MCI Scores Round 1 Round 2

Factor Adj OR p level Family income (Round 1/log) 1.011 0.011 Length of residence (Husband) 0.997 0.687 Length of residence (Wife) 0.988 0.199 Borrowed money last year for health expenses 0.609 0.051 Own house 0.619 0.010 Duration of marriage (Wife report) 0.953 0.001 Regret marrying spouse (Husband) 1.470 0.164 Regret marrying spouse (Wife) 1.358 0.164 Husband has other wives (Wife report) 1.265 0.543 Husband has other wives (Husband report) 0.474 0.211 *Model also controls for occupation type of husband and wives (ns) n=950 couples, weighted for loss to follow up

FACTORS ASSOCIATED WITH COUPLE LOSS-TO-FOLLOW UP (ETHIOPIA)

ROC (RECEIVING OPERATING CHARACTERISTICS) CURVE TO ASSESS PROPENSITY SCORE

.25 .5 .75 1 Sensitivity .25 .5 .75 1 1 - Specificity

Area under curve = 0.6743 se(area) = 0.0196

1 2 3 4 Density .2 .4 .6 .8 Propensity Score Captured in 2nd round Missed in 2nd round

Closeness of curve to diagonal line is favorable to constructed propensity score model Distribution of propensity scores of those missed and relocated are similar (Ethiopia results only)

Factor Reg Coeff p level Middle class score (Round 1) 0.777 0.000 Fixed asset score (Round 1) 0.088 0.000 Husband's years of education (Round 1) 0.020 0.007 Borrowed money last year for health expenses

• 0.126

0.122 Number of children < age 7 1 0.128 0.061 2 0.088 0.365 n=693 couples, weighted for loss to follow up

FACTORS AFFECTING ROUND 2 TRANSITORY WEALTH SCORE

 Critical importance of training and supervision

• It’s not worth doing, if it’s not done well
• Standardized data-entry formats

 Importance of longitudinal study design

• Under-estimated loss-to-follow up which impacts Round 2 sample

power

 Challenges with relocating couples in peri-urban areas

• Couple follow-up rates are not surprisingly lower than individual

follow-up rates

• Household loss due to logical events (marital disruption, migration,

death)

 Ability to decompose overall wealth into permanent and transitory components  This type of study is rare in the African setting.

WHAT WE’VE LEARNED ABOUT CHANGE THROUGH FHWS

Whether childbearing patterns consistently influence family health and wealth outcomes

WHAT WE HAVEN’T LEARNED AS YET

THANK YOU AND MANY THANKS TO THE PRODIGIOUS EFFORTS OF THE EXTENDED FAMILY OF RESEARCHERS AND FHWS STUDY PARTICIPANTS AND SUPPORT FROM THE BILL & MELINDA GATES FOUNDATION THROUGH THE GATES INSTITUTE.