Urban Poverty And Household Noncommunicable Disease Burden In Ghana: A Case Study Of Ashiedu Keteke Submetropolitan Area

ABSTRACT The epidemiological and demographic transitions in low- and middle-income countries (LMICs) and the accompanying health and economic challenges have resulted into a high burden of disease particularly on households. Urbanisation and poverty are two major drivers of the burden of non-communicable diseases (NCDs). Drawing on the concepts of cost-of-illness and biographical disruption, this thesis investigates the burden of NCDs on urban households in the context of poverty. Cross sectional survey of 806 households (2,524 individuals) and in-depth interviews (27 individuals living with NCDs) were analysed by triangulating quantitative and qualitative methodologies. Analysis of variance (ANOVA) was used to determine the statistically significant differences between mean total household healthcare expenditure while accounting for household NCD status. Predictors of health seeking behaviour among diagnosed household members were determined using binary logistic regression and to determine the predictors of household healthcare expenditure, multivariate linear regression was used. Thematic network analysis was used to identify how indirect and intangible burdens of chronic disease manifest in poor households and the coping mechanism adopt to navigate direct burden of disease. One in five (20.1%) households had at least a member diagnosed with at least one NCD condition with hypertension being the most prevalent condition. A third (33.3%) of persons diagnosed did not treat (use medication or any other therapy) the condition during the two weeks preceding the survey. The predictors of treatment behaviour are age, marital status, and insurance status of infected person. The mean total household healthcare expenditure for the three types of households show a statistically significant differences F (2,799) = 4.58, p = 0.011). Indirect burden of disease manifests in households in the forms of income loss and investment challenges. Adoption of healthy lifestyle behaviours and psychosocial stressors are the forms of intangible burden of disease on households. While it comes with challenges, health insurance is the major means by which households cope with direct burden of disease. Other mechanisms that poor urban households depend on to cope with direct burden of disease are sales of household assets, savings and investments, social support and waiver of health-seeking privileges. The lack of effective coping mechanism options including social support systems results in the use of strategies that perpetuate poverty at the household level. Poverty is also a major determinant of treatment behaviour and adherence to healthy lifestyle behaviour. Poverty and NCDs mutually reinforce each other and lead to increase vulnerability and exclusion. Based on the results of this thesis, recommendations include: developing healthy lifestyle interventions aimed at reducing the risk of exposure to NCDs, re-engineering the current health insurance scheme to reduce administrative congestions and out-of-pocket payment, and investing in economic empowerment interventions to accelerate poverty reduction in the study communities.