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METHODOLOGY
Open Access

Simplified Asset Indices to Measure Wealth and Equity in Health Programs: A Reliability and Validity Analysis Using Survey Data From 16 Countries

Nirali M Chakraborty, Kenzo Fry, Rasika Behl and Kim Longfield
Global Health: Science and Practice March 2016, 4(1):141-154; https://doi.org/10.9745/GHSP-D-15-00384
Nirali M Chakraborty
aPopulation Services International, Washington, DC, USA
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Kenzo Fry
bIndependent consultant, London, UK
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Rasika Behl
cUniversity of California, Global Health Group, San Francisco, CA, USA
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Kim Longfield
aPopulation Services International, Washington, DC, USA
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  • FIGURE 1.
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    FIGURE 1.

    Types Included in the Standard DHS Wealth Index and in Each Alternative Simplified Index

    Abbreviation: DHS, Demographic and Health Survey.

    * Alternative E may contain some common questions from the DHS VI questionnaire and/or some country‐specific variables. See main body of the article for further details.

  • FIGURE 2.
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    FIGURE 2.

    Example Simplified Wealth Asset Questionnaires for Alternative E for Bangladesh and Benin

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    TABLE 1 Number of Survey Questions Required for the Standard DHS Wealth Index and for Each Alternative Simplified Index
    Country, Survey Type and YearVariables IncludedaNumber of Survey Questions
    Standard DHS IndexStandard DHS IndexAlternative AAlternative BAlternative CAlternative DAlternative E
    Bangladesh, DHS 2011CS, U/R, H, A33251722308
    Benin, DHS 2011–12CS, U/R, H, A41312128306
    Cambodia, DHS 2010CS, H302921262614
    Cameroon, DHS 2011CS, U/R, H, A47312128309
    Ethiopia, DHS 2011CS, U/R, H, A362920262514
    Malawi, MIS 2012U/R, H, A252619231917
    Mozambique, DHS 2011U/R, H, A332921262110
    Nepal, DHS 2011CS, U/R, H, A443020272910
    Nigeria, DHS 2013CS, U/R, H, A263021272811
    Pakistan, DHS 2012–13CS, U/R, H, A472921263414
    Philippines, DHS 2013CS, U/R30191919259
    Rwanda, MIS 2013CS, U/R, H, A382819251915
    Senegal, DHS 2012-13CS, U/R, H, A412819252818
    Tanzania, AIS 2012–13CS, U/R, H, A37312128248
    Uganda, DHS 2011CS, U/R, H, A413020272810
    Zimbabwe, DHS 2010–11CS, U/R, H, A382821252616
    • Abbreviations: AIS, AIDS Indicator Survey; DHS, Demographic and Health Survey; MIS, Malaria Indicator Survey.

    • ↵a Variables included in the original DHS analysis, beyond the core variables from the DHS VI questionnaire. CS, country-specific; U/R, urban and rural areas analyzed separately before combining; H, Hectares or land area; A, animals.

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    TABLE 2 Reliability Between the Standard DHS Wealth Index and Each Alternative Index Included in the Preliminary Analysis
    Alternative AAlternative BAlternative CAlternative D
    CountryAgreementKappaAgreementKappaAgreementKappaAgreementKappa
    Bangladesh73.20%0.66568.10%0.60160.00%0.50083.22%0.790
    Benin85.40%0.81883.30%0.79183.90%0.79983.30%0.791
    Cambodia73.20%0.66578.90%0.73675.20%0.69085.26%0.816
    Cameroon81.10%0.76478.60%0.73379.10%0.73884.40%0.805
    Ethiopia65.90%0.57462.10%0.52662.60%0.53369.30%0.616
    Malawi88.60%0.85773.10%0.66464.80%0.56073.10%0.664
    Mozambique87.90%0.84878.70%0.73474.50%0.68178.70%0.734
    Nepal74.60%0.68277.60%0.72077.20%0.71487.55%0.844
    Nigeria76.40%0.70572.20%0.65277.00%0.71274.86%0.686
    Pakistan74.20%0.67873.50%0.66971.80%0.64889.22%0.865
    Philippines79.20%0.74078.40%0.73078.40%0.73088.17%0.854
    Rwanda88.80%0.86078.20%0.72871.40%0.64278.20%0.728
    Senegal80.90%0.76176.40%0.70580.50%0.75477.45%0.718
    Tanzania81.50%0.76980.30%0.75375.10%0.68985.34%0.817
    Uganda76.50%0.70872.60%0.65769.00%0.61286.92%0.837
    Zimbabwe86.50%0.83281.70%0.77278.70%0.73480.73%0.759
    Median 80.05% 0.751 77.90% 0.724 76.10% 0.701 83.26% 0.791
    Range 65.90% to 88.80% 0.574 to 0.860 62.10% to 83.30% 0.526 to 0.791 60.00% to 71.80% 0.500 to 0.648 69.30% to 89.20% 0.616 to 0.865
    • Abbreviation: DHS, Demographic and Health Survey.

