Barriers to treatment-seeking for impairment of vision among elderly persons in a resettlement colony of Delhi: A population-based cross-sectional study.

Background & objectives: Uncorrected refractive error and cataract are the two most common causes of impairment of vision among elderly persons, and both are treatable. Treatment-seeking in patients is driven by symptom (decreased vision) rather than any anatomical or physiological measurement. The objective of this study was to evaluate the treatment-seeking behavior and barriers to treatment-seeking among elderly persons with impairment of vision in an urban resettlement colony of New Delhi, India. Methods: This community-based, cross-sectional study was conducted among 604 persons aged ≥60 yr selected by the simple random sampling. House-to-house visit was done, and a self-developed pretested semi-structured interview schedule was used to collect socio-demographic information, treatment-seeking behaviour and barriers to treatment-seeking. Results: Majority of participants reported impairment of vision (84%); 16.5 per cent of them did not visit any healthcare facility for their vision problem. Lack of felt need (48.1%) was the most common barrier to visiting healthcare facility. Of the 401 participants who gave a history of being prescribed spectacles, 277 (69%) used spectacles. Discomfort, lack of improvement in vision and lack of felt need were the most common reasons cited for non-usage. Among 300 participants who gave a history of cataract, 61 (20.3%) had not undergone cataract surgery. Lack of felt need was the most common barrier to cataract surgery. Interpretation & conclusions: A substantial proportion of elderly persons in the urban community have impairment of vision. Lack of felt need was the main reason for not visiting healthcare facility. As quality of spectacles was an important reported deterrent to use of spectacles, provision of appropriate refraction services and low-cost, good quality spectacles would be important.

Burden of falls among elderly persons in India: A systematic review and meta-analysis.

Background: . Falls are one of the leading causes of death and disability among elderly persons. In India, there is paucity of data on the prevalence of falls, particularly among community-dwelling elderly persons. To estimate healthcare costs related to falls and formulation of fall prevention strategies, there is a need of reliable estimates of magnitude of falls. We aimed to provide a community-based pooled estimate of the burden of falls among elderly persons in India. Methods: . A systematic literature search was done manually as well as electronically through PubMed, Google Scholar, Cochrane library, IndMed, Embase and WHO databases. Community-based original studies conducted in India were included. No restriction for the date was used. Meta-analysis was done using the random effects model. Results: . Sixteen studies were included in the review and meta-analysis. These studies included a total of 14 844 elderly persons, of which 2707 reported falling. The pooled prevalence of falls was found to be 31% (95% CI 23%-39%). There was significant heterogeneity between the studies (I2 = 98.08%, p<0.01). Conclusion: . There is a high prevalence of falls among elderly persons in India. However, the available studies have considerable methodological variations and are of limited quality. Realistic estimates are required for designing programmes for prevention of falls and for rehabilitation.

Correction: Disability and its association with sociodemographic factors among elderly persons residing in an urban resettlement colony, New Delhi, India.

[This corrects the article DOI: 10.1371/journal.pone.0222992.].

Sleep Quality Assessment of Adolescents Residing in an Urban Resettlement Colony, New Delhi, India.

BACKGROUND: Sleep is essential for physical and psychological development of children as well as adolescents. Poor sleep has been noted to lead to poor diet, obesity, stunted growth, mental health issues, and substance abuse. Despite the knowledge regarding the importance of sufficient sleep, the prevalence of insufficient sleep has been noted to increase among children and adolescents. OBJECTIVE AND AIM: The aim of the study was to determine the prevalence of poor sleep quality among adolescents of an urban resettlement colony and to evaluate the association of poor sleep quality with the correlates. MATERIALS AND METHODS: A community-based cross-sectional study was conducted including 620 adolescents aged 10-19 years, in an Urban Resettlement Colony, Dakshinpuri Extension, New Delhi. A self-reported interview was conducted with the pretested, semi-structured interview schedule. The interview focused on sociodemographic variable, sleep quality using Pittsburgh sleep quality index, Perceived stress scale, screen time, and anthropometric measurements. RESULTS: The mean of Pittsburgh sleep quality index total score was 2.3 (standard deviation = 1.9). Among the adolescents, 7.3% of them were found to be poor sleepers. Poor sleep quality was observed to be higher during school days as compared to vacation (9.3%, 6.5%, respectively). Adolescents of age group equal to and > 15 years have higher odds of having poor sleep quality than those younger than 15 years of age (odds ratio = 4.9; 95% confidence interval: 2.2, 10.8). CONCLUSION: Significant difference in sleep duration was noted among adolescents of age ≥15 years as compared to the younger group in the present study.

