Measuring Disability in Population-Based Surveys: The relationship between clinical impairments, self-reported functional limitations and equal opportunities in two Low and Middle Income Country settings

Background: Measuring disability in population-based surveys is imperative to support the meaningful inclusion of persons with disabilities in their societies. Disability is a complex bio-psycho-social phenomenon incorporating dysfunctioning in any of three interlinked levels (impairments in body function or structure, activity limitations or participation restrictions), resulting from the interaction between a health condition and contextual factors. There is little consensus on how to measure different components of disability in population-based surveys, or how these components inter-relate. A comprehensive population-based methodology is needed to be able to assess the prevalence and lived experience of disability, incorporating the three levels at which dysfunctioning occurs. Study Aim: To develop and undertake a comprehensive population-based survey methodology of disability in two settings and i) use this to explore the inter-relationship between tools measuring different components of disability ii) assess the prevalence and iii) lived experience of disability, including predictors of inclusion. Methods: A scoping review of the literature was undertaken to inform the development of an all-age population-based survey of disability. Population-based surveys (n=4080) of disability incorporating measures of impairment (vision, hearing, musculoskeletal, depression), activity limitation (Washington Group Extended Set) and participation restrictions (SINTEF participation module) were undertaken in one district each of Cameroon (North West Region, 2013) and India (Telangana State, 2014). A nested case-control study of people with and without disabilities was undertaken, to identify predictors of inclusion (e.g. access to health and rehabilitation, education, livelihoods). Key Findings: Overall disability prevalence was 12.2% (India) and 10.5% (Cameroon). Approximately 40% of people in each setting who screened positive for a clinical impairment did not report a functional limitation. A self-reported functional limitation tool followed by clinical screening of all those who report any level of difficulty would identify 94% of persons with disabilities in Cameroon and 95% in India, meeting the study criteria. Persons with disabilities in both settings experienced unequal opportunities. Children with disabilities were at least ten times less likely to be enrolled in education than children without disabilities; whilst adults with disabilities were five times less likely to be working than adults without disabilities, and between twice (Cameroon) and three times (India) more likely to have experienced a significant health problem in the past year. Conclusion: This study provides a suggested way forward for the measurement of disability in population-based surveys that would support the meaningful inclusion of persons with disabilities in their societies

[Accepted Manuscript] Field testing a draft version of the UNICEF/Washington Group Module on child functioning and disability. Background, methodology and preliminary findings from Cameroon and India

Background Global child disability data are generally non-comparable, comprising different tools, methodologies and disability definitions. UNICEF and The Washington Group on Disability Statistics (WG) have developed a new tool on child functioning and disability to address this need. Aims The aim of this paper is to describe the development of the new module, and to present an independent field test of the draft module in two contrasting settings. Methods UNICEF and the WG developed a parent-reported survey module to identify children aged 2�17 years with functional difficulties in population-based surveys through: review of existing documentation, consultation with experts and cognitive testing. A field test of the draft module was undertaken in Cameroon and India within a population-based survey. Functional limitation in each of 14 domains was scored on a scale comprising �no difficulty�, �some difficulty�, �a lot of difficulty� and �cannot do�. Results In all, 1713 children in Cameroon and 1101 children in India were assessed. Sixty-four percent of children in Cameroon and 35% of children in India were reported to have at least some difficulty in one or more domain. The proportion reported to have either �a lot of difficulty� or �cannot do� was 9% in Cameroon and 4% in India. There were no significant differences in reported functional difficulties by sex but children aged 2�4 were reported to have fewer functional difficulties of any kind compared with older children in both countries. Conclusion Comparable estimates were generated between the two countries, providing an initial overview of the tool's outputs. The continued development of this standardised questionnaire for the collection of robust and reliable data on child disability is essential

In vivo three-dimensional blood velocity profile shapes in the human common, internal, and external carotid arteries

