EVALUATION OF HEALTH STATUS AND ITS CORRELATES AMONG FARMERS IN AKWA IBOM STATE
The study ascertain the index of health statusof farmers and its correlates in Akwa Ibom State, Nigeria, followingobservations of poor health conditions of people in developing countries and the potential dangers towards food security by international development agencies. Specifically,socioeconomic characteristics ofthe respondents were mapped and interaction between health status index and its correlates were evaluated. Also the influence of ill-health on the farming activities were assessed in the study area. Multistage sampling procedure was used to select 240 respondents in the agricultural zones of Akwa Ibom State. Primary data were obtained and analyzedusing descriptive and inferential statistical tools. The results revealed that farmers: 55.8%were between 51 to 65 years and 46.3% schooled up to NCE level. Thirty-five or 14.6% earned annual incomeabove 75, 600 Naira while 98.8% cultivated between 2.25 hectares of land. Overall mean health status index stood at 0.39 as majority (81.7%) of farmerswas within the poor health status category.Decomposition of health status index bysocioeconomic characteristics revealed that the following had a higher mean health status index within its components; male (0.4094), married (0.4062), highly educated (0.4198) and highest annual income earners (0.4351).The relationship between health status index and thesecorrelates (nutrition and food security(r=0.20), alcohol and caffeine consumption(r=-0.322), vulnerability to accidents(r=-0.161), health insurance/financial capacity for medical checkup(r=0.171)were statistically significant at 95% probability level with overallR = 0.50 and an adjusted R2=0.250, implying that 25% of variation in the health status was accounted for by the eight independent variables. Thus, farmers in Akwa Ibom State had poor health status. Therefore, there is a need for an evidence-based and systematic intervention programme to improve the health conditions of farmers in Akwa Ibom State.
TABLE OF CONTENTS
CHAPTER TITLE PAGE
Title Page - - - - i
Declaration - - - - ii
Certification - - - - iii
Dedication - - - - iv
Acknowledgements - - - v
Abstract - - - - vii
Table of Contents - - - viii
List of Tables - - - - xi
List of Appendix - - - xiii
Abbreviations - - - - xiv
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study - - - - - - - 1
1.2 Statement of the Problem - - - - - - - 5
1.3 Objective of the Study - - - - - - - 7
1.4 Hypothesis of the Study - - - - - - - 8
1.5 Significance of the Study - - - - - - - 8
CHAPTER TWO: REVIEW OF RELATED LITERATURE
2.1 Socioeconomic Status and Health of farmers - - - - - 9
2.2 Health Status of Farmers - - - - - - 11
2.2.1 Chronic Diseases and Health Status - - - - - - 13
2.3 Health Disparity by Socioeconomic Characteristics - - - - 17
2.4 Correlates of Health Status of Farmers - - - - - 20
2.4.1 Health and Agricultural Production - - - - - - 23
2.4.2 Food Quality and Health Status - - - - - - 25
2.4.3 Farm Hazards and Injury - - - - - - - 27
2.5 Measurement of Health Status - - - - - 28
2.6 Conceptual Framework of Health Status and its Correlates - - - 29
2.7 Theoretical Framework of the Study - - - - - 31
CHAPTER THREE: RESEARCH METHODOLOGY
3.1 The Study Area - - - - - - - - 33
3.2 The Population of the Study - - - - - - - 34
3.3 Sampling Procedure and Sample Size - - - - - 34
3.4 Data Collection - - - - - - - - 35
3.5 Instruments for Data Collection - - - - - - 36
3.6 Validity and Reliability of Instrument - - - - - 36
3.7 Measurement of Variables - - - - - - - 36
3.8 Method of Data Analysis - - - - - - - 38
CHAPTER FOUR: RESULT AND DISCUSSION
4.1 Socio Economic Characteristics of Farmers - - - - - 42
4.2 Assessment of Health Status of Respondents - - - - 44
4.2.1 Overall Health Status of Farmers - - - - - - 53
4.3 Analysis of the Health Status Profile of the Respondents - - - 55
4.4 Assessment of Correlates of Health Statusof the Respondents - - 59
4.4.1 Analysis of the Components of Correlates of Health Status - - - 59
4.5 Effects of ill Health on Farming Activities - - - - - 73
4.6 Testing of Hypothesis - - - - - - - - 75
CHAPTER FIVE: SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
5.1 Summary - - - - - - - - - 79
5.2 Conclusions - - - - - - - - - 81
5.3 Recommendations - - - - - - - - 82
1.1 Background to the Study
Health is a level of functional and metabolic efficiency of a living being (Asenso, 2011). In humans, it is the general condition of a person in mind, body and spirit, usually referred to as being free from illness, injury or pain. The World Health Organization (WHO 2006) defined health in its broader sense as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. According to the International Labour Organization (ILO, 2004) health is a state of being hale, sound or whole, in body, mind or soul, especially the state of being free from physical disease or pains. Health is more than not being sick. It is a resource of everyday living. It is the ability to realize hopes, satisfy needs, change or cope with life experiences and participate fully in the society (WHO, 2004). In essence, health status is the current state of individuals’ health which includes the wellness, fitness and any underlying disease or injuries (WHO, 2011).