Disability and its association with sociodemographic factors among elderly persons residing in an urban resettlement colony, New Delhi, India.

Disability prevents an individual from performing to the fullest potential. It is multidimensional. Disability may be physical, mental, social, personal, and environmental or a combination of these. The elderly experience an increased burden of disability, especially in areas where there are limited resources and rapid urbanization. Comparison of reported disability is difficult because several definitions and scales are in use. We used the World Health Organization Disability Assessment Schedule version 2.0 (WHODAS 2.0) to study the prevalence of disability, and its association with sociodemographic factors among elderly persons residing in an urban resettlement colony, New Delhi, India. The WHODAS 2.0 provides continuous summary scores, where higher scores indicate higher disability, and vice versa. Elderly persons aged 60 years and above were selected by simple random sampling in this community-based cross-sectional study. Trained interviewers administered the semi-structured interview schedule and WHODAS 2.0. The prevalence of disability was 7.4% (5.8% - 9.3%) among the 931 participants. The prevalence was higher among females than males. Female sex, elderly aged 70 years and above, and those who were illiterate had increased risk of higher disability scores. Participants who were in government or private service had 50% decreased risk of having higher disability scores. The burden of disability was high among elderly persons residing in this resettlement colony. Community-based holistic interventions are required to mitigate the disability, and to improve the functioning of elderly persons.

Prevalence of visual impairment and its association with vision-related quality of life among elderly persons in a resettlement colony of Delhi.

BACKGROUND: The population of India is ageing. The number and percentage of elderly persons is increasing. Visual impairment is common among elderly persons and affects their vision-related quality of life. The objective of this study was to estimate the prevalence of visual impairment among elderly persons aged 60 years and above residing in a resettlement colony of Delhi and study its association with socio-demographic variables and vision-related quality of life. METHODS: A total of 604 elderly participants were selected by simple random sampling. House-to-house visit was done, and a self-developed pre-tested semi-structured interview schedule was used to collect socio-demographic information. Visual acuity was measured using Snellen's chart, and distant direct ophthalmoscopy was done to diagnose cataract. Vision-related quality of life was assessed by Indian Vision Function Questionnaire-33 (IND-VFQ-33). RESULTS: Of the 604 participants, 555 (91.9%) were available for interview. The prevalence of visual impairment was 24.5% (95% CI: 20.9% - 28.1%). Cataract was the leading cause of visual impairment (50.7%), followed by uncorrected refractive error (36.8%). Illiteracy (aOR: 3.49, 1.37-8.87), economic dependence on family members (aOR: 1.92, 1.04 - 3.54), not currently working (aOR: 1.89, 1.20-2.98) and chewing of tobacco products (aOR: 2.56, 1.48-4.42) were significantly associated with visual impairment among study participants. Vison-related quality of life was worse among those with visual impairment. CONCLUSION: Burden of visual impairment is high among elderly persons living in urban resettlement colonies. It is largely avoidable. Eye-care services should be accessible and affordable to them.

Awareness and utilization of social welfare schemes by elderly persons residing in an urban resettlement colony of Delhi.

BACKGROUND: Demographic transition increased the proportion of elderly in India. Elderly persons experience increased economic dependency for their day-to-day existence. The Government of India provides monetary benefit through social welfare schemes. Health outcomes of the elderly improve when they are economically independent. We aimed to assess the awareness and utilization of social welfare schemes among elderly persons in an urban resettlement colony of Delhi. MATERIALS AND METHODS: This was a community-based cross-sectional study conducted from February to May 2018. Two specially recruited interviewers administered the self-developed semi-structured interview schedule. It consisted of sociodemographic data, awareness, and utilization of various schemes. RESULTS: A total of 931 [416 (37.4%) males and 515 (55.3%) females] participants completed the interview. Of the total, 809 (86.9%) participants were aware of at least one social welfare scheme. Participants utilizing any of the social welfare schemes were 393 (42.2%). Females utilized the social welfare schemes almost twice as compared to males (AOR = 1.7, 95% CI: 1.1-2.6). Participants aged 75 years and above had four times higher utilization of social welfare schemes compared to 60-64 years age group (AOR = 3.9, 95% CI: 2.4-6.4). CONCLUSION: Although the awareness of social welfare schemes among elderly persons was good, their utilization has scope for significant improvement. Focus is needed on elderly males and among the younger elderly persons.

