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Wang EB, Garcia Morales EE, Gross AL, Lin FR, Reed NS, Deal JA. Residential Differences and Depression Among Older Adults With Dual Sensory Loss. JAMA Otolaryngol Head Neck Surg 2025; 151:202-210. [PMID: 39745745 PMCID: PMC11907313 DOI: 10.1001/jamaoto.2024.4488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 11/03/2024] [Indexed: 03/14/2025]
Abstract
Importance Investigating rural-urban and regional differences in the association between dual sensory loss (concurrent hearing and vision loss) and depression may highlight gaps in sensory loss research and health care services, and by socioeconomic status. Whether urbanicity and region may modify associations between sensory loss and depression is unknown. Objective To describe the rural-urban and regional differences in the association of dual sensory loss with depression among older adults. Design, Setting, and Participants This cross-sectional study used data from wave 1 (April 2017-December 2019) of the population-based Longitudinal Aging Study in India (LASI). Participants were recruited from 35 states and union territories in India. LASI incorporated a multistage stratified area probability cluster sampling design to recruit participants 45 years and older and their spouses; 31 447 eligible participants 60 years of age or older were interviewed. Data analyses were conducted from May 17, 2022, to November 11, 2023. Exposures Sensory loss (no sensory loss, hearing loss only, vision loss only, and dual sensory loss) was determined by respondents' self-reported perceived difficulty regarding hearing and vision function. Main Outcomes and Measures The Composite International Diagnostic Interview (CIDI-SF) scale was used to identify major episodic depression. Logistic regression was used to estimate the odds ratios (ORs) and 95% CIs of depression comparing participants with vs without sensory loss, adjusting for demographic and clinical covariates. Rural-urban and regional differences were assessed by including interaction terms between these variables and sensory loss. Results The study analysis included 27 927 participants (mean [SD] age, 68.0 [7.2] years; 14 477 [51%] females and 13 450 [49%] males). The fully adjusted models showed that the odds of depression with dual sensory loss (vs no loss) was higher in urban (OR, 3.16; 95% CI, 2.00-4.99) vs rural (OR, 1.73; 95% CI, 1.31-2.29) residents and among residents in the West (OR, 5.10; 95% CI, 1.74-14.97) vs North (OR, 1.38; 95% CI, 0.81-2.35) regions. Conclusions and Relevance These findings indicate that sensory loss is associated with depression in older adults, with differences by urbanicity and region. Adults with sensory loss across multiple systems may be an important group to target for intervention.
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Affiliation(s)
- Ethan B. Wang
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Emmanuel E. Garcia Morales
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alden L. Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Frank R. Lin
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nicholas S. Reed
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jennifer A. Deal
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Chandy BR, Davey C, Oswald WE, Kaliappan SP, Aruldas K, Banks LM, Jasper S, Nagarajan G, Galagan S, Kennedy DS, Walson JL, Koshy B, Ajjampur SSR, Kuper H. Prevalence of Functional Difficulty Among School-Aged Children and Effect on School Enrolment in Rural Southern India: A Cross-Sectional Analysis. J Epidemiol Glob Health 2024; 14:1476-1489. [PMID: 39298111 PMCID: PMC11652546 DOI: 10.1007/s44197-024-00293-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 08/22/2024] [Indexed: 09/21/2024] Open
Abstract
Despite the large number of children in India, there is little information on the impact of children's disability on school enrolment, and how this differs by population. We estimated the prevalence of childhood disability in two sites in Tamil Nadu, southern India, and the effect of functional difficulty on school enrolment. We used a parent-reported survey containing the UNICEF-Washington Group questions to identify children aged 5 to 17 years with functional difficulty during a census conducted for an ongoing trial. We estimated pooled- and gender-specific prevalence of functional difficulty among 29,044 children. We fitted regression models to identify subgroups with higher rates of functional difficulty and the effect of functional difficulty on reported school enrolment. We estimated the modification of the effect of functional difficulty by age, gender, socioeconomic status, household education, and sub-site, on additive and multiplicative scales. We found of 29,044 children, 299 (1.0%) had any functional difficulty, equal among boys and girls. Being understood (0.5%) and walking (0.4%) were the most common difficulties. Functional difficulty was strongly associated with non-enrolment in school (Prevalence ratio [PR] 4.59, 95% CI: 3.87, 5.43) after adjusting for age, gender, and site. We show scale-dependent differences between age and socioeconomic groups in the effect of functional difficulty on enrolment. This study shows that at least one in a hundred children in this region have severe functional difficulties and nearly half of these children are not enrolled in school, highlighting the need for further efforts and evidence-based interventions to increase school enrolment among these groups.
