|Year : 2015 | Volume
| Issue : 2 | Page : 115-119
Disability in the rural areas of Bareilly, India
Syed Esam Mahmood1, Arun Singh2, Zeashan H Zaidi3
1 Department of Community Medicine, Mahamaya Rajkiya Allopathic Medical College, Ambedkarnagar, India
2 Department of Community Medicine, Rohilkhand Medical College and Hospital, Bareilly, India
3 Department of Community Medicine, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
|Date of Web Publication||17-Jan-2016|
Syed Esam Mahmood
Department of Community Medicine, Mahamaya Rajkiya Allopathic Medical College, Ambedkarnagar, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Disability is one of the major public health problems in the developing countries. Eighty percent of the disabled reside in rural areas. Disability prevalence studies carried out in rural India are very few. Thus, studying the prevalence of disability in a rural community will be a useful contribution in proper health planning for the disabled.
Objectives: To determine the prevalence and distribution of disability in terms of age, gender, education, religion, socioeconomic status, and types in a rural community of Bareilly.
Materials and Methods: A cross-sectional study was conducted in the villages of Bithri Chainpur and Nawabganj Blocks of Bareilly District. A house to house survey was conducted in 25 villages. Chi-square test was used for statistical analysis.
Results: The overall prevalence of disability was found to be 37.0% (333 out of 900). One hundred and fifty-nine individuals had multiple disabilities. The most common type of disability was visual (27.33%), followed by locomotor disability (10.0%), hearing (9.66%), speech (4.0%), and mental disability (3.66%). The prevalence was found to be higher among males and those aged above 60 years. Higher prevalence was also found among the illiterates and those belonging to low socioeconomic strata.
Conclusion: The prevalence of disability was high in the study population. Better health policies, programs, and preventive measures to reduce the burden of disability in a rural community should be framed.
Keywords: Disability, India, prevalence, rural areas
|How to cite this article:|
Mahmood SE, Singh A, Zaidi ZH. Disability in the rural areas of Bareilly, India. Indian J Health Sci Biomed Res 2015;8:115-9
| Background|| |
Disability is associated with impairment, handicap, and well-being of a person. A disability has been defined as "any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being" (World Health Organization [WHO] 1980).  The Disabilities Act, 1995, states disabilities as visual, hearing, locomotor disability, and mental illness. According to WHO (1989) estimates, 10% of the world's population has some kind of disability and around 80% of the disabled population resides in rural areas.  Disability is a major public health problem in the developing countries. The reported disability prevalence rates vary dramatically due to differing definitions of disability, different methodologies of data collection, and variation in the quality of study design. The number of people with disabilities has been increasing because of war injuries, infectious diseases, malnutrition, chronic diseases, substance abuse, accidents, population growth, and medical advances (WHO 2005).  These disabilities cause poverty due to the barriers faced by the disabled in education, employment, and social activities. Primary prevention is the most effective way of reducing disability problem in the developing countries. Though government programs and policies have come up to provide income assistance and work-related supports to the disabled, awareness regarding the existing laws and social programs is low among the disabled.  Disability prevalence studies carried out in rural India are very few, especially in the Northern region. Such information can be a useful tool for developing community-based rehabilitation programs for the disabled. With this background, this study was conducted in the rural areas of the District Bareilly to determine the prevalence of disability and to find out the distribution of the disabilities in terms of age, gender, education, religion, socioeconomic status, and types.
| Materials and Methods|| |
A cross-sectional study was conducted during January-March 2012 in all the villages of Bithri Chainpur and Nawabganj Blocks of Bareilly District after getting ethical clearance from the institution. The study was carried out in the rural field practice area of Rural Health Training Centre of Department of Community Medicine, Rohilkhand Medical College and Hospital, Bareilly which covers a population of about 25,000 in over 25 villages. Probability proportional to size sampling technique was used to select the study sample from each village. Optimal sampling size was calculated on the basis of prior prevalence rate of disability of 10.0% reported by the WHO (1989). The sample size was calculated by the formula 4PQ/L 2 where P is the prevalence (10.0%), Q is 100-P = 90.0%, and L is the error, that is, 20%. Sample size came to be 900. A house to house survey was conducted by a team of trained doctors and medical social workers of the department using a predesigned, pretested schedule (annexure 1). All individuals residing in the selected households were interviewed after informed consent and further identified for any disability (locomotor, mental, visual, speech, and hearing). Detailed information regarding sociodemographic characteristics (age, gender, education, religion, and socioeconomic status) and deformity (physical, mental, or emotional health conditions) was collected. Modified Prasad's classification was applied to measure the individual's socioeconomic status.  The National Sample Survey Organization (2003) definitions of disabilities were adapted for uniformity. 
