Prevalence, pattern and determinants of disabilities in India: Insights from NFHS-5 (2019-21)

Epidemiology of disability and access to disability support and rehabilitation services in India: a secondary data analysis of the National Sample Survey (2018)

OBJECTIVE

The aim of this study was to examine the epidemiology of disability in India and assess access to disability support and rehabilitation services by people with disability (PWD).

DESIGN

This study is a secondary analysis of data from the 76th round of the National Sample Survey (2018), focusing on disability in India.

SETTING

The survey employed a stratified two-stage sampling design based on Census 2011, covering all states and union territories of India. Villages and urban blocks were selected in the first stage, while households were chosen in the second stage across rural and urban areas.

PARTICIPANTS

The survey included data from a population of 576 796 individuals residing in 118 152 households from 8992 village/urban blocks (5378 rural villages and 3614 urban blocks). The analysis focused on 107 125 individuals (61 707 male and 45 305 female) who reported at least one disability.

OUTCOME MEASURES

The primary outcome was 'any disability'. Secondary outcomes included access to disability support and rehabilitation services, which assessed difficulties in accessing public buildings and transport, loss of employment after disability, availability of government support, enrolment in special schools, and possession of a disability certificate.

RESULTS

The overall weighted disability prevalence was 2.2%, with significant disparities across sociodemographic characteristics. Among PWD, 45.9% of those who acquired disability after birth were aged between 15 years and 59 years, and 20.8% received no government aid. About 40% of PWD struggled to use public transport, and 57.7% had difficulties accessing public buildings. Additionally, 60.7% reported job loss due to disability, and 69.6% lacked a disability certificate.

CONCLUSION

This study highlights disparities faced by PWD in accessing disability support and rehabilitation services. There is an urgent need for concerted efforts to minimise such experiences. This will help us enhance the well-being and participation of PWD and empower them to contribute to society with their true potential.

Mapping gaps and exploring impairment and disability prevalence in South Asian (SAARC) countries: a scoping review

Despite the considerable health and economic burden of disability in the South Asian (SA) region, there is limited evidence of impairments and disabilities prevalence and the need for Assistive Technologies (ATs). This scoping review aims to synthesise the evidence of the impairments and disabilities in SA countries. This review followed Arksey and O'Malley's methodological framework. EBSCOhost, EMBASE, PubMed, and Web of Science databases were searched for original research articles from SA countries. In this study, impairment and disability refer to functional limitations restricting individuals from performing activities, including visual, hearing, speaking, cognitive, mobility, and self-care difficulties. The review included full-text, English-language articles addressing any impairment and disability, without restrictions on publication date. This review identified 105 articles distributed over the six impairment and disability domains: visual, hearing, mobility, self-care, speaking, and cognitive. Most evidence originated from India (50.5%) and focused on visual impairments (53.3%). The review identified that heterogeneity in methodologies, case identification definitions, and study settings contributed to variations in prevalence estimation and restricted the comparability within and across countries. Besides, the uneven distribution of studies across countries suggests varying inclinations of countries toward specific impairment and disability domains. The review identified variations in prevalence due to differences in methodologies, definitions, and contexts. The review also identified the uneven distribution of studies, limited evidence on ATs, reliance on self-reported data, and lack of nationally representative research. Future research should use standardised case identification and evidence-based approaches to enhance comparability and minimise response biases.

Using Structural Competency to Augment Culturally Responsive Research on Mental Health in Neoliberal Context: Ethnographic Reflections

