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e ISSN: 2645-9248 Journal homepage: www.jidhealth.com Open Access
Impact of family structure and sociodemographic characteristics on
parents headed families in Ramadi City, Iraq
Badea'a Thamir Yahyaa1, Ru'ya Abdulhadi Al-Rawi1, Mustafa Yaseen Taha2, Yaseen T. Sarhan1,
Ban Nadum Abdul Fatah1, Ahmed K. Al-Delaimy1, Mustafa Ali Mustafa Al-Samarrai1, Omar Rashid
Mukhlif3, Mahasin A. Al-Taha1
Abstract
Background: Several factors in the family profile contribute significantly to determining the effective policy when
heading the family. This study aims to evaluate the sociodemographic and economic burdens on parents-headed
families in Ramadi City, west of Iraq.
Methods: A prospective cross-sectional household-based survey was conducted from 1st to 28th February 2019
among Iraqi people residents in Ramadi city, Anbar province. A multistage sampling technique was recruited to identify
the eligible sample. A semi-structured questionnaire was used to interview (face-to-face) the respondents. Data from
267 households have undergone univariate and bivariate analyses. Multiple logistic regression, odds ratio (OR), and
confidence intervals (CIs) were estimated to explore the predicting variables. The statistically significant is considered
at less than 0.05.
Results: The mean age of respondents was 43.88 (± 12.1) years (range: 25 to 69 years). Out of the total surveyed
people, 52.8% were young (less than 44 years), male-headed families (59.6%), low educated level (65.5%),
unemployed (52.4%), married (67.4%) and headed big families of seven members and above (43.1%). History of
chronic diseases and smoking habits was positive among 46.4% and 45.7% of respondents, respectively. Findings of
the binary logistic regressions showed that history of smoking (OR = 7.201, 95% CI: 3.254 to15.936), families of 7
members and above (OR = 6.239, 95% CI: 2.938 to 13.250), unhappy (OR = 5.237, 95% CI: 2.140 to 12.818), aged 44
years and above (OR = 3.518, 95% CI: 1.581 to 7.829), being single (unmarried, divorced, widow) (OR = 2.697, 95%
CI: 1.230 to 5.914), and had a monthly income of less than USD400 (OR = 2.333, 95% CI: 1.112 to 4.859) are
significantly associated with female-headed family.
Conclusion: Priority must be given to some elements such as genetic, physical differences, biopsychosocial factors,
and the economic situation when discussing parents' behavior in heading the family.
Keywords: Family Profile, Sociodemographic Factors, Gender, Head of Family, Society, Iraq
Background
The family forms an indispensable unit in building a society in
many cultures, especially in Arab communities. Therefore, any
society's development depends on the family's success in
building its components. The Iraqi family is distinguished by
the number of its members and its close association with the
restoration of society [1]. However, the rapid developments in
technology, accelerated lifestyle changes, successive wars,
displacement, malnutrition, unsafe drinking water, and poor
medical and healthcare services
Were existential challenges that led to the restructuring of the
family entity, such as the early separation of children from the
family and appearance of single-head families [2,3,4]. United
Nations Development Program (UNDP) reported in 2013 that
for every ten Iraqi families, one family is headed by the female
gender [5]. Most of these women were either widow, divorced
or responsible for caring for their unwell husbands. Iraq's
security and economic disturbances burdened poor families and
doubled the incidence of chronic diseases. Hussain and Lafta
[6] found that the incidence of cardiovascular disease and
diabetes had significantly increased after 2003. A report by
WHO (2016) found that non-communicable diseases (NCDs)
were responsible for about 55.0% of total death among Iraqi
___________________________________________________
med.badeaa.thamir@uoanbar.edu.iq
1Department of Family and Community Medicine, Faculty of Medicine, Anbar
University, Anbar, Iraq
A full list of author information is available at the end of the article
10.47108/jidhealth.Vol5.Iss4.266
http://www.jidhealth.com/
Yahyaa BT, et al., Journal of Ideas in Health (2022); 5(4):794-799 795
people in 2016 [7]. NCDs are directly related to the lifestyle and
behavior of individuals and society. Bad dietary choices,
physical inactivity, heavy smoking, and drug and alcohol
addiction are the common predictors of NCDs [8]. The
prevalence of obesity (Body Mass Index, BMI ≥30 kg/m2) in
Iraq was 66.9% in a national survey (2005–2006) [9] and 33.9%
in a 2015 national survey [10]. The trend in Iraq seems higher
than the global trend of obesity which reported a male
prevalence of 10.8% and a female prevalence of 14.9% [11].