Objective: True understanding of carotid bifurcation pathophysiology requires a detailed knowledge of the hemodynamic conditions within the arteries. Data on carotid artery hemodynamics are usually based on simplified, computer-based, or in vitro experimental models, most of which assume that the velocity profiles are axially symmetric away from the carotid bulb. Modeling accuracy and, more importantly, our understanding of the pathophysiology of carotid bifurcation disease could be considerably improved by more precise knowledge of the in vivo flow properties within the human carotid artery. The purpose of this work was to determine the three-dimensional pulsatile velocity profiles of human carotid arteries. Methods: Flow velocities were measured over the cardiac cycle using duplex ultrasonography, before and after endarterectomy, in the surgically exposed common (CCA), internal (ICA), and external (ECA) carotid arteries (n = 16) proximal and distal to the stenosis/endarterectomy zone. These measurements were linked to a standardized grid across the flow lumina of the CCA, ICA, and ECA. The individual velocities were then used to build mean three-dimensional pulsatile velocity profiles for each of the carotid artery branches. Results: Pulsatile velocity profiles in all arteries were asymmetric about the arterial centerline. Posterior velocities were higher than anterior velocities in all arteries. In the CCA and ECA, velocities were higher laterally, while in the ICA, velocities were higher medially. Pre- and postendarterectomy velocity profiles were significantly different. After endarterectomy, velocity values increased in the common and internal and decreased in the external carotid artery. Conclusions: The in vivo hemodynamics of the human carotid artery are different from those used in most current computer-based and in vitro models. The new information on three-dimensional blood velocity profiles can be used to design models that more closely replicate the actual hemodynamic conditions within the carotid bifurcation. Such models can be used to further improve our understanding of the pathophysiologic processes leading to stroke and for the rational design of medical and interventional therapies

Outcomes of Aortic Surgery for Abdominal Aortic Graft Infections

Background: Literature on postoperative outcomes following aortic surgery for aortic graft infection (AGI) is limited by relatively small sample sizes, resulting in lack of national benchmarks for quality of care. We report in-hospital outcomes following abdominal aortic surgery for AGI and identify factors associated with postoperative complications using the Nationwide Inpatient Sample (NIS) database. Methods: Patients who underwent aortic graft resection for AGI were identified from the 2002 to 2008 NIS database, a multicenter database capturing 20% of all US admissions. Multivariable logistic regression analyses were performed. Results: Among 394 patients (men: 73.4%) who underwent abdominal aortic surgery for AGI, 53% of the admissions were emergent/urgent. A significant trend for decreasing number of abdominal aortic surgery for AGIs per year was observed (Pearson r correlation: -.96; P = .0006). Over the same time span, a significant correlation was also seen with decrease in open and increase in endovascular aortic aneurysm repairs in the NIS database. In-hospital rates of overall postoperative morbidity and mortality were 68.3% and 19.8%, respectively. In-hospital rates of postoperative respiratory failure, renal failure, and cardiac arrest were 35.5%, 14.2%, and 8.9%, respectively. Median length of stay was 26 days, with median hospital charges being US$184 162. On multivariable analysis, increase in age per year (odds ratio [OR] 1.07; 95% confidence interval [CI]: 1.03-1.12) was independently associated with postoperative morbidity, while higher hospital volume for this procedure was protective (OR: 0.71; 95% CI: 0.56-0.89). No preoperative factors were independently associated with postoperative mortality. Conclusion: Incidence of abdominal aortic surgery for AGI has progressively declined over the span of our study in association with decreased open and increased endovascular aortic aneurysm repairs. Aortic surgery for AGI is associated with very high morbidity and mortality rates along with prolonged lengths of stay and elevated hospital charges. The outcomes of operations for AGI are better in younger patients and higher volume hospitals

The impact of the Lesotho Child Grant Programme in the lives of children and adults with disabilities: Disaggregated analysis of a community randomized controlled trial