Relationship between height and arm span of elderly persons in an urban colony of New Delhi.

Anthropometric changes take place with increasing age. Progressive loss of height makes it difficult to use height for calculation of body mass index in nutritional screening of elderly persons. There is a need to find other alternative methods which could be used as proxy measurements of height in them. To assess the relationship of height and arm span and among elderly persons. A community-based cross-sectional study was conducted among elderly persons in urban colony of Delhi. Height and arm span of persons aged 60 years and above (n = 711) were measured according to standard methods. Correlation between arm span and height was calculated. The mean arm span was seen to be more than the mean height in all age-groups and both sexes. There was a linear relationship between height and arm-span in all age-groups. There was a strong correlation between arm span and height in all age groups. Arm span could be used instead of height as an alternative in the conventional body mass index in elderly persons.

Screen-based media use and screen time assessment among adolescents residing in an Urban Resettlement Colony in New Delhi, India.

BACKGROUND: Media forms an important part of the lives of adolescents in as much as the shows they watch on television, playing video games, as well as visiting the various websites. There is a growing concern of the influence of media on every aspect of health of children and adolescents. About 95% of the population in India has availability of television. India has limited studies which have explored the use of screen-based media (SBM) and its effect on child health. This study was conducted to assess the pattern of SBM use. METHODS: A community-based cross-sectional study was conducted in an Urban Resettlement Colony, New Delhi. The study included 550 adolescents of age group from 10 to 19 years of age selected through simple random sampling from a list of adolescents residing in the area. A semi-structured interview schedule was used. RESULTS: About 98% of the adolescents used SBM. Television formed the maximum used media (96.5%). The mean (standard deviation) of the screen time was found to be 3.8 (2.77) h/day. Out of the total screen time, time contributed by television is 2.8 h/day followed by other SBM. About 68% of adolescents reported having screen time more than the recommended (>2 h). Significant association was observed between screen time and watching television while eating [odds ratio (95% confidence interval) = 0.35 (0.22, 0.55)]. CONCLUSION: High proportion of adolescents use SBM for more than the recommended screen time. We should have a recommendation for maximum screen time separately for developing countries.

Acute morbidity profile and treatment seeking behaviour among people residing in an urban resettlement colony in Delhi, India.

BACKGROUND: Rapid urbanization has resulted in increased burden of communicable and non-communicable diseases, especially among urban poor population. In the absence of a well-functioning three tier health care system in urban India, health needs of urban poor are rarely fulfilled. The objective of this study was to assess primary health care services utilization pattern and its associated selected socio-demographic determinants in an urban population of Dakshinpuri Extension, South-east district of Delhi. MATERIALS AND METHODS: A community based cross-sectional study was done from November 2013 to November 2014 with a sample size of 440 households through simple random sampling. Information was obtained regarding the socio-demographic characteristics and morbidity pattern of all the members of household in the preceding one year of the conduct of the present study through a pretested semi structured interview schedule. Association of various socio-demographic characteristics with primary and secondary health care facilities utilisation was studied with bivariate and multivariate logistic regression. RESULTS: In this study, 42% of the household members suffered from acute illnesses and symptoms in the preceding one year. Secondary/tertiary health care facilities were approached mostly for seeking treatment. Majority of the household members sought treatment from private health care facilities. Significantly higher utilisation of secondary/tertiary health care facilities was found by head of households and household members who are married. CONCLUSION: Primary health care system needs to be revamped to improve healthcare delivery among urban population. Strategies to decongest secondary/tertiary health care facilities in urban India needs focus.

A study of falls among elderly persons in a rural area of Haryana.

