Inégalités de santé à Ouagadougou

The existing literature suggests that urban Africa today bears a compound burden of communicable and non-communicable diseases. Empirical studies based on the few available sources confirm this double burden. However, no study has yet approached the question of how those health burdens are distributed across the different social strata of a single African city.

Data from the Ougadougou population observatory (Observatoire de Population de Ouagadougou or OPO) collected between 2008 and 2013 in a total of five formal districts and informal neighborhoods of Ougadougou, the capital of Burkina Faso, show that child and maternal mortality are relatively low compared to what has been found for other countries by other observatories around the continent. Maternal and infant disease prevention programmes such as vaccination campaigns and delivery and post-delivery care now reach nearly all strata of the population, and with all else kept equal, poor children in the OPO study districts are no longer at particular risk of malnutrition. However, mortality due to infectious diseases is unequally distributed, due in particular to sharply unequal recourse to treatment in a context where patients themselves must pay most of their health expenses. Despite these inequalities, the findings clearly show that infectious diseases—particularly HIV/AIDS, respiratory infections, and, among children, malaria—continue to affect a significant proportion of middle-class city inhabitants. Meanwhile, what is at issue in maternity-related health problems is not so much the availability of medical services as their quality.

Furthermore, economically privileged adults would be in much better health if they had not massively adopted behaviours that put them at risk for non-communicable diseases. With all else kept equal, office workers and people with an elementary school education are relatively heavy smokers; the rich are more likely to be overweight and physically inactive; and office workers seem to be at greatest risk for depression. Despite the distribution of risk factors—not a good sign for relatively privileged city residents—those same residents die later from those diseases; poorer residents are less likely to be able to afford treatment for them, which is extremely expensive and not readily available. Nonetheless, even the rich often die early from non-communicable diseases given how difficult it is to obtain treatment for them in the country’s capital city. Last, functional limitations in old age seem indifferent to socio-economic gradient, a phenomenon probably due to the fact that older persons are more likely than others to die as soon as they experience a health problem.

As these findings clearly indicate, there is no polarized health transition in Ouagadougou, despite the fact that health inequalities there are still quite marked. Rich and poor alike are affected by the double burden of communicable and non-communicable diseases. And even though relatively privileged Ouagadougou inhabitants are at lower risk of dying from the latter, there are signs of a counter-transition: risk factors are more widespread among the relatively privileged, and socio-economic differences have relatively little impact on functional limitations in old age.

Source: Sous la direction de Clémentine Rossier, Abdramane Bassiahi Soura, Géraldine Duthé, 2019, Inégalités de santé à Ouagadougou. Résultats d’un observatoire de population urbaine au Burkina Faso, Ined, Collection : Grandes Enquêtes

Contacts: Clémentine Rossier, Abdramane Bassiahi Soura, Géraldine Duthé

Online: January 2019