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Affiliation(s)
- Bobeena Rachel Chandy
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, TN, India
| | | | - William E Oswald
- Global Health Division, International Development Group, RTI International, Research Triangle Park, NC, USA
| | | | - Kumudha Aruldas
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, TN, India
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Smitha Jasper
- Department of Ophthalmology, Christian Medical College, Vellore, TN, India
| | - Guru Nagarajan
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, TN, India
| | - Sean Galagan
- Departments of Global Health, Medicine, Pediatrics and Epidemiology, University of Washington, Seattle, USA
| | - David S Kennedy
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Judd L Walson
- Departments of Global Health, Medicine, Pediatrics and Epidemiology, University of Washington, Seattle, USA
| | - Beena Koshy
- Department of Developmental Paediatrics, Christian Medical College, Vellore, TN, India
| | - Sitara S R Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, TN, India
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Chandy BR, Davey C, Oswald WE, Kaliappan SP, Aruldas K, Banks LM, Jasper S, Nagarajan G, Galagan S, Kennedy DS, Walson JL, Koshy B, Ajjampur SS, Kuper H. Prevalence of functional difficulty among school-aged children and effect on school enrolment in rural southern India: A cross-sectional analysis. RESEARCH SQUARE 2024:rs.3.rs-4154190. [PMID: 38746354 PMCID: PMC11092848 DOI: 10.21203/rs.3.rs-4154190/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Despite the large number of children in India, there is little information on the impact of children's disability on school enrolment, and how this differs by population. We estimated the prevalence of childhood disability in two sites in Tamil Nadu, southern India, and the effect of functional difficulty on school enrolment. We used a parent-reported survey containing the UNICEF-Washington Group questions to identify children aged 5 to 17 years with functional difficulty during a census conducted for an ongoing trial. We estimated pooled- and gender-specific prevalence of functional difficulty among 29,044 children. We fitted regression models to identify subgroups with higher rates of functional difficulty and the effect of functional difficulty on reported school enrolment. We estimated the modification of the effect of functional difficulty by age, gender, socioeconomic status, household education, and sub-site, on additive and multiplicative scales. We found of 29,044 children, 299 (1.0%) had any functional difficulty, equal among boys and girls. Being understood (0.5%) and walking (0.4%) were the most common difficulties. Functional difficulty was strongly associated with non-enrolment in school (Prevalence ratio [PR] 4.59, 95% CI: 3.87, 5.43) after adjusting for age, gender, and site. We show scale-dependent differences between age and socioeconomic groups in the effect of functional difficulty on enrolment. This study shows that at least one in a hundred children in this region have severe functional difficulties and nearly half of these children are not enrolled in school, highlighting the need for further efforts and evidence-based interventions to increase school enrolment among these groups.
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Rashmi R, Mohanty SK. Socioeconomic and geographic variations of disabilities in India: evidence from the National Family Health Survey, 2019-21. Int J Health Geogr 2024; 23:4. [PMID: 38369479 PMCID: PMC10874552 DOI: 10.1186/s12942-024-00363-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/09/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Increasing disability is of global and national concern. Lack of evidence on disability across socioeconomic groups and geographic levels (especially small areas) impeded interventions for these disadvantaged subgroups. We aimed to examine the socioeconomic and geographic variations in disabilities, namely hearing, speech, visual, mental, and locomotor, in Indian participants using cross-sectional data from the National Family Health Survey 2019-2021. METHODS Using data from 27,93,971 individuals, we estimated age-sex-adjusted disability rates at the national and sub-national levels. The extent of socioeconomic variations in disabilities was explored using the Erreygers Concentration Index and presented graphically through a concentration curve. We adopted a four-level random intercept logit model to compute the variance partitioning coefficient (VPC) to assess the significance of each geographical unit in total variability. We also calculated precision-weighted disability estimates of individuals across 707 districts and showed their correlation with within-district or between-cluster standard deviation. RESULTS We estimated the prevalence of any disability of 10 per 1000 population. The locomotor disability was common, followed by mental, speech, hearing, and visual. The concentration index of each type of disability was highest in the poorest wealth quintile households and illiterate 18 + individuals, confirming higher socioeconomic variations in disability rates. Clusters share the largest source of geographic variation for any disability (6.5%), hearing (5.8%), visual (24.3%), and locomotor (17.4%). However, States/Union Territories (UTs) account for the highest variation in speech (3.7%) and mental (6.5%) disabilities, where the variation at the cluster level becomes negligible. Districts with the highest disability rates were clustered in Madhya Pradesh, Maharashtra, Karnataka, Tamil Nadu, Telangana, and Punjab. Further, we found positive correlations between the district rates and cluster standard deviations (SDs) for disabilities. CONCLUSIONS Though the growing disability condition in India is itself a concerning issue, wide variations across socioeconomic groups and geographic locations indicate the implementation of several policy-relevant implications focusing on these vulnerable chunks of the population. Further, the critical importance of small-area variations within districts suggests the design of strategies targeting these high-burden areas of disabilities.
