Dataset Information

Disability among Older People: Analysis of Data from Disability Surveys in Six Low- and Middle-Income Countries.

ABSTRACT: This analysis of surveys from six low- and middle-income countries (LMICs) aimed to (i) estimate the prevalence of disability among older adults and (ii) compare experiences and participation in key life areas among older people with and without disabilities which may show vulnerability during the COVID-19 pandemic. Data were analysed from district-level or national surveys in Cameroon, Guatemala, Haiti, India, Nepal and the Maldives, which across the six databases totalled 3499 participants aged 60 years and above including 691 people with disabilities. Disability was common among adults 60+, ranging from 9.7% (8.0-11.8) in Nepal to 39.2% in India (95% CI 34.1-44.5%). Mobility was the most commonly reported functional difficulty. In each setting, older people with disabilities were significantly less likely to be working and reported greater participation restrictions and environmental barriers in key life areas compared to people in the same age categories without disabilities (p < 0.05). Disability is common in this population, and older people with disabilities may have greater difficulties participating in COVID-19 responses and have high economic vulnerabilities. It is imperative to prioritise the needs of older people with disabilities in the COVID-19 pandemic, including ensuring accessibility of both health services and the community in general.

SUBMITTER: Prynn JE

PROVIDER: S-EPMC8297350 | biostudies-literature | 2021 Jun

REPOSITORIES: biostudies-literature

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Disability among Older People: Analysis of Data from Disability Surveys in Six Low- and Middle-Income Countries.

Prynn Josephine E JE Polack Sarah S Mactaggart Islay I Banks Lena Morgon LM Hameed Shaffa S Dionicio Carlos C Neupane Shailes S Murthy Gvs G Oye Joseph J Naber Jonathan J Kuper Hannah H

International journal of environmental research and public health 20210629 13

This analysis of surveys from six low- and middle-income countries (LMICs) aimed to (i) estimate the prevalence of disability among older adults and (ii) compare experiences and participation in key life areas among older people with and without disabilities which may show vulnerability during the COVID-19 pandemic. Data were analysed from district-level or national surveys in Cameroon, Guatemala, Haiti, India, Nepal and the Maldives, which across the six databases totalled 3499 participants age ...[more]

PMID: 34209792

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Project description:IntroductionAccessing glucose meters, test strips, lancets and continuous/flash glucose monitoring devices for self-monitoring blood glucose (SMBG) is crucial for the management of diabetes. Yet little is known about access to SMBG devices in low-income and middle-income countries.MethodsIn 2022/2023, facility-based surveys were undertaken in selected regions and sectors in Fiji, Indonesia, Kyrgyzstan, Mali, Peru and Vietnam. Availability and patient prices were collected in public sector outlets (hospital dispensaries/clinics) and private pharmacies in the community by in-person visits (except in Mali where it was collected by phone). Data were also collected in medical device shops (Vietnam), online marketplaces (Indonesia) and online from device manufacturers.Availability was assessed as the percentage of outlets with the device in stock on the day of data collection. Median prices were calculated and reported in US dollars (US$). Affordability was assessed as the number of days' wages needed by the lowest-paid unskilled government worker to purchase each device. The affordability of self-monitoring was then compared with that of insulin.ResultsSMBG devices were not generally provided to individuals for self-testing by governments in Fiji, Indonesia, Kyrgyzstan and Peru. Public sector availability ranged from 0% to 57% (meters) and 0% to 53% (strips). In private pharmacies, availability was 31% to 100% (meters) and 39% to 100% (strips). Some large regional variations were seen within countries. Median prices for one meter ranged from US$15.62 to US$35.18. For one strip, median prices ranged from US$0.27 to US$0.56. Continuous/flash glucose monitoring devices were only found online at US$88-US$107 per sensor. Between 1.5 and 10.9 days' wages were needed to purchase 1 meter, and 1.0-12.8 days' wages for 50 strips. Online purchases of 1-month supply of continuous/flash device sensors required 15-65 days' wages. The cost of self-testing exceeded the cost of human insulin vials/syringes. However, analogue prefilled pens/pen needles were often higher priced than the cost of self-testing.ConclusionPoor availability and high prices were found for SMBG devices which can impact diabetes management. Prices of meters, test strips and sensors were unaffordable. Pricing for these essential tools requires further investigation including cost of goods sold; government procurement prices and volumes; and price components in supply chains. Accessing SMBG devices must not be considered in isolation to accessing insulin. Governments need to include SMBG devices in their package of essential diabetes services. They must also support ongoing monitoring to ensure people are accessing SMBG devices.

