Assessing Education Level Aids the Distribution of Resources in a Developing Global Health Program in Honduras

Appropriately assessing the health status of a community before beginning a medical or public health intervention is essential to ensure the equitable distribution of finite resources. Identification of demographic indicators that predict health could provide tools to broadly assess needs within a target community and allocate programs accordingly. Medical students at The Ohio State University conducted comprehensive health needs assessments of several marginalized communities in Honduras. Using self-reported epidemiology and demographic information, a Health Scale was constructed and scored for each respondent. Mean scale scores, when compared with demographic information, demonstrated that attainment of at least a fifth grade education correlated with better family health and better community health. Likewise, parental reporting of children having received health education in school was correlated with lower incidence of pediatric diarrhea. Mothers who reported their children did not suffer from diarrhea in the last year also had significantly more education than their peers. Additionally, data trends suggest that not having progressed beyond the fourth grade may be correlated with lower age at first pregnancy and increased parity for women. In comparing demographically similar populations in Honduras, findings suggest that education is predictive of certain health indicators and provides valuable information for targeting programs aimed at improving health. Likewise, designating resources for reducing disparities in education may be a successful means of reducing health inequality in Honduras. Care should be taken with the implementation of outreach efforts to account for low literacy and formal education within communities at highest risk for health inequality.

Methods

The data for this needs assessment was collected by medical and professional students using oral interviews over the course of five weeks during the summer of 2008. The interviews took place in the communities of Siete de Abril, Monte de Olivos, Brisas de Libertad, and a construction site where many of the families from Siete de Abril were working. Interviews were conducted in private or semi private locations within the respective communities. Each interview was conducted using one of three standard thematic formats addressing either women’s health, basic epidemiology, or social or personal perceptions of health. The questions were scripted and asked in the same order and a substantial effort was made to ensure as little variation between interviews as possible. The health scale score was then constructed using affirmative and negative answers to questions regarding various aspects of personal and household epidemiology. The scores were tabulated by assigning affirmative and negative answers values of 1 or 0 and then summating the responses from the course of each individual’s interview. The scale was then corrected by subtracting the value from the highest score obtained to form a scale in which higher values correlate to better health. The results were then filtered for female respondents to ensure that each household was counted only once. Filtering for females was also helpful in eliminating a noted knowledge bias in males related to under reporting of conditions affecting their children’s health.

Results

Date collected showed a spectrum of Personal Health Scores and Family Health Scores. The data for personal health reflect both male and female respondents, while the family health is restricted to females

Mean scale scores, when compared with demographic information, demonstrated that community health correlated better with education than mean income.

Direct comparison of education and mean scale score demonstrated that attainment of at least a fifth grade education correlated with better family health