Academic journal article Journal of Health Population and Nutrition

Costs of Illness and Coping Strategies in a Coffee-Growing Rural District of Ethiopia

Academic journal article Journal of Health Population and Nutrition

Costs of Illness and Coping Strategies in a Coffee-Growing Rural District of Ethiopia

Article excerpt


Health is a key to individual productivity for the opportunity to participate in the labour market or in the production of goods. A fit and physically-capable body is an asset to anyone, while a sick, weak, and disabled body is a liability both to affected individuals and to those who care for them (1). Therefore, as soon as the effects of ill health begin to threaten a family, a sequence of mechanisms will be set in motion to avert disastrous situations. The capacity to resist impoverishment due to ill health is dependent on access to resources, such as labour, human and social capital, and productive assets (2). If households lack the necessary coping mechanisms, a 'shock' could result and those affected will become physically weaker, economically impoverished, socially dependent, and/or psychologically harmed.

Nowadays, many developing countries are facing a serious problem in financing their health services due to various demographic, economic and epidemiologic reasons. As one of the strategies to respond to this problem, people are expected to share the cost of services through out-of-pocket payments. As a result, people's ability to withstand the burden of cost-sharing in developing countries has become a debatable topic (3-5).

As 85% of the Ethiopian population is engaged in agriculture, relying on traditional labour-intensive inputs, the importance of physically-able and healthy workforce cannot be overemphasized (6). Furthermore, as there is no tradition of saving money during post-harvest and relatively surplus seasons for use during lean and difficult times, sickness and loss of working days by an adult may be catastrophic for the subsistence economy of a household in rural Ethiopia.

The main objective of this study was, therefore, to assess the strategies used by rural households in a predominantly coffee-growing district of southwest Ethiopia to cope with the financial and time costs of illness.


This cross-sectional, community-based study was carried out from February to March 2000 among 630 households in 10 randomly-selected rural villages in Goma district of Ethiopia (7). The Goma district, which is one of the 13 districts in Jimma Zone and has 93 rural villages, is reputed to be the origin of coffee in the world.

A structured, pre-tested questionnaire was used for collecting information on sociodemographic and economic status, perceived morbidity, use of health services, and coping strategies with costs of illness. Trained enumerators who speak the local language administered the questionnaire. Two trained nurse supervisors who were responsible for checking the quality of data ensured that missing or inconsistent forms were sent back for immediate correction at the field level.

The average monthly income was taken to estimate the average annual income of the households. In addition, information on other proxy assets, such as food and cash crops produced, possession of cattle, and ownership of house and land, were used as additional estimates for household economy, since getting reliable information on income was the most difficult part of the survey.

After pre-coding all the study variables, the raw data were entered into a computer using SPSS 10.0 for Windows software. Chi-square test, odds ratio, and 95% confidence interval were used for assessing the significance of the association. Statistical significance was set at p<0.05.


Heads of the 630 households responded to the interviews. Of those, 85.2% were male. Age of the study participants ranged from 18 years to 88 years, the mean ([+ or -] SD) and median age being 40.2 ([+ or -] 14.9) and 39 years respectively. Including extended family members, the mean family size was 5. Seventy percent of the respondents were farmers by occupation. The majority (69.7%) were Muslims, followed by Orthodox Christians (29. …

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