CRCHUM, Health Research Axis Ecohealth 2014, August, 12th 2014 N Atchessi, V Ridde, E Bonnet, K Kadio, M-V Zunzunégui

1. Methods to evaluate the effectiveness of a
community-based selection of indigents
N Atchessi, V Ridde, E Bonnet, K Kadio, M-V
Zunzunégui
CRCHUM, Health Research Axis
Ecohealth 2014, August, 12th 2014
Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies

2. Introduction
• Burkina Faso, West Africa
• Community-based selection of
indigents in 2010
• Step 1: CSV selection
• Step 2: CoGes Selection
• Indigents retained are those
selected by CoGes.
• Is this an effective selection
method?
• Objective: describe two
methods used to evaluate the
effectiveness of a community-
based selection of indigents
Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies

3. Method
• Method 1: Spatial analysis
• Hypothesis 1: The entities
representing the communities (CSV
and CoGes) tended to select indigents
who were physically nearer to them.
• Method 2: Analysis of characteristics
• Hypothesis 2: Indigents selected by
CoGes are the more socially and
economically vulnerable
• Strategy: Compare two groups of
indigents selected by 2 types of
community organization
According to your context
Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies

4. Method
Why these methods?
• Both methods use objective criteria to measure a
selection method based on the judgment and will
of selection committee members
• Determinants of health care access are used to
assess the effectiveness of the indigent selection
According to your context
Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies

5. Method
• Spatial analysis
 Socially and spatially representative sample of indigents in the
two groups
 Variables: village location, indigents location (GPS), road, trails
network, hydrographic network, administrative boundaries
 Analysis: geographic distribution of indigents
• Analysis of characteristics
 Variables: (Andersen and Newman model)
 predisposing factors;
 facilitating factors;
 needs.
 Logistic regression: Factors associated with possession of
indigent card
According to your context
Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies

6. Method
Challenges and limitations
• Spatial analysis
 Not enough to assess
effectiveness of selection
when used alone
 Scarcity of geographic data
• Analysis of characteristics
 Age over/under-estimated
 Self-reported variables
Strengths and opportunities
• Spatial analysis
 Assessment of effectiveness of
selection with geographic
determinants of health
 Indicators based on distance
• Analysis of characteristics
 Cross-sectional design
 Multivariate analysis
 Andersen and Newman model:
a comprehensive model
Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies

7. Results
Analysis of characteristics
Including an example
Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies
Spatial analysis:
 CSV had no particular pattern of
selection
 CoGes tended to select Indigents
who were geographically nearest
to health centers
Variables OR CI
95%
Predisposing
factors
Sex ns
Age ns
Widowed
vs. not widowed
1.40
*
[1.10-
1.78]
Facilitatingfactors
Instrumental assistance ns
Lack of financial assistance
vs. financial assistance
1.58
*
[1.26-
1.97]
Living alone
Living with spouse
vs. Living with children
1.28
*
2.00
*
[1.01-
1.63]
[1.35-
2.96]
Needs
Chronic illness ns
Vision impairment
vs. no vision impairment
1.45
*
[1.14-
1.84]
[1.28-

8. References
Thank you!
1-Andersen R, Newman JF: Societal and individual determinants of medical care utilization in the United
States. Milbank Memorial Fund Quarterly. Health and Society 1973. 51(1): 95-124.
3-Nagi SZ: An epidemiology of disability among adults in the United States. Milbank Memorial Fund
Quarterly. Health and Society 1976. 54(4): 439-467.
4-Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A
short physical performance battery assessing lower extremity function: association with self-reported
disability and prediction of mortality and nursing home admission. Journal of Gerontology 1994. 49(2):
M85-94.
5-Arnaud M., Emery X. (2000), Estimation et interpolation spatiale, Paris, Hermes Science Publications.
6-Banos A., Huguenin-Richard F. (2000), « Spatial distribution of road accidents in the vicinity of point
sources : application to child pedestrian accidents », in Flahault A., Toubiana L. (eds), Geography and
Medicine, Elsevier, pp. 54-64.
http://www.equitesante.org/home/
Session: Nuts & bolts of EcoHealth research: sharing data integration strategies for Ecohealth studies