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Affiliation(s)
- Rashmi Rashmi
- Department of Population and Development, International Institute for Population Sciences, Mumbai, 400088, India.
| | - Sanjay K Mohanty
- Department of Population and Development, International Institute for Population Sciences, Mumbai, 400088, India
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Guo Q, Sun Y, Fan M, Li Z. What is the degree of social disability risk in China under the background of the aging population? Social disability risk measurement index system design and evaluation research based on China. Front Public Health 2023; 11:1087276. [PMID: 36992893 PMCID: PMC10040778 DOI: 10.3389/fpubh.2023.1087276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/13/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectiveThe impact of the aging population in China varies between regions. It is because regions with different resource endowments, such as those related to economy, population, and medical care, have different degrees of disability risk in the face of the increases in the disabled and semi-disabled older population caused by the overall aging of the population. This study aimed to construct an evaluation system to monitor and measure the degree of social disability risk in different regions in China and to evaluate and compare the degree of social disability risk in different regions using empirical data.MethodThis study used the Delphi method to construct a social disability risk measurement index system with macro, meso, and micro dimensions. At the same time, based on the data of CHARLS2018, an AHP-entropy method was used to calculate the index's total weight, and the standard deviation classification method was used to classify the total and criterion-level measurement scores of 28 provinces.ResultsThe regional degree of social disability risk was analyzed in subdimensions. Our research indicates that China's social disability risk situation is not promising, with a general medium to high-risk level. The score of degree of social disability risk among provinces is consistent with the regional economic development level to a large extent. The risk of social disability varies significantly among the eastern and central, and western regions of China and the provinces within the three regions.DiscussionCurrently, the situation facing the degree of social disability risk in China is that the overall risk level of the country is higher, and the difference between regions is significant. It is necessary to take measures to meet better the needs of the aging population and the disabled and semi-disabled older populations in a large-range, large-scale, multilevel way.
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Affiliation(s)
- Qianqian Guo
- Department of Social Security, School of Public Health and Management, Ningxia Medical University, Yinchuan, China
| | - Yufeng Sun
- Department of Social Medicine and Health Management, School of Public Health and Management, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, China
- *Correspondence: Yufeng Sun
| | - Miao Fan
- Department of Social Security, School of Public Health and Management, Ningxia Medical University, Yinchuan, China
| | - Zhichun Li
- Department of Social Security, School of Public Health and Management, Ningxia Medical University, Yinchuan, China
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Pattnaik S, Murmu J, Agrawal R, Rehman T, Kanungo S, Pati S. Prevalence, pattern and determinants of disabilities in India: Insights from NFHS-5 (2019-21). Front Public Health 2023; 11:1036499. [PMID: 36923034 PMCID: PMC10009251 DOI: 10.3389/fpubh.2023.1036499] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 02/08/2023] [Indexed: 03/02/2023] Open
Abstract
There is a need to provide an overview of the disability burden in India as there are limited studies. The present study aimed to estimate the prevalence and assess the pattern and determinants of disability in India. We analyzed National Family Health Survey-5 data using the "svyset" command in STATA software. We assessed the correlates by multivariable regression and reported an adjusted prevalence ratio (aPR) with a 95% confidence interval (CI). QGIS 3.2.1 software was used for spatial analysis of distributions of different disabilities. The mean (SD) age of 28,43,917 respondents was 30.82 (20.62) years, with 75.83% (n = 21,56,633) and 44.44% (n = 12,63,086) of them being from a rural area and were not educated, respectively. The overall prevalence of disability was 4.52% [(95% CI: 4.48-4.55), n = 1,28,528]. Locomotor disabilities accounted for 44.70% of all disabilities (n = 51,659), followed by mental disabilities (20.28%, n = 23,436). Age 75 years and above (vs. 0-14 years) [aPR: 2.65 (2.50-2.81)], male (vs. female) [aPR: 1.02 (1.0-1.04)], no education (vs. higher education) [aPR 1.62 (1.56-1.68)], unmarried (vs married) [aPR: 1.76 (1.70-1.82)], seeking the care of non-governmental organization (NGO) (vs. other) [aPR: 1.32 (1.13-1.55)] were significant independent determinants. The highest overall prevalence of locomotor was in Lakshadweep/UTs (8.88%) and Delhi (57.03%), respectively. Out of every hundred individuals in India, four have a disability. More intervention strategies should be planned, considering factors like education, residence, health promotion and caste so that the services provided by the government can be available and accessible to everyone in need.