According to the world bank report, the prevalence of tobacco
smoking in Iraq was 18.5% in 2020 [12]. There is a noticeable
increase in nicotine consumption rates in areas experiencing
conflict. The problem of tobacco smoking in Iraq is complicated
due to the continuity of internal conflicts for many years [13].
The Iraqi family often witnesses the addition of new individuals
to the list of smokers with the deterioration of the economic,
security, and service situation. Previous studies have shown the
psychosocial and economic burdens of displacement on the
Iraqi family, especially when the family must rehabilitate the
destroyed house or rent another house [3,4]. Forced
displacement with the lack of alternatives to provide safety and
suitable living generated unbearable challenges for the head of
the family. Many of them were victims of chronic diseases and
mental disorders. This study aims to assess the effect of the
family structure and sociodemographic factors on the head of a
family in Ramadi city, Iraq.
Methods
Study design and population
We conducted a prospective cross-sectional household-based
survey from 1st to 28th February 2019 among Iraqi people
residents in the Al-Tameem neighborhood in the city center of
Ramadi, Anbar province. The sampling method was a face-to-
face survey of heads of households using a multistage sampling
technique. Ramadi city has sixteen neighborhoods; then, we
randomly selected one neighborhood; then, we theoretically
divided the selected neighborhood into four quarters; then, from
each quarter, we selected eight blocks; and then we selected ten
houses from each selected block; then, one head of house
interviewed. A well-trained team of interviewers was recruited
to explain the objectives and conditions of the study. Moreover,
the interviewers assure respondents' freedom to participate or
withdraw and that all information and opinions gathered would
be anonymous, confidential, and used for the purpose of
research". The weekend days (Friday and Saturday) were the
favored dates to meet the most eligible house heads.
In some cases, it is agreed with the respondent on the place
and the appropriate date for the interview later. The authors
ensured supervision during all stages of the study, including the
data collection phase. Out of 320 visited households, 290
agreed on the interview. The total population was 267 after
excluding 23 uncompleted questionnaires.
Inclusion and exclusion criteria
All Iraqi people, households, both genders, at least 18 years old
or older, and willing to participate are included in the study. At
the same time, we excluded incomplete data, non-household
family members, mentally unstable, and those not willing to
participate.
Sample size
The sample size calculator arrived at 264 participants, using a
margin of error of ± 6%, a confidence level of 95%, and a 50%
response distribution [14]. Non-response correction = 10%.
Thus, the total sample size was (264+26) 290. Supervision
during the data collection phase was ensured in all stages. After
excluding 23 incomplete documents, the sample was 267 for
final analysis.
Study instrument
The data was collected using a semi-structured household
questionnaire. The English language was used to prepare the
questionnaire and then translated into the local native language
(Arabic). Content validity was ensured, and Cronbach alpha
reliability reached 72.6. A pilot test was performed among
fifteen heads of households who were not included in the study.
The questionnaire has three components; the first part is the
sociodemographic and economic factors. The second part
included one closed-ended question used to self-rank the health
status. Moreover, a consent form must be signed before heads
of households are allowed to participate in the study.
Dependent variable
The dependent variable was the gender of the head of the
household as "male" and "female". In our study, the head of the
household was defined as the individual who provides support
and is responsible for governing a group of family members,
such as "dependent children, grandchildren, parents, or other
relatives" [15].
Independent variables
For the purpose of analysis, some of the sociodemographic
variables were exposed to categorization. The age variable was
categorized into two groups codded "one" for respondents aged
less than 44 years and coded "zero" for those aged 44 years and
above. The health of respondents was categorized as "healthy"
and coded "one" and "unhealthy" and coded "zero" Marital
status was captured as binary, and a value of "zero" was used
for married participants and the unmarried, widows, divorced
considered "single" and coded "one". We defined
consanguineous marriage as a union (marriage) between two
persons who are closely related as second cousins or closer. The
head of household with consanguineous marriage was coded
"0", and those without were coded "1". The big families having
seven members and more (including the parent and
grandparents) have been coded with "zero", while the families
with less than seven members cod were ed with"1". Chronic
disease variable was defined as a condition that "last one year or
more and require ongoing medical attention or limit activities of
daily living or both" [16] such as dancer, diabetes, high blood
pressure, cardiovascular diseases, etc. Respondents with at least
one chronic disease were coded "zero," and those with no
chronic illness were coded "1". The head of household with a
history of tobacco smoking, hookah, electronic cigarette, etc.,
was coded "Zero," and those with a history of smoking were
coded "one". Respondents who described themselves as happy
were coded "one," and unhappy respondents were coded "zero".