BACKGROUND: Falls are a common, disabling, and frequently fatal health concern among elderly persons. Assessment of the prevalence of falls and associated factors can lead to the identification of corrective measures, which can help in preventing falls and their consequent effects on health and well-being of the elderly. OBJECTIVES: The objective is to determine the prevalence of falls among elderly persons in a rural area and to study the association of falls with sociodemographic variables and selected health conditions. METHODS: In a community-based, cross-sectional study conducted among 456 elderly persons in a rural area, information regarding sociodemographic details, selected health conditions, and history of falls in the past 12 months was recorded. Univariate analysis followed by stepwise multivariate logistic regression analysis was carried out. The effect of sociodemographic and various health conditions on falls was analyzed using logistic regression analysis. RESULTS: Among the 456 study participants, the prevalence of falls in the past 12 months was 36.6% (95% confidence interval [CI] =32.1-40.0). The prevalence among women was 40.6% (95% CI = 34.5-46.7) and among men was 31.5% (95% CI = 25.0-37.9). Low socioeconomic status, urgency of micturition, knee pain, visual impairment, hearing impairment, functional disability, and depression were significantly associated with falls. CONCLUSIONS: Falls are common among elderly persons. Health programs for the elderly must include prevention of falls and rehabilitation of fall-related injuries.

Water and Sanitation Hygiene Practices for Under-Five Children among Households of Sugali Tribe of Chittoor District, Andhra Pradesh, India.

BACKGROUND: Increased mortality is associated with poor household water, sanitation, and hygiene (WaSH) practices. The objective was to study the WaSH practices for under-five children among households of Sugali Tribe, Chittoor district, Andhra Pradesh, India. METHODS: A community-based cross-sectional study was conducted in four mandals in 2012. A total of 500 households with under-five children were identified. Data was collected from mothers/caregivers. A summary WaSH score was generated from four specific indices, water, sanitation, hygiene, and hand washing practices, and determinants were identified. RESULTS: Of the total households, 69% reported doing nothing at home to make the water safe for drinking. Over 90% of the households reported storing water in a utensil covered with a lid and retrieving water by dipping glass in the vessels. Open defecation was a commonly reported practice (84.8%). About three-fifths of the study's households reported using water and soap for cleaning dirty hands and one-third (37.4%) reported using water and soap after defecation. The median WaSH score was 15. In the hierarchical stepwise multiple linear regression, only socioeconomic variables were significantly associated with WaSH score. CONCLUSION: WaSH related practices were generally poor in people of the Sugali Tribe in Andhra Pradesh, India.

Unintentional Childhood Injuries in Urban Delhi: A Community-Based Study.

BACKGROUND: Childhood injuries claim around a million lives around the world each year. A community-based study on childhood injuries would provide valuable information on the epidemiology of injuries. OBJECTIVE: To assess the prevalence of unintentional childhood injuries in an urban locality and determine various sociodemo graphic factors associated with childhood injuries. METHODS: The study was done in urban Delhi among 1,639 children aged less than 18 years. Information on injuries in the last one year was collected. Only those injury episodes where treatment was sought or the child was left disabled after the injury were included. Treatment seeking behavior and the impact of injury on the child and the household were also assessed. RESULTS: Among 1,639 children, 102 children suffered 116 episodes of various types of injuries in the last one year. Prevalence of injuries was 7.1% (95% CI: 5.9-8.4). Mean age was 8.5 ± 5.1 years. Prevalence was more in boys (8.4%) than girls (5.1%). Accidental falls (37.1%), dog bites (25%), and road traffic injuries (18.9%) were the three most common modes of injury. Two-thirds of children with injuries were taken to the emergency facility for treatment while 40% resorted to home remedies. Treatment expenses in some families led to the need for borrowing money, additional employment by another family member, and selling of household assets. CONCLUSIONS: The prevalence of childhood injuries in the past one year was 7.1%. Maximum injuries occurred at home and were mostly accidental falls and dog bites. Childhood injuries caused loss of school attendance and financial burden to the family.

Prevalence of malnutrition, diarrhea, and acute respiratory infections among under-five children of Sugali tribe of Chittoor district, Andhra Pradesh, India.

