- Asthma in Uganda: SES is an important factor in the development and/or exacerbation of asthma symptoms in young children.
- Mental Health: Depression in Uganda: Risk factors for developing depression are all socioeconomic, related to deprivation (no formal education, having no employment, broken family) and poverty (low SES).
- Polio in Uganda: polio has profoundly detrimental socioeconomic consequences.
- Spinal Cord Injury (SCI) in Uganda: SCIs are found in the most economically productive age group of 20 to 40 years and are therefore a big socioeconomic burden to the nation.
- Visual Impairment in Uganda: River blindness is a significant socioeconomic burden that can be treated with antibiotics.
Low income and education have been shown to be strong predictors of a range of physical and mental health problems, including respiratory viruses, arthritis, coronary disease, and schizophrenia. These problems may be due to environmental conditions in their workplace, or, in the case of mental illnesses, may be the entire cause of that person's social predicament to begin with.
Education in higher socioeconomic families is typically stressed as much more important, both within the household as well as the local community. In poorer areas, where food and safety are priority, education can take a backseat. Youth audiences are particularly at risk for many health and social problems in the United States, such as unwanted pregnancies, drug abuse, and obesity.
Income, education and occupation are important indicators in their own right. When they are combined into SES they become a powerful tool. The following notes about each are taken from Wikipedia:
Income: Is a measure of all money earned. Low income families focus on meeting immediate needs and do not accumulate wealth that could be passed on to future generations, thus increasing inequality. Families with higher and expendable income can accumulate wealth and focus on meeting immediate needs while being able to consume and enjoy luxuries and weather crises.
Education: Research shows that lower SES students have lower and slower academic achievement as compared with students of higher SES. When teachers make judgments about students based on their class and SES, they are taking the first step in preventing students from having an equal opportunity for academic achievement. Educators need to help overcome the stigma of poverty. A student of low SES and low self-esteem should not be reinforced by educators. Teachers need to view students as individuals and not as a member of an SES group. Teachers looking at students in this manner will help them to not be prejudiced towards students of certain SES groups. Raising the level of instruction can help to create equality in student achievement. Teachers relating the content taught to students' prior knowledge and relating it to real world experiences can improve achievement. Educators also need to be open and discuss class and SES differences. It is important that all are educated, understand, and be able to speak openly about SES.
Occupation: Occupations are ranked by the Census (among other organizations) and opinion polls from the general population are surveyed. Some of the most prestigious occupations are physicians and surgeons, lawyers, chemical and biomedical engineers, university professors, and communications analysts. These jobs, considered to be grouped in the high SES classification, provide more challenging work and greater control over working conditions but require more ability. The jobs with lower rankings include food preparation workers, counter attendants, bartenders and helpers, dishwashers, janitors, maids and housekeepers, vehicle cleaners, and parking lot attendants. The jobs that are less valued also offer significantly lower wages, and often are more laborious, very hazardous, and provide less autonomy.
Occupation is the most difficult factor to measure because so many exist, and there are so many competing scales. Many scales rank occupations based on the level of skill involved, from unskilled to skilled manual labor to professional, or use a combined measure using the education level needed and income involved.
The 2003 paper Deliberate self-harm as seen in Kampala, Uganda: A case-control study shows the effects of SES. Self-Harm is described in the following way (see Self-injury (Cutting, Self-Harm or Self-Mutilation):
Self-injury, also known as self-harm, self-mutilation, or self-abuse occurs when someone intentionally and repeatedly harms herself/himself in a way that is impulsive and not intended to be lethal.Self-harm is a diagnosed mental health disorder that carries all the usual stigma and prejudice with it. The Abstract summarizes the paper (all socio-economic references are highlighted in bold):
The most common methods are:
Other forms of self-injury include excessive scratching to the point of drawing blood, punching self or objects, infecting oneself, inserting objects into body openings, drinking something harmful (like bleach or detergent), and breaking bones purposefully. Most individuals who engage in non-suicidal self-injury (NSSI) hurt themselves in more than one way.
- Skin cutting (70-90%),
- Head banging or hitting (21%-44%), and
- Burning (15%-35%).
Objectives: A study to investigate deliberate self-harm (DSH) in an African context was undertaken in Uganda.
Methods: A case-control study in which 100 cases of DSH and 300 controls matched on age and sex were recruited from three general hospitals in Kampala and subjected to a structured interview using a modified version of the European Parasuicide Study Interview Schedule I.
Results: Among the cases, 63% were males, with a male to female ratio of 1.7:1 and a peak age range of 20–24 years. Higher educational attainment, higher socio-economic class and poor housing were significantly associated with DSH. District of current residence, district of birth, religion, ethnicity,marital status, number of children, current living arrangement, area of usual residence, employment status of respondent and partner were not significantly associated with DSH.Pesticides and medications, mainly antimalarials and diazepam, were the main methods of DSH used. The most commonly reported psychiatric disorders were adjustment disorder, acute stress reactions and depression.
Conclusion: DSH in Uganda appears to predominantly afflict the young.Disturbed interpersonal relationships, poverty and loneliness were important factors in the immediate precipitation of this behaviour. The fact that pesticide poisoning is still the predominantly used method in DSH in this area calls for a review of the legislation that controls the sale and availability of these agricultural chemicals.
The introduction to the paper describes the risk factor associated with DSH:
Deliberate self-harm (DSH), one of the major risk factors for completed suicide, has been shown in the West to be more prevalent among the young and especially young women (15–24 years) (Platt et al. 1992; Kerkhof 2000). Single and divorced people have also been found to be overrepresented among deliberate self-harm patients, as well as people of low education, the unemployed, those with a history of psychiatric treatment and those that are socio-economically deprived (Newson- Smith and Hirsch 1979; Urwin and Gibbons 1979; Platt et al. 1992; Kerkhof 2000).
