|Year : 2019 | Volume
| Issue : 3 | Page : 156-160
The prevalence pattern of locomotor disability and its impact on mobility, self-care, and interpersonal skills in rural areas of Jodhpur District
Kriti Mishra1, V Siddharth1, Pankaj Bhardwaj2, Abhay Elhence3, Divesh Jalan3, Pankaja Raghav2, Syed Esam Mahmood4
1 Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
2 Department of Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
3 Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
4 Department of Community Medicine, GMC, Ambedkar Nagar, Uttar Pradesh, India
|Date of Web Publication||21-Aug-2019|
B-503, Sumadhur 2 Apartment, Behind Azaad Society, Ambawadi, Ahmedabad- 380 015, Gujarat
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Context: Impact of disability is deleterious, affecting an individual's every aspect. Majority of disabled reside in rural areas of developing countries. Moreover, different types of disability add to its wide spectrum. All these make it a major health issue. Aims: The aim of this study was to note the prevalence rate and pattern of locomotor disability in a rural population of Jodhpur District and to observe its impact on mobility, self-care, and interpersonal skills of disabled. Settings: This study was carried out in rural field practice area of the Community and Family Medicine Department of tertiary care setup. Design: This was a cross-sectional study. Materials and Methods: House-to-house survey for a sample size of 1656 was conducted by a team of trained doctors, therapists, and anganwadi workers for identification of locomotor disability applying a pretested survey questionnaire. Statistical Analysis: SPSS version 22 was used for descriptive analysis of variables (frequency distribution), and the Chi-squared test was used for the association of sociodemographic factors with performance qualifier score. Results: The prevalence rate of 2.08% for locomotor disability (male = 57% and female = 43%) was noted, with 31% from 40 to 60 years, 49% were illiterate, and 60% were from lower class. The main etiologies were cerebrovascular accident (25%) and cerebral palsy (23%). About 80% faced some difficulties in mobility domain, 57% in self-care, and 63% in interpersonal skills. Statistically significant association was seen for self-care domain with education level (P = 0.04) and for interpersonal skill domain with age groups and diagnosis (P = 0.022 andP = 0.035, respectively). Conclusion: The overall prevalence of locomotor disability in rural Jodhpur was 2.08%, higher for males and higher from 40 to 60 years. Most disabled were illiterate and were from low socioeconomic status. Self-care, mobility, and interpersonal skills were primarily affected and require proper intervention.
Keywords: Disability impact, locomotor disability, prevalence rate, rural area
|How to cite this article:|
Mishra K, Siddharth V, Bhardwaj P, Elhence A, Jalan D, Raghav P, Mahmood SE. The prevalence pattern of locomotor disability and its impact on mobility, self-care, and interpersonal skills in rural areas of Jodhpur District. Niger Med J 2019;60:156-60
|How to cite this URL:|
Mishra K, Siddharth V, Bhardwaj P, Elhence A, Jalan D, Raghav P, Mahmood SE. The prevalence pattern of locomotor disability and its impact on mobility, self-care, and interpersonal skills in rural areas of Jodhpur District. Niger Med J [serial online] 2019 [cited 2019 Nov 14];60:156-60. Available from: http://www.nigeriamedj.com/text.asp?2019/60/3/156/264956
| Introduction|| |
Disability is an important public health issue. It is defined as any restriction or lack of ability to perform an activity in a manner or within the range considered normal for human beings, resulting from impairment of an organ. Disability is complicated by additional medical, psychological, or environmental factors and can significantly affect the quality of life. The social and cultural consequences of a disability lead to handicap of an individual.
According to the World Health Organization (WHO), about 15% of the world's population is estimated to be living with disability with higher occurrence in developing countries such as India, with majority of them residing in rural areas. The global population estimated in 2010 showed around 785–795 million persons aged 15 years and older to be living with disability.
According to the National Sample Survey Organization (NSSO), the number of disabled persons in India constituted about 2% of the total population with a total of 14,085,000 disabled residing in rural areas and 4,406,000 disabled in urban areas. Among different types of disabilities, the prevalence for locomotor disability was noted to be highest in the country – 1046 in rural and 901 in urban per 100,000 persons. Of these, about 13% were severely disabled as they could not perform self-care, even with aid/appliance.
