Estimating socioeconomic status for health equity surveillance in Cameroon: an expert opinion survey

Background: Despite increasing awareness of socioeconomic status’s (SES) association with health outcomes, there is no widely accepted and rapidly implementable estimation of SES measures in resource-limited settings. An exception is the Demographic and Health Surveys (DHS)’s wealth quintile index constructed from household ownership assets. To facilitate health equity surveillance, method of individual SES estimation requiring fewer number of household assets is needed. The objective of this study was to identify the DHS assets most relevant for measuring SES in Cameroon.
Methods: Participants interviewed with a structured questionnaire included stakeholders involved in the design and implementation of DHS in Cameroon for many years. Using a 5-point Likert scale, experts graded DHS assets’ likelihood to measure SES. The questionnaire was strongly reliable (Cronbach’s alpha: 0.943, 95% CI: 0.920 - 0.961, p<0.001) for using the 29 items retained to measure SES.
Results: The probabilities of agreeing that an asset can be a useful measure of SES varied from 0.016 to 0.047. The 12 DHS assets most likely to measure SES included having Refrigerator(85.3%), Television(83.8%), Laptop(79.4%), Mixer(77.9%), Computer(77.9%), Agricultural land(77.9%), Cable/Satellite(76.5%), Cell phone(76.5%), Modem/Internet key(73.5%), Water pump(72.1%), Car/truck(72.1%) and Gas stove(72.1%) with a respective probability (prior) of 0.047, 0.046, 0.044, 0.043, 0.043, 0.043, 0.042, 0.042, 0.041, 0.040, 0.040 and 0.040.
Conclusions: This research underscores the importance of integrating local expert insights to refine the measurement of SES, promoting improved health outcomes in populations, particularly in Cameroon. Future research should explore the application of this expert-opinion-driven framework in various contexts to create more comprehensive, robust, and reliable SES indicators.
Keywords: Prior Probability, Expert Opinion, Demographics and Health Survey, Socioeconomic Status, Health equity