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The influence of neighbourhood formality status and socio-economic position on self-rated health among adult men and women: a multilevel, cross sectional, population study from Aleppo, Syria

Balsam Ahmad12*, Vicky Ryan1, Wasim Maziak34, Tanja Pless-Mulloli12 and Martin White15

Author Affiliations

1 Institute of Health & Society, Newcastle University, Richardson Road, Newcastle upon Tyne NE2 4AX, UK

2 Newcastle Institute for Research on Sustainability, Newcastle University, Newcastle upon Tyne, UK

3 Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA

4 Syrian Centre for Tobacco Studies, Aleppo, Syria

5 Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK

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BMC Public Health 2013, 13:233  doi:10.1186/1471-2458-13-233

Published: 16 March 2013



There is substantial evidence from high income countries that neighbourhoods have an influence on health independent of individual characteristics. However, neighbourhood characteristics are rarely taken into account in the analysis of urban health studies from developing countries. Informal urban neighbourhoods are home to about half of the population in Aleppo, the second largest city in Syria (population>2.5 million). This study aimed to examine the influence of neighbourhood socioeconomic status (SES) and formality status on self-rated health (SRH) of adult men and women residing in formal and informal urban neighbourhoods in Aleppo.


The study used data from 2038 survey respondents to the Aleppo Household Survey, 2004 (age 18–65 years, 54.8% women, response rate 86%). Respondents were nested in 45 neighbourhoods. Five individual-level SES measures, namely education, employment, car ownership, item ownership and household density, were aggregated to the level of neighbourhood. Multilevel regression models were used to investigate associations.


We did not find evidence of important SRH variation between neighbourhoods. Neighbourhood average of household item ownership was associated with a greater likelihood of reporting excellent SRH in women; odds ratio (OR) for an increase of one item on average was 2.3 (95% CI 1.3-4.4 (versus poor SRH)) and 1.7 (95% CI 1.1-2.5 (versus normal SRH)), adjusted for individual characteristics and neighbourhood formality. After controlling for individual and neighbourhood SES measures, women living in informal neighbourhoods were less likely to report poor SRH than women living in formal neighbourhoods (OR= 0.4; 95% CI (0.2- 0.8) (versus poor SRH) and OR=0.5; 95%; CI (0.3-0.9) (versus normal SRH).


Findings support evidence from high income countries that certain characteristic of neighbourhoods affect men and women in different ways. Further research from similar urban settings in developing countries is needed to understand the mechanisms by which informal neighbourhoods influence women’s health.

Multilevel modelling; Self-rated health; Syria; Formal and informal areas; Neighbourhood; Socioeconomic status; Gender