The Annual Health Survey 2012–2013 for Rajasthan state suggested total disability prevalence of 2350 persons/100,000 population in rural areas of the state and 1697 persons/100,000 population in Jodhpur rural regions.
Disability limitation through early rehabilitative measures can minimize its impact and improve community participation. Both early detection of disability and early rehabilitative intervention are essential to improve health outcomes, increase the accessibility to educational institutions, enhance the economic participation, and reduce the poverty rates and thereby decrease their dependency on nondisabled population. However, only 2% of the disabled persons have access to rehabilitative services in India., Moreover, the awareness of rehabilitation services is equally limited, especially in rural areas. Thus, the present study was designed to note the prevalence pattern of locomotor disability in rural population of Jodhpur District and its impact on activity and participation of these disabled individuals.
| Materials and Methods|| |
A descriptive study (cross-sectional observational type) was carried out in rural field practice area of the Department of Community Medicine and Family Medicine, namely Center for Rural Health AIIMS (CRHA) at Keru and Dhundhara from October 1, 2016, to December 31, 2016. Ethical clearance was obtained beforehand from the Institutional Ethical Committee at All India Institute of Medical Sciences, Jodhpur. The purpose of the study was explained to individuals during the survey. Written informed consent was obtained from individuals who agreed to participate in the study, and subsequently, information was collected from these individuals.
Optimal sampling size was calculated on basis of prior prevalence rate of locomotor disability of 1046/100,000 persons in rural population as reported by the NSSO. The sample size was calculated by the formula 4PQ/L 2 where P was prevalence (1.046), Q is 100 − P = 98.954, and L was fixed error, that is, 5%. The sample size was estimated to be 1656. Keeping the average family size of six members as noted in rural population of southwestern Rajasthan, 280 houses were selected (140 house in Keru and 140 in Dhundhara) through random sampling method. The house-to-house survey was conducted by a team of trained doctors, therapists, and anganwadi workers for identification of locomotor disability.
For maintaining uniformity in identification, the operational definition of locomotor disability as mentioned by the NSSO was used. According to the NSSO, a locomotor disabled person includes those with loss or absence or inactivity of whole or part of limb(s) due to amputation, paralysis, deformity, or dysfunction of joints affecting normal ability to move him/her or move objects; born disabled persons; and those with physical deformities in body (other than limbs), such as deformities of spine like hunch back, scoliosis etc., and persons with stiff neck of permanent nature would also be included. The pattern of disability was measured through a predesigned, pretested pro-forma as used by Mahmood et al. Out of the pretested pro-forma, the first section which explored the sociodemographic characteristics was used. Further, the impact of disability was measured using activity-participation subsection of the International Classification of Functioning, Disability, and Health (ICF) checklist version 2.1a. ICF was developed by the WHO to study the impact of health on daily activities. It is a practical tool to elicit and record information on functional aspects of disability for an individual. Performance qualifier indicates the extent of participation restriction by describing a person's actual performance of a task or action in his or her current environment.
Statistical analysis was done using IBM SPSS Statistics for Windows Version 22.0, Armonk, NY, IBM Corp. Released 2013. Frequency and percentage distribution was calculated for demographic variables and performance qualifier score was attained for the disabled study population. The association of sociodemographic factors with performance qualifier score for domain of mobility, self-care, and interpersonal skill was calculated using the Chi-squared test.
| Results|| |
Of 280 houses (140 in each center), a total of 35 cases of disability were observed with a prevalence rate of 2083/100,000 (2.08%). Of these, 20 were male and 15 were female. Nearly one-third (11 of 35) belonged to the age group of 40–60 years. Half of them (49%) were illiterate and 60% belonged to lower socioeconomic class. The average family size in the current study was noted as 7. [Table 1] represents the socioeconomic and demographic profile of these 35 persons. The main causes for locomotor disability were cerebrovascular accident (n = 9, 25%) and cerebral palsy (n = 8, 23%). The remaining etiologies are elaborated in [Table 2].
|Table 1: Demographic profile of persons with locomotor disability observed in the study (n=35)|
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Among them, 28 persons (80%) faced some difficulties in the mobility domain and 20 persons (57%) in the self-care domain. In interpersonal skills, 5 children could not be included since the questions in subset were not applicable to them. In this domain, 19 of 30 (63%) faced difficulty due to their disability. The distribution based on the severity of difficulty for the three domains is represented in [Table 3].