Operational definitions used
• A person with restrictions or lack of abilities to perform an activity in the manner or within the range considered normal for the human being was treated as having disability
• A person was considered as mentally disabled if he/she had difficulty in understanding the routine communication or showed unusual behavior (such as self-talking, laughing, crying, staring with no reason, violence without provocation or reason, fear and suspicion without reason, and lack of coherent memory)
• Individuals, who had no light perception even with both eyes or those with light perception but could not correctly count fingers of hand from a distance of 3 m even with spectacles or contact lenses in good daylight, were treated as visually disabled
• Individuals, who often asked for repetition of words or who felt difficulty in the conversation or had a tendency to see the face of the speaker, came under the category of moderate hearing disability. Persons, who could hear only shouted words or could hear only from a speaker in front, were considered as having a severe hearing disability. Persons, who could only hear loud sounds such as thunder or understand only gestures, were classified as having a profound hearing disability. An individual, who had any one of above three categories, was considered as having hearing disability in the present study
• Speech of a person was judged to be disordered if the listener did not understand her/his speech. This included those who could not speak at all, spoke with limited words or whose speech could not be understood due to stammering, nasal voice or hoarse voice or discordant voice or loss of speech
• Locomotor disabled person included those with loss or absence or inactivity of whole or part of limb (s) due to amputation, paralysis, deformity, or dysfunction of joints effecting normal ability to move him/her or move objects. Born disabled persons were also included in locomotor disability.
The individuals identified with disabilities were further referred to the medical college to specialists (psychiatrist, orthopedic surgeon, ophthalmologist, and otorhinologist) who examined them and certified those having a disability. The disabled were provided with spectacles, hearing aids, tricycle and calipers along with surgical corrections, physiotherapy, speech, and occupational therapies. Data entry was done using SPSS software windows version 14.0 software. Chi-square test and regression analysis were used to analyze the data.
| Results|| |
A total of 900 persons from the selected villages were surveyed. A total of 333 persons were identified with disabilities during the survey which were further confirmed to be disabled by specialists. The overall prevalence of disability was found to be 37.0%. One hundred and fifty-nine individuals had multiple disabilities. The most common type of disability was visual (246, 27.33%), followed by locomotor disability (90, 10.0%), hearing (87, 9.66%), speech (36, 4.0%), and mental disability (33, 3.66%).
The proportion of persons having disabilities significantly increased with the increase in age (P < 0.0001), being highest in the above 60 years of age group (79.59%) and lowest in 0-19 years of age group (16.66%). The present study showed that 62.16% (207) of disabled were males and 37.83% (126) were females, the difference being statistically significant (P < 0.0001). The proportion of disabilities was also found to be significantly higher among the illiterates as compared to the literate ones (P < 0.0001). The percentage prevalence of disabilities was highest in the lower class (37.03%), as compared to those belonging to the middle (33.33%) class, difference being statistically insignificant (P > 0.05). Statistically insignificant difference was also found with religion [Table 1]. Age, gender, and education were found significant on univariate analysis. Age and gender were found to be significant predictors to disability in the study population in the multivariate model [Table 2].
|Table 1: Prevalence of disability according to sociodemographic variables|
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|Table 2: Multivariate logistic regression analysis of predictors of disability|
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| Discussion|| |
In the current study, the overall prevalence of disability was found to be 37.0% which is much higher to that reported by National Sample Survey Organization (2003)  and Census (2001)  which revealed a prevalence of nearly 2%. In South-east Asia, the prevalence of disability ranges from 1.5% to 21.3% of the total population, depending on definition and severity of disability.  Pati  conducted a study in a rural community of Karnataka and reported a prevalence of 2.02%. In another recent community-based study conducted in rural Karnataka by Ganesh et al.,  a prevalence of 6.3% has been reported. The finding of disability prevalence of 4.87% in Sunsari District of Nepal reported by Karkee et al. is also much lower than our study.  Older rural studies by Pandit and Bhave in India and Hosain in Bangladesh have reported prevalence of 10.01% and 8.5%, respectively. , The differing prevalence rates of disability found in these studies are due to differences in the samples and definitions used. The most common type of disabilities observed in our study were visual (27.33%) and locomotor (10.0%). Kumar et al.  also found that locomotor disability was the commonest disability in their rural study. Similar findings were recorded in studies by Ganesh et al. and Karkee et al. , In the current study, the proportion of disabilities increased significantly with the increase in age, being highest in the individuals aged above 60 years. Similar findings have been reported by a study conducted in rural China by Alhajj et al.  A higher proportion of disability was found among males than females in our study. Gender wise differences in disability were found to be statistically significant (P < 0.05) in a study conducted among elderly people in Northern India by Joshi et al.  In contrast, no gender differences were observed in a study conducted in rural Tamil Nadu among the geriatric population by Venkatarao et al. The proportion of disabilities was also found to be significantly higher among the illiterates as compared to the literate ones in our study. Similar findings have been reported in studies by Ganesh et al. and Alhajj et al. , The percentage prevalence of disabilities was slightly higher in the lower class as compared to the middle class. The prevalence of disabilities was also found to be higher among the lower socioeconomic groups in studies by Pati and Borker et al. , Studies to determine the prevalence and pattern of disabilities in rural areas are few. Variations of prevalence rates of disabilities were found in different studies as there were no similar criteria adopted during survey and sampling. In some studies, the data were collected by workers having limited knowledge and training, and thus mild degrees of disability could not have been identified by them. The strengths of our study are that our results are based on a population survey of 25,000 individuals conducted by a team of trained doctors and workers. Those individuals identified with disabilities were further certified to be disabled by the specialists.
| Conclusion|| |
Early detection and medical intervention of disabilities in the rural population are the most important measures to be focused. Education, employment, nondiscrimination, vocational training, and rehabilitation of the persons with disability should be strengthened. Mass awareness through media on general health, hygiene, and sanitation should be promoted. Better health policies should be framed to reduce the burden of disease.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]
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