Culturally responsive methodologies (CRMs) foreground critical engagement, people's voices, and connection with cultural heritage. Similarly, structural competency (SC) advocates for structural humility and cultural safety to address the structural hierarchies and humanize interactions within health care and research settings. In the Global South countries like India, where persistent colonial legacy and neoliberal influences in the post-colonial era continue to dehumanize mental health care and disempower minoritized communities, CRMs are often overlooked. This paper argues that integrating SC could potentially augment the deconstructing and humanizing features of CRM for mental health research in developing countries. Three ethnographic reflections from research on mental health care in India are utilized to highlight (a) the influence of power discourses on the process of developing humanizing dialogic spaces, (b) the potential of research dialogue in building insights about human distress, possibilities, or paradoxes of recovery or healing, and (c) the possibility of creating a more holistic mental health care of the distressed in the neoliberal times. The paper discusses how mental health researchers' structural competencies contribute toward centering the voices (needs, aspirations, and priorities) and reaffirming the dignity of the minoritized communities by enabling documentation of (a) the challenges in developing humanizing research space amidst the dehumanizing and hierarchical care settings and (b) the narratives of distress and healing paradoxes among participants in care settings, influenced by social gender and class hierarchies, shared within these humanizing spaces.

Access to Disability-related Healthcare among People with Visual Disability in India: Evidence from a National Sample Survey

Background

Despite progress, there are still gaps and inequalities in achieving universal health coverage (UHC), particularly among marginalized populations such as people with visual disability (VD). This study aimed to evaluate access to disability-related healthcare among people with VD in India.

Methods

Data from the Survey of Persons with Disabilities in India, the 76th round of the National Sample Survey (NSS), which was conducted between July 2018 and December 2018, were used in this study. Binomial logistic regression was used to find the association between access to disability-related healthcare and sociodemographic characteristics.

Results

The prevalence of VD in the general population was 0.23%. About 15% of people with VD did not have access to healthcare for disability. Access was lower in the older age group (Adjusted Odds Ratio (AOR) =0.68) than in the younger age group, females (AOR = 0.89), persons with low literacy (AOR = 0.72), low consumption expenditure (AOR = 0.60), and people belonging to the scheduled tribes (STs) (AOR = 0.57). Affordability was the leading reason for poor accessibility. About 55% of people with VD had zero out-of-pocket expenditure (OOPE), 35.8% had monthly OOPE below INR 1000, and 1.3% had monthly OOPE INR >5000.

Conclusion

The study found gaps in access to healthcare in people with VD in India. This population is falling behind in the core elements of UHC, i.e. affordability and inequality. India should adopt a comprehensive strategy that includes age-specific interventions, improved rural access, measures for socioeconomic equity, gender sensitivity, and expanded public health insurance coverage and social security schemes for people with VD.

Disability and its sociodemographic correlates among older people in Nepal: evidence from the 2022 Nepal Demographic Health Survey

BACKGROUND

Older people are more vulnerable and have a higher risk of having a disability. There are very few studies on disability among older people in Nepal. To fill this knowledge and research gap, this study examines the prevalence and analyzes sociodemographic correlates of disability among older people in Nepal.

METHODS

The 2022 Nepal Demographic and Health Survey data was used for this study. The study included 3014 older people aged 60 years and above. The Washington Group Short Set Questions were used to measure disability. Disability was categorized as 'with disability' and 'without disability'. Descriptive statistics were used to assess the prevalence of disability while multivariate logistic regression was used as inferential statistics to analyze sociodemographic correlates of disability.

RESULTS

The results show that more than a quarter (27%) of older people had disabilities. The prevalence of disability was higher among older people aged 80 years and above (54%), females (31%), no education (31%), widowed (40%), residing in Karnali province (39%), and those who belonged to poor household wealth (31%). This pattern was consistent in both older males and females. Older people aged 70-79 or 80 years and above, those who had no education or primary education and who were widowed, were more likely to have a disability. Older people from rich household wealth and from Koshi, Madhesh, Bagmati, Gandaki, Lumbini and Sudurpashchim provinces were less likely to have a disability.

CONCLUSIONS

The burden of disability among older people in Nepal is considerable. Therefore, there is a need for health interventions targeting the identified groups at risk of disability to improve the well-being of older people.

Evaluation of the effectiveness of novel oral hygiene aids in the prevention of gingival diseases in children and adolescents with special healthcare needs - A systematic review and meta-analysis

Background

Due to a lack of manual dexterity, impaired cognitive and general development, and awareness of caregivers, special children are not able to maintain good oral health. This leads to the development of dental plaque, gingival inflammation, and further periodontal diseases. It is, thus, necessary for dentists and caregivers to understand which of oral hygiene aids can be best suited for a child with special healthcare needs. The aim of this review is to evaluate the most efficacious oral healthcare aids in children and adolescents with special healthcare needs.

