Maternal economic status influences more on their health behavior than their knowledge: Community-based survey in rural Cambodia

Objectives: In developing countries, measuring household income is extremely difficult. Wealth, i.e. net assets, is an alternative indicator to household income. We developed a wealth index appropriate for rural areas in Cambodia and compared it with single-item asset scales. We also analyzed its relationship with maternal health behavior and knowledge.

Methods: The study was conducted in four communes in Kampong Cham Province. A structured questionnaire was administered to 640 women who delivered babies within one year prior to the survey. The development of the Cambodian rural version of wealth index followed the procedures of Demographic and Health Survey (DHS) Wealth Index. Out of more than 70 asset items in Cambodian DHS, we selected 18 items by assessing the distribution and relationship with health behavior for each item and placing them into the principal components analysis. Those items whose factor loading were below 0.4 were removed. Next, we constructed an 11- item wealth index weighted by factor loading. Cronbach's a was 0.81 showing good level of reliability. Economic status was tabulated using quintiles and health behavior and knowledge of the women were calculated for each quintile.

Results: Mean age (SD) of subjects were 27.0 (6.4) years. Comparing with the wealth index, single-item asset scales, such as cell phone and roof materials, reflect the wealthiest or the poorest quintile with inclined distribution to other quintiles. Frequency of antenatal and postnatal care increased as economic status improved. In the poorest and the wealthiest quintiles, home delivery rate was 66.9% and 39.8% respectively. Skilled birth attendance was 37.8% in the poorest and 81.3% in the wealthiest quintile. The help seeking rate increased significantly from the poorest to the wealthiest quintile for medical complications such as edema (52% to 89%), prolonged labor (0% to 90%), bleeding (25% to 75%) and puerperium fever (38% to 100%). Service utilization of anemia prevention and tetanus toxoid was also improved. Comparing to health behavior, health knowledge differed less among quintiles.

Conclusion: Influence of economic status seemed more significant on health behavior than on health knowledge. Although health education delivers knowledge to the poorest population, barriers still exist between the knowledge and actions.