|Table 3: Frequency distribution of locomotor disabled persons based on level of difficulty in mobility, self-care, and interpersonal skill domain of International Classification of Functioning (ICF) checklist 2.1 a|
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The association of three domains with the socioeconomic and demographic factors is mentioned in [Table 4]. The self-care domain showed statistically significant association with education level (P = 0.04). For interpersonal skill domain, age group and diagnosis were statistically significant with P value as 0.022 and 0.035, respectively. Mobility domain did not show any statistically significant association with any of the factors.
|Table 4: Association of mobility, self-care and interpersonal skill domain with demographic factors for locomotor disabled persons|
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| Discussion|| |
The current study reported a prevalence rate of 2.08% for locomotor disability in Jodhpur District. The previous studies by Ganesh et al., Borker et al., Padhyegurjar et al., Suganthi and Kandaswamy, and Mahmood et al. have shown a varied range of prevalence rate of 1.8% in rural Karnataka, 0.92% in rural Goa, 5.57% in Mumbai slums, 0.91% in rural Puducherry, and 3.7% in rural Uttar Pradesh for locomotor disability, respectively.,9-12 Although locomotor disability is considered to be the most prevalent disability according to the NSSO, the prevalence rate of 1% was mentioned. This wide variation in the reported prevalence rates could be due to numerous reasons. One possible reason is the difference in operational definitions of locomotor disability, different methodologies of data collection, and variation in the quality of study design. Moreover, the different sociocultural background and different risk factors prevailing in a particular region may influence the variation in rate. Further, according to the WHO 2005, there has been an increase in a number of disabled people because of increase in accidents, infectious diseases, malnutrition, chronic diseases, substance abuse, war injuries, population growth, and medical advances. The difficulty in identifying mild and moderate degrees of physical and mental disability, even by health-care members, not only leads to many cases being missed but also enhances the variation.
The pattern of locomotor disability was assessed according to gender, education level, socioeconomic status, monthly income, age group, and predominant etiology.
The current study showed a higher prevalence rate in males (57%) in comparison to females (43%), similar to the findings in NSSO and studies by Srivastava et al. in Uttar Pradesh, Suganthi and Kandaswamy in rural Puducherry, and Mahmood et al. in rural Bareilly.,,,
As per the NSSO, 54.7% of disabled were illiterate which matches trend observed in this study, with 49% disabled persons being illiterate. A significantly higher prevalence of disabilities (60%) was seen in lower socioeconomic class with monthly income <10,000 INR for 57% of the disabled in the current study. This is in concordance with the previous studies by Pati, Ganesh et al., Borker et al., Padhyegurjar et al., Suganthi and Kandaswamy, and Mahmood et al.,9-12, The reason for this replicated finding is the two-way causation between the intricately related phenomena of disability and poverty. Persons with poor resources and low income have lesser accessibility and affordability for health facilities and rehabilitation services. Inaccessible physical environment also restricts their participation in community and confines these disabled persons to their homes. Lower education level leads to low awareness about opportunities and available policy benefits. All these further lower their standard of living and socioeconomic status leading to a vicious cycle.
In the current study, the locomotor disability was predominant in those older than 40 years, with nearly one-third (31%) in the age group of 40–60 years. However, no particular trend was observed in relation to various age groups. A similar finding was noted by Suganthi and Kandaswamy.
The etiology of disability in this study was mainly cerebrovascular accident and cerebral palsy. This is dissimilar to the previous studies. Suganthi andKandaswamy in their study found congenital causes (18.9%), residual paralysis (18.9%), and stroke (16.2%) as the three leading causes. In the NSSO and the study by Kar in West Bengal, leading cause of locomotor disability was residual paralysis due to polio in rural (29.5%) areas., This implies a change in the trend in the past one decade with a decline in the polio-related disability and successful implementation of immunization program. The rise in noncommunicable disease as a causative factor for disability is reflected in this study. Cerebrovascular accident was also seen as a leading cause of disability in the elderly in the study by Borker et al. in Goa.