Project description:BackgroundVaccine hesitancy remains a critical barrier in mitigating the effects of the ongoing COVID-19 pandemic. The willingness of health care workers (HCWs) to be vaccinated, and, in turn, recommend the COVID-19 vaccine for their patient population is an important strategy. This study aims to understand the uptake of COVID-19 vaccines and the reasoning for vaccine hesitancy among facility-based health care workers (HCWs) in LMICs.MethodsWe conducted nationally representative phone-based rapid-cycle surveys across facilities in six LMICs to better understand COVID-19 vaccine hesitancy. We gathered data on vaccine uptake among facility managers, their perceptions of vaccine uptake and hesitancy among the HCWs operating in their facilities, and their perception of vaccine hesitancy among the patient population served by the facility.Results1,148 unique public health facilities participated in the study, with vaccines being almost universally offered to facility-based respondents across five out of six countries. Among facility respondents who have been offered the vaccine, more than 9 in 10 survey respondents had already been vaccinated at the time of data collection. Vaccine uptake among other HCWs at the facility was similarly high. Over 90% of facilities in Bangladesh, Liberia, Malawi, and Nigeria reported that all or most staff had already received the COVID-19 vaccine when the survey was conducted. Concerns about side effects predominantly drive vaccine hesitancy in both HCWs and the patient population.ConclusionOur findings indicate that the opportunity to get vaccinated in participating public facilities is almost universal. We find vaccine hesitancy among facility-based HCWs, as reported by respondents, to be very low. This suggests that a potentially effective effort to increase vaccine uptake equitably would be to channel promotional activities through health facilities and HCWs.However, reasons for hesitancy, even if limited, are far from uniform across countries, highlighting the need for audience-specific messaging.

Project description:ObjectivesAdolescent childbirth is associated with older adult adverse health outcomes that negatively affect mobility function, but these associations have not been studied globally in large samples of reproductive-age women. This study examines the association between age at first childbirth and mobility disability in national surveys from low-income and middle-income countries, and hypotheses that adolescent childbirth is associated with mobility disability.DesignCross-sectional analysis.SettingPopulation health surveys from 2013 to 2018 containing mobility disability measures among ever-pregnant women ages 15-49. These included 13 Demographic Health Surveys from Haiti, Pakistan, Uganda, Cambodia, Colombia, South Africa, Timor-Leste, Albania, Gambia, Maldives, Peru, Senegal and Yemen and 1 Maternal Health Survey from Ghana.ParticipantsThe sample included 157 988 women ages 15-49 years.Primary outcome measureAdolescent childbirth was defined as 10-19 years of age. Poisson regression models were used to estimate prevalence ratios (PRs) of mobility disability among women who first gave birth during adolescence and in adult life (ages 20-45 years) in each country and across the whole sample. Countries were also analysed according to the use of standard and non-standard mobility disability measures. Covariates included current age, urban/rural residence, education and household wealth.ResultsPrevalence of adolescent childbirth (17.5%-66.2%) and mobility disability (0.32%-21.45%) varied widely across countries. Adolescent childbirth was significantly (p<0.05) associated with greater mobility disability in six of eight countries using standard disability measures. Among the six countries that did not use standard disability measures, none showed a statistically significant association between adolescent childbirth and mobility disability. Considering the whole sample and adjusting for all covariates, women who gave birth during adolescence had greater prevalence of mobility disability (pooled PR 1.19, 95% CI 1.06-1.31).ConclusionsThis analysis suggests a moderate and consistent association of adolescent childbearing with subsequent mobility disability.

Project description:IntroductionDisability and poverty are believed to operate in a cycle, with each reinforcing the other. While agreement on the existence of a link is strong, robust empirical evidence substantiating and describing this potential association is lacking. Consequently, a systematic review was undertaken to explore the relationship between disability and economic poverty, with a focus on the situation in low and middle income countries (LMICs).MethodsTen electronic databases were searched to retrieve studies of any epidemiological design, published between 1990-March 2016 with data comparing the level of poverty between people with and without disabilities in LMICs (World Bank classifications). Poverty was defined using economic measures (e.g. assets, income), while disability included both broad assessments (e.g. self-reported functional or activity limitations) and specific impairments/disorders. Data extracted included: measures of association between disability and poverty, population characteristics and study characteristics. Proportions of studies finding positive, negative, null or mixed associations between poverty and disability were then disaggregated by population and study characteristics.ResultsFrom the 15,500 records retrieved and screened, 150 studies were included in the final sample. Almost half of included studies were conducted in China, India or Brazil (n = 70, 47%). Most studies were cross-sectional in design (n = 124, 83%), focussed on specific impairment types (n = 115, 77%) and used income as the measure for economic poverty (n = 82, 55%). 122 studies (81%) found evidence of a positive association between disability and a poverty marker. This relationship persisted when results were disaggregated by gender, measure of poverty used and impairment types. By country income group at the time of data collection, the proportion of country-level analyses with a positive association increased with the rising income level, with 59% of low-income, 67% of lower-middle and 72% of upper-middle income countries finding a positive relationship. By age group, the proportion of studies reporting a positive association between disability and poverty was lowest for older adults and highest for working-age adults (69% vs. 86%).ConclusionsThere is strong evidence for a link between disability and poverty in LMICs and an urgent need for further research and programmatic/policy action to break the cycle.

Dataset Information

Disability among Older People: Analysis of Data from Disability Surveys in Six Low- and Middle-Income Countries.

Publications

Disability among Older People: Analysis of Data from Disability Surveys in Six Low- and Middle-Income Countries.

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