Evaluation is a judgment about how good, useful or successful something is. According to Ogunyinka (2014), evaluation is said to be the systematic collection of information about activities, characteristics and outcome of programmes to make judgment about the programme, improve programme effectiveness and or information decisions about future programme. Assessment of health status is important in that it enables individuals to be sensitive to changes in their health and serve to discover disease harbingers before its symptoms arise and before clinical examinations are made (Erengin and Dedeoglu, 2007).
Correlates of health status are the determinants of health status. A situation where two or more things are closely related or connected to each other or one causes the other (Murray, 2009). Health status can be influencedby factorssuch as: weight, nutrition, agility and flexibility or ability to move, smoking, alcoholic consumption, caffeine consumption, compliance with prescribed medical treatment,physical activity, diet etc. (Ugwu, 2006). National Institute of Occupational Safety and Health (2011) reported that many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment, genetics, income and education level, relationships with friends and family. All of these have considerable impact on health, and more so, commonly considered factors such as access and use of health care services have much impact on health status.
Donald (2006) posited that the importance of health as a form of human capital cannot be overemphasized, that good health and productive agriculture are important pairs in the economy of any nation especially in the fight against poverty. He further postulated that good health enhances work effectiveness and the productivity of an individual through increase in physical and mental capacities. On the other hand, health impairment or illness can affect the ability of people to perform essential tasks and can bring severe distress or even destitution to families. Poor physical, mental or even social health impacts negatively on individuals irrespective of their occupation, and this may be particularly worse on farmers and their dependents.
Agriculture is one of the most important drivers toward poverty reduction and the bedrock for economic growth, especially for the billions of people in developing countries. In agriculturally based countries, the sector generates on average, 29% of the Gross Domestic Product (GDP) and employs 65% of the labour force (World Bank, 2007). Three quarters of the world’s poor live in rural areas, particularly in Asia and Africa, and depend on agriculture as their primary source of livelihood (Ravallion and Jinadu, 2007). The World Bank (2007) suggested that, GDP growth originating fromagriculture is at least twice as effective in reducing poverty as GDP growth originating outside agriculture. Studies based on cross country estimates found that agricultural growth contributes significantly to reducing poverty and hunger, and added that poverty is the world’s most ruthless killer and greatest cause of suffering. However, the way agricultural productivity contributes to development varies across countries depending on the extent to which it is a source of economic growth and what percentage of the rural poor are strong and healthy enough to engage in agricultural activities. The linkage between agriculture, health and nutrition is bi-directional, and so health and nutrition also affect agricultural systems (Asenso, 2011). Good health is an asset for agricultural production, as healthy people can produce more and good nutrition contributes to it. Conversely, agriculture is an asset which contributes to good health and resilience, when both health and agriculture thrive, a reinforcing cycle of health can result, but when either suffers, the cycle becomes one of lowered agricultural productivity and lowered health status (WHO, 2010). According to ILO, (2004), the agricultural sector is one of the most hazardous to health worldwide. Agricultural work possesses several characteristics that are risky to health such as exposure to harsh weather, close contact with wild animals and plants, contact with agrochemicals, difficult working postures and lengthy hours, and use of hazardous agricultural tools and machinery. It is also stated that, agricultural development and practice can exacerbate the occurrence of disease vectors and parasites. More so, some agricultural practices have the effect of encouraging breeding grounds for disease vectors causing a real clash between the interest of food producers and health.