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    TABLE 3 Reliabilitya of the National Wealth Distribution Between the Standard DHS Wealth Index and Each of 3 Alternative Indices Recommended by the Expert Panel Group
    Alternative BAlternative DAlternative E
    CountryAgreementKappaAgreementKappaAgreementKappa
    Bangladesh82.50%0.72790.74%0.85584.17%0.753
    Benin91.02%0.86091.02%0.86084.91%0.764
    Cambodia87.66%0.80792.23%0.87988.36%0.818
    Cameroon88.20%0.81690.99%0.85985.26%0.770
    Ethiopia75.97%0.62480.95%0.70284.73%0.761
    Malawi83.44%0.74183.44%0.74184.30%0.755
    Mozambique89.75%0.84089.75%0.84086.09%0.783
    Nepal87.13%0.79994.08%0.90786.44%0.788
    Nigeria87.52%0.80589.21%0.83185.22%0.768
    Pakistan85.99%0.78194.47%0.91486.29%0.786
    Philippines87.55%0.80593.09%0.89285.09%0.766
    Rwanda86.83%0.79486.83%0.79484.13%0.752
    Senegal87.92%0.81188.22%0.81686.22%0.785
    Tanzania88.93%0.82792.12%0.87784.65%0.756
    Uganda83.84%0.74892.88%0.88985.70%0.777
    Zimbabwe91.48%0.86790.79%0.85685.46%0.773
    Median 87.53% 0.805 90.89% 0.856 85.24% 0.769
    Range 75.97% to 91.48% 0.624 to 0.867 80.95% to 94.47% 0.702 to 0.914 84.13% to 88.36% 0.752 to 0.818
    • ↵a Reliability assessed after grouping the 5 wealth quintiles into 3 groups: the lowest 40% (Q1+Q2), middle 20% (Q3), and richest 40% (Q4+Q5).

    • View popup
    TABLE 4 Reliabilitya of the Urban Wealth Distribution Between the Standard DHS Wealth Index and Each of 3 Alternative Indices Recommended by the Expert Panel Group
    Urban BUrban DUrban E
    CountryAgreementKappaAgreementKappaAgreementKappa
    Bangladesh83.69%0.74591.75%0.87185.00%0.766
    Benin90.18%0.84791.91%0.87485.11%0.768
    Cambodia86.34%0.78790.76%0.85685.37%0.771
    Cameroon82.82%0.73286.15%0.82785.69%0.776
    Ethiopia86.93%0.79688.10%0.81485.39%0.771
    Malawi87.42%0.80387.42%0.80393.96%0.906
    Mozambique94.54%0.91594.54%0.91589.01%0.828
    Nepal87.26%0.80192.95%0.89084.26%0.754
    Nigeria84.57%0.75989.43%0.83584.26%0.754
    Pakistan78.41%0.66394.17%0.90984.27%0.754
    Philippines84.39%0.75692.51%0.88385.24%0.769
    Rwanda94.86%0.92094.86%0.92093.62%0.900
    Senegal81.86%0.71786.79%0.79485.30%0.770
    Tanzania91.01%0.86092.33%0.88083.95%0.750
    Uganda81.55%0.71293.22%0.89484.12%0.752
    Zimbabwe42.14%0.59375.02%0.61083.96%0.750
    Median 85.46% 0.773 91.83% 0.873 85.17% 0.769
    Range 42.14% to 94.54% 0.593 to 0.920 75.02% to 94.86% 0.610 to 0.920 83.95% to 94.00% 0.750 to 0.906
    • ↵a Reliability assessed after grouping the 5 wealth quintiles into 3 groups: the lowest 40% (Q1+Q2), middle 20% (Q3), and richest 40% (Q4+Q5).

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Global Health: Science and Practice: 4 (1)
Global Health: Science and Practice
Vol. 4, No. 1
March 21, 2016
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Simplified Asset Indices to Measure Wealth and Equity in Health Programs: A Reliability and Validity Analysis Using Survey Data From 16 Countries
Nirali M Chakraborty, Kenzo Fry, Rasika Behl, Kim Longfield
Global Health: Science and Practice Mar 2016, 4 (1) 141-154; DOI: 10.9745/GHSP-D-15-00384

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Simplified Asset Indices to Measure Wealth and Equity in Health Programs: A Reliability and Validity Analysis Using Survey Data From 16 Countries
Nirali M Chakraborty, Kenzo Fry, Rasika Behl, Kim Longfield
Global Health: Science and Practice Mar 2016, 4 (1) 141-154; DOI: 10.9745/GHSP-D-15-00384
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    • ABSTRACT
    • INTRODUCTION
    • APPROACHES TO MEASURING WEALTH
    • CONVENTIONAL WAYS OF MEASURING EQUITY IN SOCIAL FRANCHISING
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