L’état de santé perçu et les incapacités en Afrique subsaharienne : différences socioéconomiques et de genre

Although the relationship between self-rated health (SRH) and physical and mental health is well documented in developed countries, very few studies have analyzed this association in the developing world, particularly in sub-Saharan Africa. Furthermore, research in various social contexts has documented that disability and poor SRH are more common among women and persons with lower socioeconomic status (SES), but it is unclear whether these associations also hold in sub-Saharan African settings. The general objective of the present thesis was to better understand the social stratification in health in sub-Saharan Africa. More specifically, this study aimed to: 1) To examine the associations of SRH with measures of physical and mental health (chronic diseases, functional limitations, and depression) among adults in Ouagadougou, Burkina Faso, and how these associations vary by sex, education level, and age; 2) To analyze differences in cognitive impairment and mobility disability between older men and women in Ouagadougou, Burkina Faso, and to assess the extent to which these differences could be attributable to gender inequalities in life course social and health conditions; 3) To examine the relationship between SES and multiple disability measures among adults aged 18 and older in 18 sub-Saharan African countries and to determine whether socioeconomic differences in disability are characterized by an increase, decrease or stability with increasing age. The results of our analyses are in three scientific research articles, which rest upon data taken from a cross-sectional interviewer-administered health survey conducted in 2010 in areas of the Ouagadougou Health and Demographic Surveillance System, and the World Health Survey conducted in 2002-2004 by the World Health Organization (WHO). In the first article, poor SRH was strongly associated with chronic diseases and functional limitations, but not with depression. The effect of functional limitations on poor SRH intensified with age and with decreasing education level. In contrast, the effect of chronic diseases appeared to decrease with age. No variation by sex was observed in the associations of SRH with chronic diseases, functional limitations, and depression. These findings suggest that different subpopulations delineated by age and education level weight the components of health differently in their self-rated health in Ouagadougou. The results of the second article indicated that female gender was positively associated with higher levels of cognitive impairment and mobility disability. The female excess in these disabilities was only partially explained by gender differences in nutritional status, marital status and, to a lesser extent, education. These results suggest that enhancing nutritional status and educational opportunities throughout life span could prevent cognitive impairment and mobility disability and partly reduce the female excess in these disabilities. In the third article, we found that the lack of education was positively associated with poorer functional health, and the health gap between educational levels remains static with increasing age. These findings suggest that, in sub-Saharan Africa, compared to the well educated, the undereducated have fewer economic and social resources and health-promoting behaviors which have beneficial, albeit constant effects on functional health over the life course.

Keyphrases: Self-rated health, Disability, Functional health status, Gender differences, Socioeconomic differences, Adults, Older persons, Ouagadougou, Ouagadougou, Burkina Faso, Burkina Faso, Sub-Saharan Africa