According to FAO(2006), more than 850 million people face acute food insecurity and hunger on yearly basis, 80% of these live in rural areas. This could be partly as a result of the difficulties farmers face in agricultural production such as land tenure system, insufficient capital, high cost of labour and machinery, poor processing and storage facilities etc.Many small-scale farmers are unable to produce sufficient quantities of food, even for self-consumption.As pointed out by the World Bank (2007), illness and death from HIV/AIDS, malaria, tuberculosis, and other diseases reduce agricultural productivity through the loss of labour, knowledge of productive adults, and assets to cope with illness.When disease afflicts farmers, their productivity is reduced and they remain in poverty, the effects fall back on the nation at large.
Poor health brings hardships to households including debilitation, substantial monetary expenditures, loss of labour and sometimes death. Poor health lessons the farmers’ ability to innovate, experiment, and operationalize changes in agricultural systems. For instance, “a farmer who is ill cannot attend FarmerFieldSchool or interact with extension officers to learn about new technologies and improve practices, and so may lack the knowledge to innovate (Croppenstedt and Muller, 2010). Health also affects agricultural output, particularly its demand. Antle and Pingali (2010) asserted that malnutrition and disease patterns influence market demand for food-quality, quantity, diversity and the price people are able and willing to pay. More so, health status of adults affects the duration of labour force participation and their intensity of work effort. Poor health will result in a loss of days worked or reduce workers’ capacity, and is likely to reduce output.A research carried out in Ethiopia by Croppenstedt and Muller, in 2010 estimated the impact of health and nutritional status on efficiency and productivity of cereal growing farmers. The results showed that, healthy farmers were found to produce more cereal per unit inputs, earn more income, and supply more labour than farmers affected by sickness.
Nutritional inadequacy impairs the ability of people to perform biologically (diminishing strength and endurance) and this in turn affects working capacity. Most of the rural poor are engaged in moderate or heavy physical work so that the negative impact of poor nutrition on performance is particularly severe for them. In 1978 the World Health Organization (WHO, 1995) adopted the “Global strategy of Health for all by the year 2000”, this action regarded health as a basic human right. It stipulated that “all the people in all the countries of the world should have at least such a level of health that they are capable of working productively and participate actively in the social life of the community in which they live. The aim was to ensure that all peoples have adequate access to safe water, sanitary facilities, immunization against major infections and local health care, yet many nations including Nigeria could not meet the year 2000 deadline of “health for all”.
In AkwaIbomState, the problem of poor agricultural productivity is quite challenging, (Ekong, 2006) as most farmers are involved in subsistence farming and their ages are advancing. Like any other occupation, farmers are exposed to hazardous conditions such as poor tools handling, routine contacts with various chemicals, and gas emissions from chemicals/ grain storage rooms, long working hours, exposure to extreme temperature (Akwa Ibom State Ministry of Agriculture, 2008). Apart from this, farmers in Akwa Ibom State are faced with most common diseases such as malaria, diarrhea, typhoid fever, rheumatism, measles, tuberculosis, pneumonia, arthritis, chicken pox, injuries, cuts, and more recently HIV/AIDS which in many cases will lead to excess expenditure on health care services and of course unexpected or premature death among farmers (Ekong, 2006),
Farmers are subjected to sprains, pains, fatigue, stress of financial losses and uncertainties, intensified farm pressures, natural disasters and intergenerational conflicts. In many cases, these farmers may not really know the root or the way out of their health problems and as such may attribute it to evil forces (Udoh and Umoren, 1997). On other occasions, they may try to remedy their health problems through the use of local herbs which if care is not taken; may end up worsening the problems.