Materials and Methods

Systematic search was conducted in databases: PubMed, Cochrane, Google Scholar, Scopus, and ProQuest for studies published from January 1, 2000, till December 31, 2023. Randomized trials conducted among children and adolescents with special healthcare needs below 18 years using oral hygiene aids to reduce plaque were included in this review.

Results

A total of 23 articles satisfying eligibility criteria were included in the systematic review and 11 articles for meta-analysis. Meta-analysis was divided into two parts. Novel toothbrushes were more effective than manual toothbrushes with P = 0.01 (SMD: Standard Mean Difference) 95% confidence interval: -4.23 (-7.62, -0.85), I 2 = 99.63%). In chemical oral hygiene aids, chlorhexidine (CHX) spray at concentration of 0.12% was found to be more effective than placebo to control plaque and was not statistically significant.

Conclusion

Current evidence suggests that novel mechanical oral hygiene aids used with CHX spray as an adjunct can be best suited for children and adolescents with special healthcare needs to control plaque.

The Use of the Parents' Evaluation of Developmental Status and Developmental Milestones in Screening Children for Developmental Delay in India

BACKGROUND/OBJECTIVES

The Parents' Evaluation of Developmental Status (PEDS) and Developmental Milestones (PEDS:DM) are cost-effective, self-report tools that can be conveniently utilized in low- and middle-income countries to screen for developmental delays in children. This study assessed the diagnostic accuracy of PEDS and PEDS:DM in distinguishing children with typical development (TD) from those with developmental disabilities (DD). It also examined the relationship between parents' general concerns and specific developmental concerns about their children.

METHOD

The study included 407 children with TD and 59 children with DD, recruited from diverse socioeconomic backgrounds in Chandigarh, Himachal Pradesh, and the National Capital Region of India. Parents of children aged 4 to 8 years completed the PEDS and PEDS:DM online.

RESULTS

The PEDS demonstrated high sensitivity (91%) but low specificity (47%), whereas the PEDS:DM showed poor sensitivity (17%) and specificity (6%). Parents of TD children who expressed general developmental concerns were likely to report specific concerns related to behavior, self-help skills, health, and cognitive development. Parents of DD children with general concerns reported specific issues with fine motor skills, behavior, school performance, cognitive development, and health.

CONCLUSIONS

These findings suggest that while PEDS and PEDS:DM can support early detection of developmental delays, their interpretation should be approached with caution. The study provides preliminary insights into the applicability of these screening tools for children aged 4-8 years in India.

A Study of Disability Severity, Barriers, and Facilitating Factors in Accessing Healthcare Among Differently Abled Adults

BACKGROUND

Disability impacts many individuals, thus restricting access to necessary healthcare. Barriers that affect health equity among people with disabilities include physical inaccessibility, financial constraints, and stigma in society. This study aims to report on the level of disability and factors determining healthcare access among adult differently abled persons in Chennai, Tamil Nadu, focusing on the WHO Disability Assessment Schedule (WHODAS 2.0).

METHODS

In this cross-sectional study, 300 differently abled adults affiliated with the Tamil Nadu Udavikkaram Association participated. The severity of disability was assessed using WHODAS 2.0, while a structured questionnaire elicited details on socio-demographic characteristics, barriers to healthcare utilization, and facilitating factors. Data was analyzed using SPSS version 16 (IBM Corp., Armonk, New York, USA), with descriptive statistics and odds ratios calculated for key variables.

RESULTS

Most participants (N=286, 93%) had mild levels of disability with problems mainly in self-care and mobility. The main barriers reported were healthcare expenses, distance to facilities, and lack of family support. Key facilitators were government schemes and assistive devices. Socio-economic factors like income and education showed marked correlations with the severity of disability.

CONCLUSION

Healthcare access varies with disability severity, revealing a need for targeted financial, familial, and accessibility interventions to reduce disparity. Future longitudinal studies may provide insights into the development of policies and programs to support individuals living with disabilities.