Globally, people with disabilities are disproportionally affected by poverty. Social protection policies, including cash transfers, are key strategies to address poverty “in all its forms”, but it is currently unclear how such programmes affect people with disabilities. This study examines differences in the impact of the Lesotho Child Grant Programme (CGP) on food security, health, education and livelihoods between people with and without disabilities using data from a community randomized control trial. Overall, this study finds the CGP had significant and differential impacts for people with disabilities across multiple health indicators (e.g. increased health expenditures, self-rated health, likelihood of seeking healthcare). The CGP also had an impact on food security, decreasing the number of months households with and without members with disabilities faced extreme food shortages. There was also a modest but significant and differential impact of the CGP on the engagement of people with disabilities in paid work. The CGP only had an impact on school enrolment for children without disabilities, however the difference in impact was non-significant and likely due to underpowered sample sizes. Overall, people with disabilities receiving the CGP still experienced high levels of absolute deprivation, and were generally still worse off compared to people without disabilities, indicating a need for adapted or complementary social protection and other poverty alleviation programmes

Prevalence of blindness and distance vision impairment in the Gambia across three decades of eye health programming.

BACKGROUND/AIMS: The 1986 Gambia National Eye Health Survey provided baseline data for a National Eye Health Programme. A second survey in 1996 evaluated changes in population eye health a decade later. We completed a third survey in 2019, to determine the current state of population eye health, considering service developments and demographic change. METHODS: We estimated prevalence and causes of vision impairment (VI) in a nationally representative population-based sample of adults 35 years and older. We used multistage cluster random sampling to sample 10 800 adults 35 and above in 360 clusters of 30. We measured monocular distance visual acuity (uncorrected and with available correction) using Peek Acuity. Participants with either eye uncorrected or presenting (with available correction) acuity <6/12 were retested with pinhole and refraction, and dilated exams were completed on all eyes by ophthalmologists using a direct ophthalmoscope, slit lamp and 90 D lens. RESULTS: We examined 9188 participants (response rate 83%). The 2013 census age-sex adjusted prevalence of blindness (presenting acuity<3/60 in better seeing eye) was 1.2% (95% CI 0.9 to 1.4) and of moderate or severe VI (MSVI,<6/18 to ≥3/60) was 8.9% (95% CI 9.1 to 9.7). Prevalence of all distance VI (<6/12) was 13.4% (12.4-14.4). Compared with 1996, the relative risk of blindness decreased (risk ratio 0.7, 95% CI 0.5 to 1.0) and MSVI increased (risk ratio 1.5, 95% CI 1.2 to 0.17). CONCLUSION: Significant progress has been made to reduce blindness and increase access to eye health across the Gambia, with further work is needed to decrease the risk of MSVI

Socioeconomic position and eye health outcomes: identifying inequality in rapid population-based surveys

OBJECTIVE: Monitoring health outcomes disaggregated by socioeconomic position (SEP) is crucial to ensure no one is left behind in efforts to achieve universal health coverage. In eye health planning, rapid population surveys are most commonly implemented; these need an SEP measure that is feasible to collect within the constraints of a streamlined examination protocol. We aimed to assess whether each of four SEP measures identified inequality-an underserved group or socioeconomic gradient-in key eye health outcomes. DESIGN: Population-based cross-sectional survey. PARTICIPANTS: A subset of 4020 adults 50 years and older from a nationally representative sample of 9188 adults aged 35 years and older in The Gambia. OUTCOME MEASURES: Blindness (presenting visual acuity (PVA) <3/60), any vision impairment (VI) (PVA <6/12), cataract surgical coverage (CSC) and effective cataract surgical coverage (eCSC) at two operable cataract thresholds (<6/12 and <6/60) analysed by one objective asset-based measure (EquityTool) and three subjective measures of relative SEP (a self-reported economic ladder question and self-reported household food adequacy and income sufficiency). RESULTS: Subjective household food adequacy and income sufficiency demonstrated a socioeconomic gradient (queuing pattern) in point estimates of any VI and CSC and eCSC at both operable cataract thresholds. Any VI, CSC <6/60 and eCSC <6/60 were worse among people who reported inadequate household food compared with those with just adequate food. Any VI and CSC <6/60 were worse among people who reported not enough household income compared with those with just enough income. Neither the subjective economic ladder question nor the objective asset-wealth measure demonstrated any socioeconomic gradient or pattern of inequality in any of the eye health outcomes. CONCLUSION: We recommend pilot-testing self-reported food adequacy and income sufficiency as SEP variables in vision and eye health surveys in other locations, including assessing the acceptability, reliability and repeatability of each question