Identification of the Critical Attributes of Function of Health in a Rural West African Population

Rationale: Pharmacoeconomic guidelines and policy reports suggest that we identify attributes of health that are mostly affected in population groups. Objective: The identification of the attributes of function of health most critical among rural community members in a health district in Burkina Faso. Method: Morbidity data was collected between 2000 and 2001 in a health survey of 880 representative households that were selected using a two stage cluster sampling procedure. The survey was in the Nouna Health District, Burkina Faso. The data contain information that describes illnesses in five domains namely, limitation, severity, mental and social burden as well as general hindrance from occupational work. A total of 1858 combinations of illness state descriptions were available in a useable form for data analysis. A chi-square test was carried out to distinguish between the attributes used to describe the mostly reported illnesses. Results: The mean age was 29 and 49% were female. Most (42%) of the reported illnesses were described as bad enough. The most frequently reported limitations were inability to work in the field or do handicraft (23%); limitations in recreational activities, sports, education, and reproduction (18%); and in daily activities like preparing meals, house-keeping or looking after live-stock (17%). Three of the most commonly reported illnesses, malaria, bronchitis and diarrhoea were described as causing significantly different types of limitation (p = 0.047). Analysis of the three severity levels of malaria most frequently reported showed that limitation, mental and social burden as well as occupational work hindrance increased with increasing severity level. For malaria cases suffered by females and children less than 15, limitations in recreational activities, sports, education and reproduction were most critical. For males and those above 15, limitation in field work or handicraft were most critical. Conclusion: Attributes that relate to sports, education, reproduction, ability to work in the field or to do handicraft are critical among members in a rural West African community. These attributes of health are not explicitly captured in the more commonly used health state preference measures like EQ-5D and SF-6D. Cost-effectiveness analyses that fail to incorporate these attributes might be measuring health benefit inaccurately