Oral health status of children with intellectual and developmental disabilities in India: a systematic review and meta-analysis

INTRODUCTION

India has committed to the Sustainable Development Goals (SDGs) 2030 principle of "Leave No One Behind", which seeks to reduce disparities and vulnerabilities. The dearth of data on the oral health conditions of children with intellectual and developmental (IDD) disabilities in India is significant. Our systematic review intended to collate and synthesise data on the oral health status of children with IDD.

METHODS

Online electronic databases such as PubMed-MEDLINE, Embase, and Scopus were searched using appropriate keywords from the earliest available data until 31st March 2024, with no language restriction. Cross-sectional studies conducted amongst individuals below 18 years of age with intellectual, or developmental disabilities, in India were included. Quality assessment and meta-analysis using a random-effects model for variables reported from four or more studies and a prediction interval was calculated.

RESULTS

Out of 2388 studies, a total of 15 studies were included. Our study showed that 91% (95% [confidence interval] CI: 0.80-0.96) of IDD children use toothbrushes regularly. However, poor oral hygiene was found among 38% (95% CI = 0.21-0.59) of IDD children. The pooled prevalence of dental caries among children was found to be 64% (95% CI: 0.45-0.79). Periodontal disease was reported in only one study among 54.20% of IDD children.

CONCLUSIONS

Our findings suggest that despite brushing regularly the incidence of caries and poor oral hygiene in children with IDD is high. Flexible, tailored interventions that go beyond a uniform approach must be implemented to effectively address oral health requirements of children with IDD. Specific Health Programmes should be established for their preventive oral care.

Lived experiences of diabetes self-management among persons with disabilities in rural Tamil Nadu - a case study approach

BACKGROUND

People with disabilities have numerous challenges in diabetes self-management. Poor self-management leads to the worsening of disability and secondary complications of diabetes. This study was conducted to explore the challenges in diabetes self-management and the factors influencing diabetes self-management among people with disabilities.

METHODS

We conducted 16 case studies among people with physical, neurological, visual, hearing, and multiple disabilities who were affected by diabetes. We adopted a thematic content analysis approach to analyse the data.

RESULTS

People with disabilities have challenges in adopting healthy diets as they are unable to purchase and consume fruits and vegetables which are costly, unavailable, and inaccessible. They have difficulty in doing physical activity due to lack of inclusive public spaces which are inaccessible, lack of motivation, and dependence on others for their mobility. Irregular drug supply in the public health system and unaffordable cost of drugs hamper adherence to medications. Laboratories are inaccessible to people with disabilities thus preventing monitoring of blood sugars. They have poor quality of life, life with pain and mental health issues, which prevent adoption of self-management behaviors. The intersectionality of age and gender with disability worsens self-management behaviors. Inaccessible health system, poor quality of health care and insensitive health care providers further complicate self-management.

CONCLUSION

This study documents the challenges faced by persons with disabilities in practicing diabetes self management. There is a need for public health policy and planning that is inclusive of persons with disabilities to make access to diabetes care universal.

Telehealth as a Strategy for Health Equity: A Scoping Review of Telehealth in India During and Following the COVID-19 Pandemic for People with Disabilities

Introduction: Telehealth in India is growing rapidly and represents a strategy to promote affordable, inclusive, timely and safe access to healthcare. Yet there is a risk that telehealth increases inequity due to the digital divide and existing poor health literacy. Methods: A scoping review was conducted to explore use of telehealth in India during and following the COVID-19 pandemic by people with disabilities to inform strategies to increase equity of telehealth for people with disabilities. Of 1966 studies from the initial search in four databases and three specific telehealth journals, 20 sources met the inclusion criteria, limited to a focus on physical disability in India. Results: Findings showed examples of how people with disabilities can exercise increased control in the timing of appointments, convenience of receiving services from home and not having to travel to clinics or hospitals, and platform preference through tools and applications already familiar to them. Carers and families of people with disabilities were described as highly valued stakeholders with important roles in the uptake and effectiveness of telehealth for people with disabilities. The identified benefits of telehealth resulted in high levels of user satisfaction due to increased control and convenience, however, systemic barriers for accessibility remain. Conclusion: This review suggested that if telehealth is not designed intentionally to change the status quo for people with disabilities and prioritize equity, then the benefits may not be sustainable. Recommendations for telehealth India are provided, based on both findings from the literature and analysis of results.