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Thiagesan R, Gopichandran V, Soundari H. Ethical Framework to Address Barriers to Healthcare for People with Disabilities in India. Asian Bioeth Rev 2023; 15:1-11. [PMID: 36694541 PMCID: PMC9853476 DOI: 10.1007/s41649-023-00239-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/22/2023] Open
Abstract
Disability is one of the key public health issues in India and the burden will increase given the trend of an aging population. People with disabilities experience greater vulnerability as they may develop secondary health issues. They face various barriers while accessing health services. This is a major ethical concern. In this article, we frame the barriers to healthcare provision to persons with disabilities and propose an ethical framework to address these barriers. This ethical framework is derived from the basic ethical principles of justice, fairness, trust, solidarity, stewardship, proportionality, and responsiveness. The framework proposes strategies to address these barriers to healthcare service delivery for persons with disabilities in India.
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Affiliation(s)
- Rajeswaran Thiagesan
- Centre for Applied Research, The Gandhigram Rural Institute – Deemed to be University, Dindigul, Tamil Nadu India
- Resource Group for Education and Advocacy for Community Health (REACH), Chennai, India
| | - Vijayaprasad Gopichandran
- Department of Community Medicine, ESIC Medical College & Post Graduate Institute of Medical Science and Research (PGIMSR), Chennai, India
| | - Hilaria Soundari
- Centre for Applied Research, The Gandhigram Rural Institute – Deemed to be University, Dindigul, Tamil Nadu India
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Kamalakannan S, Karunakaran V, Kaliappan AB, Nagarajan R. Systematic Development of the ReWin Application: A Digital Therapeutic Rehabilitation Innovation for People With Stroke-related Disabilities in India. JMIR Rehabil Assist Technol 2022; 9:e40374. [PMID: 36422867 PMCID: PMC9732759 DOI: 10.2196/40374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/12/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
This is a viewpoint paper that aims to describe the systematic approach to the development of a technology-driven stroke rehabilitation innovation to manage disabilities following a stroke at home in India. This paper intends to sensitize public health innovators and intervention development experts about the important aspects that need to be considered to develop a culturally sensitive, patient-centered, scalable solution for stroke care using technology. Stroke has been the second-leading cause of death and the third-leading cause of disability globally for the past 3 decades. The emerging technological innovations for stroke care were predominantly designed and developed by digital technology experts as stand-alone products with very minimal efforts to explore their feasibility, acceptability, and, more importantly, scalability. Hence, a digital therapeutic rehabilitation innovation for people with stroke-related disabilities in India was systematically developed and is being evaluated. ReWin is an innovation that is technologically driven and envisions digital therapeutics as a medium for the provision of rehabilitation to persons with disabilities. It is conceptualized and developed based on the International Classification of Functioning, Disability and Health. ReWin encompasses specific technological aspects to enable its scientific framework and conceptualization to suit the context and needs of stroke care providers and consumers. The framework is built with 2 separate applications, one for the providers and one for the patients and caregivers. Each of these applications has a specific inbuilt design to add data about the demographic details of the user, stroke severity using the National Institute of Health Stroke Scale, and self-assessment of disability measured by the modified Barthel Index. Users can communicate with each other and decide on their therapeutic goals, therapy training information, and progress remotely from where they are. The ultimate outcome expected from the ReWin innovation is a continuum of care for stroke survivors that is effective, safe, and of good quality. Systematic development cannot make the intervention scalable. The intervention needs to be evaluated for its feasibility, acceptability, and effectiveness. Currently, ReWin is being evaluated for its feasibility and acceptability. The evaluation of ReWin will provide an opportunity to develop a scalable solution for empowering therapists and persons with disabilities, in general, to objectively self-manage their treatment. Findings from this study will also provide valuable information about the resources required to deliver such interventions in resource-constrained settings like India.
