Socio-economic inequalities as a predictor of health in South Africa - the Yenza cross-sectional study

The objectives were to describe the demographic environmental and health characteristics of the rural Eastern Cape and to explore demographic and environmental predictors of health. A Cross-sectional study was used. Engcobo and Umtata in the Eastern Cape South Africa was the setting used for the study. The participants used in the study were 12 049 people from 4 608 households. Outcome measures: (i) Children: immunisation history and being breastfed; (ii) women aged 15 - 45 years: use of contraception; (iii) women aged 20 - 25 years: total numbers of dead children; and (iv) all adults: smoking status body mass index and blood pressure. 2 741 houses (59.5%) were structurally adequate 1 795 (39.0%) had access to clean water and 1 174 (25.6%) had access to gas or electric energy. Of children up to 5 years of age 1 436 (44.2%) were fully immunised and 2 472 (76.1%) were breastfed in their first year of life. Among women aged 15 - 45 years 903 (37.8%) used contraceptives and among women aged 20 - 25 years 56 (11.8%) had lost at least 1 child. Self-report of chronic illness and disability was low. Current smokers include 264 men (12.7%) and 325 women (6.0%) and 315 men (15.2%) and 1 439 women (26.7%) had a body mass index > 30. Adequate housing (odds ratio (OR) 1.31 95% confidence interval (CI): 1.12 - 1.53) and access to refuse disposal (OR 1.65 95% CI: 1.36 - 2.00) were predictive of complete immunisation in children. Children living in houses with access to clean water (OR 0.8 95% CI: 0. 64 - 0.99) and a fitted toilet (OR 0.56 95% CI: 0.38 - 0.83) were less likely to be breastfed in the first year of their life. Women aged 15 - 45 years were likely to use contraception if they were well educated (OR 2.75 95% CI: 1.76 - 4.28) and lived in houses with access to refuse disposal (OR 1.46 95% CI: 1.20 - 1.78). Better education was associated with a reduced likelihood of loss of a child (OR 0.11 95% CI: 0.02 - 0.51) and being a smoker (OR 0.52 95% CI: 0.38 - 0.73). Obesity was associated with being female (OR 1.88 95% CI: 1.62 - 2.18) and living in a house with electricity (OR 1.46 95% CI: 1.26 - 1.68). High blood pressure was associated with living in a house with electricity (OR 1.36 95% CI: 1.10 - 1.70) and with monthly household income exceeding R2 000 (OR 1.38 95% CI: 1.07 - 1.78). High socio-economic deprivation in the Eastern Cape is associated with health status comparable to that of poorer regions in sub-Saharan Africa. The educational level of the population access to electricity clean water and refuse disposal facilities are important predictors of child maternal and adult health. (authors)