At the time of data collection (1st January 2021), the exchange
rate of Iraqi Dinar (IQD)1 = United States Dollar (USD)
0.0008. Therefore, the monthly income (including all incentives
Yahyaa BT, et al., Journal of Ideas in Health (2022); 5(4):794-799 796
and bounces) of our respondents was coded "zero" for those
who earned less than USD 400 (IQD 600,000) and coded "one"
for those who earned more than USD 400. The occupation was
recorded and coded into "one" for is currently employed (has a
fixed employment in the government of private sectors) and the
code of "zero" for those currently unemployed.
Statistical analysis
The data were analyzed using IBM SPSS version 16.
Categorical variables are presented in terms of frequencies and
percentages. Bivariate analyses were performed using the chi-
square test for the categorized variables. In the multiple logistic
regression, odds ratio (OR) and confidence intervals (CIs) were
estimated, and only the variables with a p-value of < 0.05 were
recruited to explore the factors that predict female-headed
households. The statistically significant is considered at less
than 0.05.
Results
Descriptive and general characteristics of related factors
Three hundred and sixty-seven heads of households have been
surveyed. The mean age was 43.88 (± 12.1) years, ranging from
25 to 69 years old. Most of the respondents were males
(59.6%), aged less than 44 years old (52.8%), married (67.4%),
and with a history of consanguineous marriage among 56.6% of
them. Most household respondents had a low educated level
(65.5%), with big families of seven members and above
(43.1%), were exposed to internal displacement (49.1%), and
described themselves as unhappy people (68.2%). History of
chronic diseases and smoking habits was positive among 46.4%
and 45.7% of respondents, respectively. However, 63.3% of
them ranked themselves as healthy. Concerning the economic
situation, more than half of the respondents were unemployed
(52.4%), with a monthly salary exceeding USD 400 (57.7%)
(Table 1).
Table 1 Univariate and bivariate analysis of household-related factors (n=367)
Factors Category Total
(n=267)
Female
108(40.4)
Male
159(59.6)
χ2 P
Age <44 years 141(52.8) 30(21.3) 111(78.7) 45.60 0.000
>44 years 126(47.2) 78(61.9) 48(38.1)
Health Unhealthy 98(36.7) 51(52.0) 47(48.0) 8.64 0.004
Healthy 169(63.3) 57(33.7) 112(66.3)
Marital status Single 87(32.6) 50(57.5) 37(42.5) 15.52 0.000
Married 180 (67.4) 58(32.2) 122(67.8)
Consanguineous marriage Yes 112(41.9) 39(34.8) 73(65.2) 2.54 0.111
No 155(58.1) 69(44.5) 86 (55.5)
Family members > 7 115(43.1) 83(72.2) 32(27.8) 84.40 0.000
< 7 152(56.9) 25(16.4) 127(83.6)
Chronic diseases Yes 124(46.4) 81(65.3) 43(34.7) 59.46 0.000
No 143(53.6) 27(18.9) 116(81.1)
Smoking habits Yes 122(45.7) 70(57.4) 52(42.6) 26.72 0.000
No 145(54.5) 38(26.2) 107(73.8)
Educational level Low 175(65.5) 67(38.3) 108(61.7) 0.99 0.320
High 92(34.5) 41(44.6) 51(55.4)
Employment Unemployed 140(52.4) 65(46.4) 75(53.6) 4.37 0.037
Employed 127(47.6) 43(33.9) 84(66.1)
Happiness Unhappy 182(68.2) 90(49.5) 92(50.5) 19.23 0.000
Happy 85(31.8) 18(21.2) 67(78.8)
Displacement Yes 131(49.1) 68(51.9) 63(48.1) 14.00 0.000
No 136(50.9) 40(29.4) 96(70.6)
Income level USD<400 113(42.3) 57(50.4) 56(49.6) 8.12 0.004
USD>400 154(57.7) 51(33.1) 103(66.9)
Factors associated with gender in bivariate analysis
Cross tabulation showed that only unhealthy respondents (chi-
square test (χ2 = 8.64, P = 0.004), who were aged 44 years and
above (χ2 = 45.60, P < 0.001), being single (χ2 = 15.52,
P < 0.001), big family of seven members and above (χ2 = 84.40,
P < 0.001), chronic diseases (χ2 = 59.46, P < 0.001), smoking
habits (χ2 = 26.72, P < 0.001), unemployed (χ2 = 4.37,
P = 0.037), unhappy (χ2 = 19.23, P < 0.001), internally displaced
(χ2 = 14.00, P < 0.001), and monthly income of USD<400
(χ2 = 8.12, P = 0.004) have significantly associated with female
gender (table 1).