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Affiliation(s)
- Sureshkumar Kamalakannan
- Department of Social Work Education and Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, United Kingdom
- South Asia Centre for Disability Inclusive Development and Research, Indian Institute of Public Health Hyderabad, Public Health Foundation of India, Hyderabad, India
| | - Vijay Karunakaran
- Department of mHealth Design and Development, InGage Technologies Pvt, Ltd, Chennai, India
| | | | - Ramakumar Nagarajan
- Neurological Rehabilitation Department, Chennai Advanced Rehabilitation Centre, Chennai, India
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Riley A, Daruwalla N, Kanougiya S, Gupta A, Wickenden M, Osrin D. Intimate partner violence against women with disability and associated mental health concerns: a cross-sectional survey in Mumbai, India. BMJ Open 2022; 12:e056475. [PMID: 35477887 PMCID: PMC9047698 DOI: 10.1136/bmjopen-2021-056475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/15/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The risk of intimate partner violence (IPV) against women with disability is believed to be high. We aimed to compare the prevalence of past-year IPV against women with and without functional difficulties in urban informal settlements, to review its social determinants and to explore its association with mental health. DESIGN Cross-sectional survey. SETTING Fifty clusters within four informal settlements. PARTICIPANTS 5122 women aged 18-49 years. PRIMARY AND SECONDARY OUTCOME MEASURES We used the Washington Group Short Set of Questions to assess functional difficulties. IPV in the past year was described by binary composites of questions about physical, sexual and emotional violence. We screened for symptoms of depression using the Patient Health Questionnaire-9 and of anxiety using the Generalised Anxiety Disorder-7. Multivariable logistic regression models examined associations between functional difficulties, IPV and mental health. RESULTS 10% of participants who screened positive for functional disability had greater odds of experiencing physical or sexual IPV (adjusted OR (AOR) 1.68, 95% CI 1.23 to 2.29) and emotional IPV (1.52, 95% CI 1.16 to 2.00) than women who screened negative. Women who screened positive for functional disability had greater odds than women who screened negative of symptoms suggesting moderate or severe anxiety (AOR 2.50, 95% CI 1.78 to 3.49), depression (2.91, 95% CI 2.13 to 3.99) and suicidal thinking (AOR 1.94, 95% CI 1.50 to 2.50). CONCLUSIONS The burden of IPV fell disproportionately on women with functional difficulties, who were also more likely to screen positive for common mental disorder. Public health initiatives need to respond at local and national levels to address the overlapping and mutually reinforcing determinants of violence, while existing policy needs to be better utilised to ensure protection for the most vulnerable.
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Affiliation(s)
- Andrew Riley
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Nayreen Daruwalla
- Program on Prevention of Violence Against Women and Children, SNEHA, Mumbai, Maharashtra, India
| | - Suman Kanougiya
- Tata Institute of Social Sciences (TISS), Mumbai, Maharashtra, India
| | - Apoorwa Gupta
- Program on Prevention of Violence Against Women and Children, SNEHA, Mumbai, Maharashtra, India
| | - Mary Wickenden
- Institute of Development Studies, University of Sussex, Brighton, UK
| | - David Osrin
- Institute for Global Health, University College London, London, UK
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Russell PSS, Nagaraj S, Vengadavaradan A, Russell S, Mammen PM, Shankar SR, Viswanathan SA, Earnest R, Chikkala SM, Rebekah G. Prevalence of intellectual disability in India: A meta-analysis. World J Clin Pediatr 2022; 11:206-214. [PMID: 35433303 PMCID: PMC8985497 DOI: 10.5409/wjcp.v11.i2.206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/18/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Burden due to intellectual disability (ID) is only third to the depressive disorders and anxiety disorders in India. This national burden significantly contributes to the global burden of ID and hence one has to think globally and act locally to reduce this burden. At its best the collective prevalence of ID is in the form of narrative reviews. There is an urgent need to document the summary prevalence of ID to enhance further policymaking, national programs and resource allocation.
AIM To establish the summary prevalence of ID during the past 60 years in India.
METHODS Two researchers independently and electronically searched PubMed, Scopus, and the Cochrane library from January 1961 to December 2020 using appropriate search terms. Two other investigators extracted the study design, setting, participant characteristics, and measures used to identify ID. Two other researchers appraised the quality of the studies using the Joanna Briggs Institute critical appraisal format for Prevalence Studies. Funnel plot and Egger’s regression test were used to ascertain the publication and small study effect on the prevalence. To evaluate the summary prevalence of ID, we used the random effects model with arcsine square-root transformation. Heterogeneity of I2 ≥ 50% was considered substantial and we determined the heterogeneity with meta-regression. The analyses were performed using STATA (version 16).
RESULTS Nineteen studies were included in the meta-analysis. There was publication bias; the trim-and-fill method was used to further ascertain bias. Concerns with control of confounders and the reliable measure of outcome were noted in the critical appraisal. The summary prevalence of ID was 2% [(95%CI: 2%, 3%); I2 = 98%] and the adjusted summary prevalence was 1.4%. Meta-regression demonstrated that age of the participants was statistically significantly related to the prevalence; other factors did not influence the prevalence or heterogeneity.