The study also explored the impact of locomotor disability on various day-to-day tasks using ICF domains. It was found that locomotor disability primarily affected domains of mobility and self-care, with nearly 80% and 57% facing some difficulties in these domains. This also restricted interpersonal interaction in 63%. The impact is obvious since locomotor impairment will influence movement and inability to move will hinder in self-care.
The self-care domain showed a stronger association with education level, which is obvious. An educated disabled person or educated family members will be more aware of the importance of self-care and hence emphasize on it either by performing it for the person or ensuring a setup where the basic self-care tasks are heeded.
Interpersonal interaction showed a significant association with age groups and diagnosis. Based on the diagnosis, the comorbidities may be variable and may not affect only the locomotor system. A patient with cerebrovascular accident and cerebral palsy may have associated speech and cognitive difficulties and hence affect the interpersonal interactions. Furthermore, interactive skills decline over the years with the elderly having a poor social circle and often being isolated. Previous studies related to disability among the elderly have revealed that increasing age tends to be associated with increased risk of functional disability.
Although mobility domain is affected, it did not show any association with any of these demographic factors. This could be because of the small sample size. Another possibility may be that mobility difficulties are experienced uniformly irrespective of gender, age, education level, and socioeconomic status in those persons with locomotor disability.
Preventive and rehabilitative measures at an early stage can limit disability and handicap., However, nonavailability, nonaccessibility, and poor awareness of rehabilitation services among these unreached disabled persons living in rural areas and small towns is a big challenge in developing countries like India. Other major considerations include the utilization of available rehabilitation services and their cost-effectiveness. In spite of available government programs and policies providing income assistance and work-related supports to the disabled, awareness regarding them is low among the disabled.,,
The rehabilitation provided so far by the institute, where the current study was conducted, has been institutional-based type, benefitting those who avail such facilities at the tertiary care. However, these individuals are often neglected in the community because of inaccessibility and lack of awareness of rehabilitation services, leading to their limited utilization. Hence, systematic research into prevalence pattern and determinants of disability is essential to develop rehabilitation programs, relevant to a given contextual scenario in this particular region of the country. This facilitates social re-integration of the disabled into the given community context smoothly in due course of time.
The current study helped us to know the problem present in the community in the region surrounding the institute, providing data from rural setup. It not only revealed the magnitude but also the factors associated with disability. It also stratified major functional domains in which an individual with locomotor disability may face issues with. Based on these findings, rehabilitation modules for three most common conditions, i.e., cerebrovascular accident, cerebral palsy, and osteoarthritis, are being designed. These modules will be easily understandable and simple enough to be implemented by any health care professional even at primary health center level. In this way, personals working at the primary health care level can provide and support initiatives of limiting disabilities and preventing the handicap of an individual. Thus, the out-reach programs would address the accessibility issue and enhance awareness of rehabilitation services among the rural disabled persons. Only then, the challenges brought by a disability can be combated at large.
The study had its limitations of exploring locomotor disability in rural regions of the district and not including the urban regions which may have a different pattern and impact of the disability on individuals. Furthermore, it was focused to a specific region leading to difficulty in generalization of the findings to other populations in India, due to vast difference in living conditions and variations in accessibility to health facilities across the country. The impact of disability was noted in only three domains of the ICF checklist, and other components such as domestic life, employment, and social/civic life were not studied.
| Conclusion and Recommendations|| |
The prevalence of locomotor disability in rural Jodhpur was noted as 2.08%, higher for males and higher from 40 to 60 years. Most disabled were illiterate and were from low socioeconomic status. Self-care, mobility, and interpersonal skills were primarily affected and require proper intervention. Thus, a systematic research into pattern and determinants of disability with stratification of functional domains affected may help formulate outreach rehabilitation programs relevant in a given contextual environment. This can not only limit the impact of disability but also address the accessibility issue and enhance rehabilitation awareness in a given region. Moreover, the primary health-care system can play a major role in these outreach services to combat disability at large. Studies observing the prevalence pattern in urban areas in the given region, impact of disability on remaining domains of ICF checklist, and effectiveness of outreach programs in the rural region can be explored in future.
The authors would like to thank medical officers and staff of Primary health Center and Community Health Center, for their contribution in data collection.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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