INTRODUCTION: Over a period, tribal population has migrated to cities in search of livelihood. Data on various health problems of the tribes are sparse. Sugalis constitute the third largest tribe in Andhra Pradesh and have settlements in urban areas. OBJECTIVE: To estimate the prevalence of malnutrition, diarrhea, and acute respiratory infections (ARI) among under-five children of Sugali tribe living in Chittoor district of Andhra Pradesh state in South India. MATERIALS AND METHODS: A community-based cross-sectional study was conducted in four community blocks/mandals in 2012. A total of 500 Sugali households with under-five were identified. Demographic details, episodes of diarrhea, and ARI among under-five children and treatment/care seeking behavior were collected from mothers/care givers by interview. Nutritional status was assessed using new WHO standards. RESULTS: Of the total 669 children in these 500 households, 343 (51.3%) were girls and 326 (48.7%) were boys. In the last 1 month, 21.4% (18.4-24.6) reported diarrhea and 51.6% (47.7-55.3) reported ARI. The prevalence of underweight, wasting, and stunting among under-five children was 32.7% (29.1-36.4), 18.3% (15.3-21.4), and 38.3% (34.2-41.9), respectively. Majority (70%) sought treatment for illness in modern system of medicine and only few continued with the practice of herbs and traditional medicine. DISCUSSION: Despite living in urban area, the tribal children had high prevalence of malnutrition, diarrhea, and ARI, though lower compared to other tribes in India possibly due to improved access to health care services. Efforts need to be strengthened for social inclusion of tribes into mainstream.

Burden of Hypertension and Diabetes among Urban Population Aged ≥ 60 years in South Delhi: A Community Based Study.

INTRODUCTION: India is going through a demographic transition, and the number of elderly is expected to increase both in absolute numbers, as well as in proportion. The elderly are one of the most vulnerable and high-risk group in terms of health status in any society, and more so for non- communicable diseases. AIMS: To estimate the prevalence of diabetes and hypertension among elderly persons and association with socio-demographic variables; & to assess the awareness, treatment and control status of those with diabetes and hypertension. MATERIALS AND METHODS: A cross-sectional community based study was carried out in a resettlement colony of South-east Delhi in Dakshinpuri Extension, Dr. Ambedkar Nagar. Elderly persons aged 60 years and above were selected by cluster random sampling. Information about self-reported diseases, socio-demographic variables was collected; fasting blood sugar and blood pressure were measured. Prevalence of diabetes and hypertension were calculated and association was tested by Chi-square test. Multivariate logistic regression analysis was used. RESULTS: A total of 710 elderly persons participated in the study. Diabetes was seen in 24.0% and 67% were hypertensive. Isolated hypertension was detected in 25.9%. No statistically significant difference by gender (p=0.11), age (p=0.16), education (p=0.31) and economic dependency (p=0.28), was seen in both diabetes and hypertension. Out of 167 persons with diabetes, 62.3% were on treatment and 33.6% were under control; while out of 477 hypertensives, 41% were under treatment and only one-third of them had their blood pressure under control. CONCLUSION: This study highlighted a significant burden of non-communicable diseases amongst elderly persons in a low-middle class community in Delhi. It also showed the lack of awareness about their disease conditions and need for screening, diagnostic and treatment services at the primary level.

Work-related Neck Pain Among Desk Job Workers of Tertiary Care Hospital in New Delhi, India: Burden and Determinants.

BACKGROUND: Work-related Neck Pain (WRNP) is a leading cause of disability and absenteeism. There is dearth of information about burden and determinants of WRNP in health facility setting in India. MATERIALS AND METHODS: A cross-sectional study was carried out at tertiary care hospital in New Delhi. All Group C desk job workers involved in the administrative work were included in the study. Participants were screened for WRNP by using pretested semi-structured questionnaire. Detailed information on probable risk factors was collected among patients with WRNP. Neck examination by trained investigator was done. Work place assessment was done by using observation check-list using the recommendations of the ISO Standard (Ergonomic requirements for office work with visual display terminals). Crude and adjusted odds ratio was calculated with 95% confidence interval to understand the determinants of WRNP. RESULTS: In total, 441 participants were included in the study. Of them, 58% were males. Majority of participants aged between31-50 years. One-year prevalence of neck pain and WRNP was reported as 43.3%, (95% CI 38.7%-47.9%) and 28.3%, (95% CI 24.3%-32.7%) respectively. On multivariate analysis, female gender (OR-2.0 95% CI) and poor perception of breaks during working hours (OR-2.4 95% CI), along with work place related factors such as posture (OR-5.4 95% CI) and height of the screen (<10 cms) (OR-2.6) were identified as independent determinants of WRNP. CONCLUSION: High one-year prevalence of WRNP was reported among desk job workers. Burden of WRNP was reported more among females as compared to males. Most common factor identified was Computer use for more than 4-6 hours was most important predictor of WRNP followed by work related factors such as height of screen and posture are associated with WRNP.