CONCLUSION The summary prevalence of ID in India was established to be 2% taking into consideration the individual prevalence studies over the last six decades. This knowledge should improve the existing disability and mental health policies, national programs and service delivery to reduce the national and global burden associated with ID.
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Affiliation(s)
| | - Sahana Nagaraj
- Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | - Ashvini Vengadavaradan
- Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | - Sushila Russell
- Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | - Priya Mary Mammen
- Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | - Satya Raj Shankar
- Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | | | - Richa Earnest
- Department of Psychiatry, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | - Swetha Madhuri Chikkala
- Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | - Grace Rebekah
- Department of Biostatistic, Christian Medical College, Vellore 632 002, Tamil Nadu, India
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Berlinski S, Duryea S, Perez-Vincent SM. Prevalence and correlates of disability in Latin America and the Caribbean: Evidence from 8 national censuses. PLoS One 2021; 16:e0258825. [PMID: 34705856 PMCID: PMC8550602 DOI: 10.1371/journal.pone.0258825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 10/06/2021] [Indexed: 11/19/2022] Open
Abstract
We estimate disability prevalence rates and gaps in social conditions in eight Latin America and the Caribbean (LAC) countries and project current and future disability prevalence rates in the region. Using data from representative samples of the population in eight countries, we find that reported disability prevalence varies widely across countries, ranging between 4.5 percent in Trinidad and Tobago (2011) to 24.9 percent in Brazil (2010). Differences in surveying approaches and demographic structures likely explain a part of this variation. We find marked sociodemographic gradients for disability. We also report significant disability gaps: people living with disabilities have lower educational attendance and completion rates and lower employment rates. We use age and sex-specific disability rates from our sample of countries and information on the current and future demographic structures in LAC countries to project disability prevalence for the whole region. We project that the total number of people with disabilities in this region will increase by approximately 60 million between 2020 and 2050. Our projections suggest that countries need to systematically plan and implement inclusion policies to adequately address the growing population of people with disabilities in the years to come.
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Affiliation(s)
- Samuel Berlinski
- Inter-American Development Bank, Washington, D.C., United States of America
- IZA Institute of Labor Economics, Bonn, Germany
- * E-mail:
| | - Suzanne Duryea
- Inter-American Development Bank, Washington, D.C., United States of America
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Sen MS, Deep R, Nair V, Chadda RK. Audit of requests for disability certification of adults received at a tertiary care general hospital psychiatry unit. Indian J Psychiatry 2021; 63:495-499. [PMID: 34789938 PMCID: PMC8522620 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_1188_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/17/2021] [Accepted: 05/17/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Persons with disability (PwD) are entitled to certain benefits from the State on grounds of being disabled. With the recent enactment of the Rights of PwD Act, 2016, and increased efforts to provide assistance to persons with certifiable disabilities, data pertaining to disability requests can be useful to understand the way in which services are utilized. MATERIALS AND METHODS This study is an audit of the disability certificates issued to all subjects with age ≥18 years between 2016 and 2019 at a tertiary care general hospital psychiatry unit, and discusses the pattern and profile of the certificates. RESULTS A total of 356 patients were issued disability certificates (2016-2019). The mean age of the subjects was 32.8 (±11.2) years and about 30% of them were females. Intellectual disability (58.3%) was the most common diagnosis, followed by schizophrenia and related disorders (31%), while all other disorders constituted a smaller proportion (11%) of the sample. About 60% of the subjects had moderate disability, 37.4% had severe disability, and 1.7% had profound disability. CONCLUSION A large majority of the certificates were issued to subjects with intellectual disability. Patients with severe mental illnesses are probably not accessing the disability benefits optimally. This audit also points to under-representation of women as well as an overall underutilization of services by individuals with mental disability.