1.2 Statement of Problem
International health development drivers like UNICEF and WHO observed that health conditions of the people in many developing countries are still unsatisfactory, and in many instances, the health status of their populations remain below that of the dwellers in other developed countries (WHO, 2011).Nigeria as a developing country has a vast growth in population both in urban and rural areas (Ojo and Iniodu, 2000). It is further observed that increasing population has a significant effect on increasing demand for increase in food production by the citizenry. But the occupational environment for the agricultural industry present a wide variety of hazards to its workers including exposures to poisonous chemicals, noise, organic dust, psychological stress and medical and physical traumatic injuries (National Safety Council, 2011). For instance, the World Health Organization estimates that 40- 50% of the world’s population are at health risk related work (exposed to physical, chemical, biological, psychological and ergonomics hazards) and that there are approximately 157 million new cases of occupational work-related diseases each year. This is attributed mainly to injuries sustained from the use of new technology, use of unsuitable imported machinery and poor working conditions (especially in agriculture and small-scale enterprises). The different types of injuries include amputations of limbs, eye injuries, and respiratory diseases, pesticide poisoning and musculo-skeletal disorders. This is estimated to amount to an economic loss of 10-15% GNP in developing countries (WHO, 2010). The health and safety of farmers are vital not only for themselves but also for the entire nation, after all without a safe production process, without safe producers, there cannot be safe consumers.
Ekong (2006) opined that most farmers still suffer from diverse diseases such as malaria, typhoid fever, rheumatism, tuberculosis, arthritis etc as a result of poor nutrition, hazardous nature of agricultural work, and poor usage of working equipment.There isa high level of redundant or unemployed farmers, reduction of farm labour and abandonment of many farming activities (Udoh and Umoren, 1997) all linked to health status of farmers in the state.Disease deprives countries, communities and households of their strongest, most productive people. It strips away assets of all forms: human, financial, social, physical and natural including its effect on ability of households to acquire enough nutritious food for members to lead active, healthy lives, exorbitant health care cost, labour shortages, declining asset base, breakdown of social bonds, downgraded crops, and loss of livestock. According to Akpabio, (2005) diseases lead to increase in dependency ratio due to the rise in the number of dependents relying on a small number of productive family members.
The Government of Akwa Ibom State of Nigeria has made numerous efforts toward the provision of health care facilities and services to its population. Notable among them are the expansion of medical education, improvement of public health care services, and provision of Primary Health Care (PHC) centers across the state(Akwa Ibom State Ministry of Agriculture, 2008). Despite the observed concerted efforts made by the Akwa Ibom State Government on improving health care of the dwellers, it would be pertinent to ask,“What is the health status of farmers in the rural areas”. With uncertainties in respect of empirical facts on health status index of Akwa Ibom farmers by extension non-urban dwellers, there is the need to evaluate the health status of the farmers, ascertain the correlates of health status, also the extent to which health status can be influencedby the correlates, and assess the effect of ill health on farming activities. Against this background the following questions became pertinent: what are the socioeconomic characteristics of the farmers in the study area?What is the health status of farmers?What is the health status profile?What are the correlates of health status? What are the effects of ill health on farming activities?
1.3 Objective of the Study
The general objective of the study is to evaluate the health status and its correlates among farmers in AkwaIbomState. The specific objectives of the study are to:
(i) Identify the socio-economic characteristics of farmers in AkwaIbomState
(ii) Assess the health status of farmers in the study area
(iii) Analyze the health status profileof the farmers in the study area
(iv) Ascertain the correlates of health status of farmers in the study area and
(v) Assess the effect of ill health on farming activities in the study area.
1.4 Hypothesis of the Study
The hypothesis of this study was stated in the null form as follows.
There is no significant relationship between the health status of farmers and its correlates (nutrition, and food security, exposure to harsh weather, alcohol and caffeine consumption, use of safety measures, housing condition, compliance to medical prescription etc) in the study area.
1.5 Significance of the Study
Agricultural production and functional health status are primarily factors that relate with each other. This study evaluated the health status and its correlates among farmers in Akwa Ibom State. It is expected that the results of this study will be of immense value to farmers in their farming communities, policy makers, extension agents, government and to the country at large. The study will enable government not only to focus policies on development of agricultural technologies but also make policy for increased income to boost food security, enhance health status and expand the welfare basis for rural communities. Furthermore, it will serve as a guide to development programming oriented non-governmental organizations (NGOs) on preventive measures which farmers should adopt in order to prevent or reduce health risks, and then see the need to change to safer agricultural practices. The study will enable scientists develop preventive measures and surveillance systems for health problems. Finally, this study will assist researchers to study on a broader correlation between health status of farmers and farm labour productivity. This will go a long way towards boosting agricultural productivity and sustainable development..