Factors associated with female-headed households in
multiple logistic regression
In the multivariable logistic regressions, the head of household
who had a history of smoking (OR = 7.201, 95% CI: 3.254
to15.936) belonged to a big family of 7 members and above
(OR = 6.239, 95% CI: 2.938 to 13.250), and rated himself as
unhappy (OR = 5.237, 95% CI: 2.140 to 12.818), had the
highest odds ratios, respectively. At the same time, the head of
household aged 44 years and above (OR = 3.518, 95% CI: 1.581
to 7.829), being single (unmarried, divorced, widow)
(OR = 2.697, 95% CI: 1.230 to 5.914), had a monthly income of
less than USD400 (OR = 2.333, 95% CI: 1.112 to 4.859) had
the lowest odds ratios, respectively. The Hosmer and
Lemeshow test indicated a good fit (P = 0.626). The total model
was significant (p = < 0.001) and accounted for 63.1% of the
variance (Nagelkerke R square = 0.631).
Yahyaa BT, et al., Journal of Ideas in Health (2022); 5(4):794-799 797
Table 2. Factors associated with female-headed households in multiple logistic regression (n=267)
Variables Categories B S.E. Wald P-value Exp(B) 95% CI
Age 44 years and above 1.258 0.408 9.498 0.002 3.518 1.581-7.829
Less than 44 years Reference
Marital status Single (divorced, widow) 0.992 0.401 6.135 0.013 2.697 1.230-5.914
Married Reference
Family members Seven members and above 1.831 0.384 22.700 0.000 6.239 2.938-13.250
Less than 7 Reference
Chronic disease Yes 1.171 0.413 8.057 0.005 3.226 1.437-7.241
No Reference
Tobacco smoking Yes 1. 974 0.405 23.726 0.000 7.201 3.254-15.936
No Reference
Happiness Unhappy 1.565 0.457 13.143 0.000 5.237 2.140-12.818
Happy Reference
Monthly Income Less than USD400 0.847 0.378 5.019 0.025 2.333 1.112-4.859
USD400 and above Reference
Discussion
In this study, we tried to discuss the impact of family structure
and sociodemographic factors on the head of household in Iraq.
Among 267 surveyed households, 59.6% were male-headed
households, and 40.4% were female-headed households. Our
finding was incompatible with previous reports of 10.0% and
7.7% female-headed families in Iraq, which have been issued
by the United Nation Office for Coordination and Humanitarian
Affairs (OCHA), Inter-Agency Information and Analysis Unit
(IAU), and MOPDC-CSO (Central Statistical Organization) in
2010, respectively [17,18]. Taking into account the difference
in the sample and the region at the local level, the percentage of
families headed by females varies greatly at the global level.
The past five decades have witnessed a sharp increase and
difference in proportions with a difference in societies
worldwide [19]. Our study is largely corresponding to the
global trend estimating that 33.0%-50.0% of families are
headed by females [19,20]. A report from the world health
organization [21] indicated that "as people age, they become
more vulnerable to diseases and disability".
Similarly, our finding showed that respondents aged 44 years
and above were 3.518 times more female-headed than male-
headed families. Many Iraqi families had lost their fathers due
to repeated wars over the past four decades, which led to a
cumulative number of families headed by females. Moreover,
logistic regression showed 2.697 times of single (divorced,
widow) female-headed families than their counterparts. In fact,
recent official statistics showed high divorce rates in Iraqi
society; however, most young widows are desirable for
marriage, especially by relatives, due to the high percentages of
consanguineous marriage, the conservative advantage in Iraqi
society, and the keenness to take care of orphans [1]. Therefore,
the chances of marriage might be less among widows and
divorced women aged forty years and above, especially in large
families. An Iraqi family's average number of members is six or
seven [1]. Part of our results showed that families of 7 members
and above were 6.239 times more female-headed families than
male-headed families, which puts an additional burden on the
woman's shoulders. Women-headed families suffer daily to
provide food, water, education, and health care [22]. The higher
the number of family members, the higher the needs and the
more difficult administration. Many poor families were forced
to allow their young children to work to earn an extra income
for the family.