Socioeconomic and geographic variations of disabilities in India: evidence from the National Family Health Survey, 2019-21

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.

Rehabilitation Engineering: A Narrative Review on Recent Advances in Mobility Aids in India

Mobility has been characterized as the capacity to move across an environment safely, pleasantly, elegantly, and autonomously. India's current population is 1.4 billion, out of which 2.3%, i.e., 32 million people, are suffering from some kind of disability. With the rise in the geriatric population, the incidence of non-communicable and communicable diseases also rises and presents the risk of disorders that may progress to disability. People often neglect their disability and learn to live with it, even when most of them can use rehabilitation programs in conjunction with various mobility aids. Affordable access to adequate healthcare and assistive devices is limited, contributing to the challenges faced by disabled adults. Despite the potential for many disabled individuals to engage in productive work, their employment rates remain significantly lower. Mobility aids can provide significant benefits to individuals affected by a range of medical conditions, including arthritis, cerebral palsy, developmental disabilities, diabetic ulcers and wounds, fractures or broken bones, injuries, and walking impairments resulting from brain injury or stroke. Each person is different and may require help in a certain way for their disability, so choosing the most appropriate aid is crucial for the individual's well-being. Commonly used mobility aids are canes, walking sticks, walkers, and wheelchairs, with prostheses being used less commonly. With the advent of techniques such as state-of-the-art 3D printing and challenging surgeries, various Indian tech companies, along with non-governmental organizations (NGOs), have brought about many significant changes in the world of prosthesis by making it better, affordable, and accessible.

Leveraging monitoring, evaluation, and learning to scale the Enabling Inclusion® program for children with disabilities in India and globally

Introduction

Children with disabilities in low- and middle-income countries face many challenges and lack adequate services, including access to rehabilitation professionals. To address this lack of access, Amar Seva Sangam Ayikudy (ASSA), a non-governmental organization (NGO) in India, designed a technology-leveraged rehabilitation program called Enabling Inclusion® (EI®), and implemented it in one state (Tamil Nadu, India) before scaling it. The model is supported by the EI® app, which enables organizations to screen, assess and monitor progress of children with disabilities via rehabilitation specialists and community rehabilitation workers, and to provide family-centered, goal-based interventions. An extensive monitoring, evaluation, and learning (MEL) framework is embedded into the program. This paper explores how this MEL system supported the scaling of the EI® model, reaching additional beneficiaries nationally and globally.

Methods

This paper describes ASSA's MEL framework and demonstrates its use for decision-making in the process of scaling. It also explores how collaborations with various government departments, NGOs, and private partners contributed to the scaling of the EI® model and technology.

Results

Scaling of the EI® program was achieved by (1) expansion of the program in rural Tamil Nadu (vertical scale-up) in partnership with the Tamil Nadu government and private partners, and (2) by licensing the EI® app and model to other NGOs in various states in India and globally (horizontal scale-up). Systematic examination of key program and performance indicators, as well as stakeholder feedback, informed decisions to modify the EI® app over time. This included further customizing to the needs of children and service providers, covering a greater range of age groups and contexts, and modifying service delivery models. Child functional independence, participation, and inclusion was further strengthened by mobilizing parent empowerment groups, community awareness programs, school advocacy, and entitlements from the government. Flexibility in the implementation model of the EI® app allowed for adaptation to local contexts and organizations, and facilitated its scale-up.

Conclusion

A dynamic, inclusive, and locally grounded MEL system, a flexible and collaborative approach, and an adaptive implementation model increased the accessibility of an early intervention and childhood rehabilitation program for children with disabilities and their families throughout the state of Tamil Nadu, across India, and internationally.