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Affiliation(s)
- Mahadev Singh Sen
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Raman Deep
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Vanaja Nair
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar Chadda
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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Mishra RS, Mohanty SK, Cordes J, Sahoo U, Singh RR, Subramanian SV. Economic gradient of onset of disability in India. BMC Public Health 2021; 21:769. [PMID: 33882902 PMCID: PMC8061006 DOI: 10.1186/s12889-021-10826-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/12/2021] [Indexed: 12/02/2022] Open
Abstract
Background Disability in India is associated with increasing non-communicable diseases, rising longevity, and increasing accidents and injuries. Though studies have examined prevalence, patterns, and socioeconomic correlates of disability, no attempt has been made in estimating age of onset of disability in India. Objective This paper investigates the economic gradient of age of onset of locomotor, visual, hearing, speech, mental retardation, mental illness, and other disabilities in India. Method We use nationally representative data of 106,894 disabled individuals from the 76th round of National Sample Survey (NSS), 2018. Descriptive statistics, kernel density, Kaplan-Meier survival curves, and linear regression models are used in the analysis. Result The disability rate in India was 2184 per 100,000 persons. The disability rate was highest for locomotor (1353) followed by hearing (296), visual (234), speech (228), mental retardation (158), and mental illness (131). Over 85% of mental retardation and 80% of speech disabilities occur at birth, while 82% of locomotor and 81% of visual disabilities occur after birth. Among those who had disability after birth, the median age for mental retardation was 2 years followed by mental illness (28 years), speech (29 years), locomotor (42 years), visual (55 years), and 56 years for hearing disability. Adjusting for socioeconomic covariates, the age of onset of locomotor and speech disabilities among the poorest individuals were 7 and 11 years earlier than the richest, respectively. Conclusion The economic gradient of onset of locomotive and speech disabilities are strong. The age of onset of disability was earliest for mental retardation followed by mental illness and speech disability. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10826-5.
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Affiliation(s)
- Radhe Shyam Mishra
- International Institute for Population Sciences, Govandi station road Deonar, Mumbai, 400088, India.
| | - Sanjay K Mohanty
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India.
| | - Jack Cordes
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Umakanta Sahoo
- International Institute for Population Sciences, Govandi station road Deonar, Mumbai, 400088, India
| | - Rajeev R Singh
- International Institute for Population Sciences, Govandi station road Deonar, Mumbai, 400088, India
| | - S V Subramanian
- Harvard Centre for Population and Development Studies, Harvard University, Cambridge, MA, USA
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Marmamula S, Modepalli SB, Kumbham TR, Challa R, Keeffe JE. Prevalence of disabilities and non-communicable diseases in an elderly population in the Telangana state, India: a population-based cross-sectional study. BMJ Open 2021; 11:e041755. [PMID: 33608399 PMCID: PMC7898867 DOI: 10.1136/bmjopen-2020-041755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To assess the prevalence of disabilities (vision, hearing, mobility, cognitive, self-care and communication) and non-communicable diseases (NCDs) among the elderly population in two districts in Telangana, India. DESIGN Population-based cross-sectional study using a cluster random sampling method to select the study clusters. SETTING Elderly population in Khammam and Warangal districts were recruited. Detailed interviews were conducted by trained community health workers. Personal and demographic information such as age, gender, level of education and a self-report of NCDs was collected. The Washington Disability Questionnaire was administered to assess the presence of disabilities. PARTICIPANTS 1821 participants aged ≥60 years, 54.5% were women, and 73.3% had no education. PRIMARY OUTCOME MEASURE Prevalence of disabilities and NCDs. RESULTS Overall, the prevalence of at least disability was 20.3% (95% CI 16.3 to 24.9). The prevalence of self- reported disabilities were: seeing (5.9%; 95% CI 4.4 to 7.8), mobility (12.8%; 95% CI 9.7 to 16.8), hearing (3.6%; 95% CI 2.7 to 4.8), cognition (4.8%; 95% CI 3.5 to 6.7), self-care (3.3%; 95% CI 2.3 to 4.7) and communication (1.8%; 95% CI 1.2 to 2.6). Overall, the prevalence of at least one NCD was 34.2% (95% CI 30.9 to 37.7). Hypertension was the most common systemic condition (25.4%; 95% CI 22.4 to 28.7), followed by diabetes (9.0%; 95% CI 7.3 to 11.0), and body pains (muscle-skeletal) (9.9%; 95% CI 8.1 to 12.2). CONCLUSION Every fifth elderly person in the districts of Khammam and Warangal in Telangana had at least one self-reported disability. Besides, a third of the elderly had at least one NCD. There is a definite need to develop comprehensive public health strategies to address disabilities and NCDs in Telangana.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
- School of Optometry & Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- Wellcome Trust /DBT India Alliance fellow, L V Prasad Eye Institute, Hyderabad, India
| | - Satya Brahmanandam Modepalli
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Thirupathi Reddy Kumbham
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Rajesh Challa
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Jill E Keeffe
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