Similarly, our study showed that 2.333 times female-headed
families had family income less than USD400 than males.
Unfortunately, children are vulnerable to different social
problems that may include smoking, drinking alcohol, and even
drug use [23]. These problems require radical solutions that are
difficult for a family headed by a female. Despite that health
status was not a predictor of gender in binary logistic
regression, yet, in cross-tabulation, the chi-square test (χ2
= 8.64, P = 0.004) was statistically different in gender. Among
267 surveyed heads of households, 63.3% were healthy, and
36.7% were unhealthy. Similarly, a previous study conducted
by Ali jadoo et al. [24] in outpatient clinics in Iraq, found that
46.4% of patients were unhealthy. Moreover, our results found
that chronic disease was a predictor factor for gender. Chronic
disease was 3.226 times more among female headed families
than male-headed families. Previous studies have confirmed
that the performance of the family and the management of
family problems, such as social, emotional, and behavioral in
children, are negatively affected by chronic parental disease
[25,26,27,28]. The longer the duration of the disease and its
intensity in the parents, the more negative effects on the
children [26,27]. Girls are more vulnerable to weak
development than boys in families led by chronically ill women
[26,28,29]. Unfortunately, most smoking parents lack the real
desire to cease smoking. Children are more likely to be exposed
to environmental tobacco smoke (ETS) from parents. There is a
big gap in prevalence of cigarette smoking between Iraqi males
(35.0%) and females 2.0% in 2020 [12]. However, the finding
of the current study found that the smoking odds ratio was
7.201 times among female headed families than among males.
The desire for smoking arises in both sexes in early puberty due
to the influence of peers. However, resorting to smoking in later
stages has a direct relationship to the social and economic
situation [30]. Several studies have indicated the existence of
mental problems in families headed by one of the parents, with
a significant increase in the prevalence of psychological
problems and depression in families headed by females
compared to males [31,32].
Yahyaa BT, et al., Journal of Ideas in Health (2022); 5(4):794-799 798
Conclusion
More than one-third of surveyed families were low educated,
young age and female-headed. History of smoking, families of
7 members and above, unhappy, aged 44 years and above, being
single (unmarried, divorced, widow and had a monthly income
of less than USD400 were the prominent variables significantly
associated with female-headed family.
Abbreviation
OR: Odds Ratio; Cis: Confidence Intervals; NCDs: Non-Communicable
Diseases; BMI: Body Mass Index; WHO: World Health Organization
Declaration
Acknowledgment
None.
Funding
The authors received no financial support for their research, authorship,
and/or publication of this article.
Availability of data and materials
Data will be available by emailing med.badeaa.thamir@uoanbar.edu.iq.
Authors’ contributions
All authors have contributed equally in designing, writing, analyzing,
interpreting the study, and drafting and reviewing the article. All
authors read and approved the final version of the manuscript.
Ethics approval and consent to participate
We conducted the research following the Declaration of Helsinki, and
the protocol was approved by the Ethics Committee of the Scientific
Issues and Postgraduate Studies Unit (PSU), College of Medicine,
University of Anbar (Ref: SR/207 at 21-Jaunary -2019). Moreover,
written informed consent obtained from each participant
after explanation of the study objectives and the guarantee of secrecy.
Consent for publication
Not applicable
Competing interest
The authors declare that they have no competing interests.
Open Access
This article is distributed under the terms of the Creative Commons
Attribution 4.0 International License
(http://creativecommons.org/licenses/by/4.0/), which permits
unrestricted use, distribution, and reproduction in any medium,
provided you give appropriate credit to the original author(s) and the
source, provide a link to the Creative Commons license, and indicate if
changes were made. The Creative Commons Public Domain Dedication
waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to
the data made available in this article unless otherwise stated.
Author Details
1Department of Family and Community Medicine, Faculty of Medicine,
Anbar University, Anbar, Iraq.
2Resident Medical Officer, Armadale hospital, WA, Australia.
Article Info
Received: 28 November 2022
Accepted: 27 December 2022
Published: 29 December 2022
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