Traditionally in Africa, suicidal behaviour has been viewed with intense social disapproval and regarded as a criminal act in many of the statute books on the continent. As a result, it attracted cultural sanctions (including secrecy) which made it difficult to investigate (German 1987).The situation to date does not appear to have changed very much. Looking at studies that have been undertaken on the continent on DSH, the picture that appears to be emerging is complex. Southern and Central Africa have been reported to have a picture of DSH that is similar to that reported in the West where there is an overrepresentation of the female, the young between the ages of 20 and 29 years, those with psychological problems and those with socio-economic deprivation (Gelfand 1976; Minnaar et al. 1980;Williams and Buchan 1981; Bosch 1987). Studies from this sub-region have also consistently shown a higher rate of DSH and completed suicide among the White and Indian races as compared to Black Africans (Gelfand 1976; Minnaar et al. 1980;Williams and Buchan 1981; Bosch 1987).
The picture from Eastern and Western Africa is reportedly different with, for example, a reversal of the expected female preponderance as reported in one study from Ibadan,Nigeria (Odejide et al. 1986). Other studies from both Uganda and Ethiopia reported no gender differences (Cardoza and Mugerwa 1972; Alem et al. 1999).
Most of the studies that have been undertaken on DSH in Africa are over 20 years old and are mainly of a descriptive nature with no case-control studies reported in the literature on this subject from this region. The associated factors leading up to DSH behaviour in the Ugandan context and Africa in general have also not been well elucidated.
A study was, therefore, undertaken to investigate DSH in the Ugandan context using a case-control study design with standardized psychological assessment instruments.
The results were summarized into several tables and were discussed as follows:
Looking at Tables 2 and 3, proportionally more cases had attained a higher level of education and were represented in the upper socio-economic classes of I and II than controls.However, proportionally more cases than controls were staying in single-roomed lodgings (locally called Muzigo) in deprived city slums...The discussion made some interesting points about the seemingly paradoxical results:
Deliberate self-harm in this study was associated with a higher educational attainment and a higher socio-ecnomic status, but paradoxically also with poorer housing.Proportionally more cases than controls stayed in single-room lodgings (locally called Muzigo) which are located in slums in an environment of overcrowding with no social amenities. Mzezewa and colleagues (1999) in a study of burns patients in Zimbabwe, many of whom had suicidal intentions, noted an over representation in their sample of people living in one-roomed lodgings which were characterized by overcrowding and poor social amenities (Mzezewa et al. 1999)...
The disparity between educational attainment and socio-economic status on the one hand and the ability to access social amenities such as housing on the other could, in this environment, occur in the lives of at least two types of persons, the urban student and the unemployed graduate. Post-primary education in Uganda is privately paid for and is accessible to only a few families. In 1995,Uganda was reported to have a tertiary student to population ratio of 154/100,000, while the average for sub-Saharan Africa was 339/100,000 and that for Sweden was 2,972/100,000 (Kasozi 2002).As reported by Kasozi in Uganda, those not enrolled in any tertiary programme often came from households with a substantially lower socio-economic status, with their household expenditures averaging less than a third of those enrolled in tertiary programmes (Kasozi 2002).To obtain a good education that will increase the prospects of getting a job, most families often have to send their children to big urban centres, such as the capital city of Kampala. Those who have graduated from tertiary institutions must remain in the city in search of jobs.Both categories of persons often have to stay in the relatively cheaper city slums in order to minimize their upkeep costs....
The majority of cases had psychiatric disorders secondary to stressors in their immediate environment or internally secondary to mental illness/symptoms, with similar results having been reported elsewhere on the continent (Minnaar et al. 1980;Mengech and Dhadphale 1984). In the majority of cases, the stressor was a disturbed interpersonal relationship, loneliness,physical or mental illness.However, also in this study, as in the Tanzanian and Egyptian studies, the socio-economic factors of poverty and unemployment were significant in precipitating DSH (Okasha and Lotaif 1979; Ndosi and Waziri 1997).
The report concluded:
DSH in this study as elsewhere in the world appears to predominantly afflict the young. There was,vhowever, a preponderance of male over female cases of DSH in this study unlike in most studies carried out in the West. This may point towards the existence of culturally ordered differences between the different genders in health-seeking behaviour for DSH in the study area. That the highly toxic organophosphate poison is still the main method of DSH used in this population calls for a revisiting of the legislation that controls the sale and availability of these agricultural chemicals. There is also a need to explore means of limiting the amount of antimalarials that are available at any one moment in the households through innovative methods, such as limiting package sizes,which has been shown to have an effect (Hawton et al. 2001). The factors underlying this behaviour appear to be disturbed interpersonal relationships, socio-economic deprivation, loneliness and mental illness/symptoms.These stressors were responsible for a pattern of mental disorders characterized by more cases with adjustment disorder and acute stress reaction than is usually reported in the West, but which pattern has been reported from other parts of Africa.In conclusion, SES is valuable tool for assessing wealth, status and educational achievement in society. That PWDs score significantly lower on all socioeconomic risk factors is significant and should not be underestimated. In the paper above it was seen that social deprivation is one of the factors that lead to DSH. From this it arises that DSH can be a prelude to suicide. DSH can then become a serious disability that is loaded with stigma and prejudice. Understanding the role of SES in DSH provides an extra dimension to the understanding of this condition.
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