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Rajput S, Kumar A, Puranik MP, Sowmya KR, Chinam N. Oral health perceptions, behaviors, and barriers among differently abled and healthy children. SPECIAL CARE IN DENTISTRY 2021; 41:358-366. [PMID: 33547693 DOI: 10.1111/scd.12573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/15/2020] [Accepted: 12/31/2020] [Indexed: 01/16/2023]
Abstract
AIM To describe and compare the oral health perceptions, behaviors, and barriers for utilization of dental care among differently abled and healthy children. METHODS Participants in this cross-sectional study were differently abled and healthy children belonging to the age group of 7-15 years. A questionnaire for measuring the children's perceptions, behaviors, and barriers was developed, validated, and applied to this study. Cronbach's α was calculated to test reliability, and test-retest reliability was assessed by Pearson's correlation test. Chi-square/Fisher exact test, Mann-Whitney U test, and factor analysis were also applied. Statistical significant differences were defined as P < 0.05, two-tailed. RESULTS A total number of 300 children in each group participated in the study. The correlations of test and retest for the questionnaire ranged from 0.69 to 0.86 (P < 0.05) with Cronbach's α score of 0.862. More than half in both the groups were aware of the presence of fluoride in their toothpaste, and parents agreed that a child's dental health is satisfactory yet only one-third of them perceived dental problems as serious. Regarding brushing twice daily, the frequency was better in the study group (26.3% and 17.3%, P = 0.01), most of them changed their toothbrush between 3 and 6 months (67.3% and 82.0%, P < 0.001), and tongue cleaner were regularly used as an oral hygiene aid (62.3% and 88.5%, P = 0.01). Members of the study group appear to have visited the dentist (26.0%) more as compared to the control group (17.7%) (P = 0.01), and most of the respondents (50.0% and 41.5%) consulted the dentist on account of dental caries. In the study group, no priority care (8.82±2.81), difficulty in communicating with the dentist (7.85±1.92), treatment cost (6.90±1.98) and fear of dental instruments (6.90±1.98), respectively, were the barriers with the highest means of scores, whereas in the control group it was related to affordability and fear. Facilities in dental clinics excluding wheelchairs (76.3% and 76.7%) and corridor signs (66.3% and 61.7%) were lacking. CONCLUSION Knowledge and attitude scores were adequate but there was a discrepancy present concerning oral health practices. Dental health was not viewed as a threat, and therefore, not many visited the dentist. Priority care and communication problems were the central issues among differently abled children, while among healthy children, the main factor was cost and fear.
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Affiliation(s)
- Soni Rajput
- Department of Community Dentistry, Goa Dental and College and Hospital, Goa, India
| | - Amit Kumar
- Oral Health Sciences Centre, PGIMER, Chandigarh, India
| | - Manjunath P Puranik
- Department of Public Health Dentistry, Government Dental College and Research Institute, Bangalore, India
| | - K R Sowmya
- Department of Public Health Dentistry, Government Dental College and Research Institute, Bangalore, India
| | - Nivedita Chinam
- Department of Oral Medicine and Radiology, Goa Dental College and Hospital, Goa, India
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Nagarajan P, Bharadwaj B, Kattimani S. Five-Year Trend in Issuing Disability Certificates from a General Hospital Psychiatric Unit in South India. Indian J Psychol Med 2020; 42:451-455. [PMID: 33414592 PMCID: PMC7750839 DOI: 10.1177/0253717620947163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mental disability is a common condition but is considered as an invisible disability. The disability certificate in psychiatry remains underexplored. Some reasons are issues of confidentiality, stigma, lack of awareness in the public, and the hesitancy in the mental health professionals. We aim to provide a brief profile of patients with mental illness issued disability certificates from a psychiatric unit over a five-year period (2013-2017). METHODS Our retrospective study is based on the data available from the copies of the issued disability certificates from a psychiatric unit that functions in a multispecialty tertiary care teaching government hospital in Southern India. Patients undergoing treatment in psychiatry apply for a disability certificate to the medical superintendent of the hospital. Each applicant undergoes a detailed workup to ascertain the diagnosis, and the mental disability is assessed using Indian Disability Evaluation and Assessment Scale (IDEAS). Those with intellectual developmental disorder (IDD) are assessed by a clinical psychologist for quantifying intelligence quotient, based on which the disability certificate is issued. Data were extracted and analyzed using SPSS. Descriptive statistics were used. RESULTS Over five years, 258 disability certificates were issued. A total of 218 were for mental illness and 40 were for IDD. Schizophrenia was the commonest primary diagnosis. There was no gender predominance, nor the influence of gender on different domains of IDEAS except on work domain dysfunction due to mental illness. The validity period was not mentioned in 81% of the issued certificates for mental illness. CONCLUSIONS This descriptive study found a lower number of certificates issued from the psychiatric unit. Schizophrenia remains the main psychiatric diagnosis for which a disability certificate was issued. We did not assess the utilization pattern of the issued certificates.
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Affiliation(s)
| | - Balaji Bharadwaj
- Dept. of Psychiatry, JIPMER, Dhanvantari Nagar, Pondicherry, India
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