Assessment of consistency between self reported health status and performance based health status (functionality) as measures of health status of adults in the Kassena-Nankana District, Ghana at the beginning of 21st century

M.Sc.(Med.), Faculty of Health Sciences, University of the Witwatersrand, 2009Introduction: Despite the steady growth of the elderly population in developing countries, this group, remains neglected in health related policies in developing countries, largely due to lack of empirical data on the health problems of elderly. There is need for research and development of convenient and cost effective ways of generating information on the health status of the elderly. Self reports of health are becoming common in health surveys of elderly throughout the world. Despite the considerable use of self reports in developed countries, in developing countries such research is only beginning. Therefore there is need for systematic documentation of factors affecting self reported health status in developing country settings for effective usage of self reports in surveys. Material and methods: The Adult Health and Aging Survey undertaken by Navrongo Health Research Centre, Ghana, as part of WHO SAGE (Study on Global Aging) aimed at generating longitudinal data on health and wellbeing of the elderly in Kassena-Nankana district of Ghana. This survey provides an opportunity to assess consistency between various dimensions of self reported health by comparing measures in an effort to establish the validity of information obtained by self reports. Analysis: Statistical analysis of self reported overall health (SRH), experiences of difficulty encountered in work and day to day activities (Overall Difficulty) and component experiences of health over various domains was carried out using ordered logistic regression and kappa analysis in order to understand what type of relationship exists between different types of measures of health. Overall self reported status of health (SRH) was the main outcome variable and three sets of variables were used as explanatory variables. The first set of variables captured functionality, the second captured psychosocial aspects of health, while the third involved demographic characteristics as possible confounders. Results: An analysis involving 4483 elderly individuals showed that functionality was associated with overall self reported health status in both summary and component forms. Addition of psychosocial domains to the model improved the model when summary functionality was used. However, addition of possible confounders did not improve the model. Conclusion and recommendations: The findings indicate that sex, marital status and ethnic background are important factors to be taken into account while interpreting the responses of self reported health in the Kassena-Nankana district of Ghana. For the current analysis both outcome and explanatory variables were self reported. The findings of the study would get validated with further research into associations between self reported measures and performance based measures and qualitative inquiries on meanings of overall and component health experiences in the same population

Validating a GPS-based approach to detect health facility visits against maternal response to prompted recall survey

INTRODUCTION: Common approaches to measure health behaviors rely on participant responses and are subject to bias. Technology-based alternatives, particularly using GPS, address these biases while opening new channels for research. This study describes the development and implementation of a GPS-based approach to detect health facility visits in rural Pune district, India. METHODS: Participants were mothers of under-five year old children within the Vadu Demographic Surveillance area. Participants received GPS-enabled smartphones pre-installed with a location-aware application to continuously record and transmit participant location data to a central server. Data were analyzed to identify health facility visits according to a parameter-based approach, optimal thresholds of which were calibrated through a simulation exercise. Lists of GPS-detected health facility visits were generated at each of six follow-up home visits and reviewed with participants through prompted recall survey, confirming visits which were correctly identified. Detected visits were analyzed using logistic regression to explore factors associated with the identification of false positive GPS-detected visits. RESULTS: We enrolled 200 participants and completed 1098 follow-up visits over the six-month study period. Prompted recall surveys were completed for 694 follow-up visits with one or more GPS-detected health facility visits. While the approach performed well during calibration (positive predictive value (PPV) 78%), performance was poor when applied to participant data. Only 440 of 22 251 detected visits were confirmed (PPV 2%). False positives increased as participants spent more time in areas of high health facility density (odds ratio (OR) = 2.29, 95% confidence interval (CI) = 1.62-3.25). Visits detected at facilities other than hospitals and clinics were also more likely to be false positives (OR = 2.78, 95% CI = 1.65-4.67) as were visits detected to facilities nearby participant homes, with the likelihood decreasing as distance increased (OR = 0.89, 95% CI = 0.82-0.97). Visit duration was not associated with confirmation status. CONCLUSIONS: The optimal parameter combination for health facility visits simulated by field workers substantially overestimated health visits from participant GPS data. This study provides useful insights into the challenges in detecting health facility visits where providers are numerous, highly clustered within urban centers and located near residential areas of the population which they serve

Social gradients in self-reported health and well-being among adults aged 50 and over in Pune District, India

Background: India’s older population is projected to increase up to 96 million by 2011 with older people accounting for 18% of its population by 2051. The Study on Global Ageing and Adult Health aims to improve empirical understanding of health and well-being of older adults in developing countries. Objectives: To examine age and socio-economic changes on a range of key domains in self-reported health and well-being amongst older adults. Design: A cross-sectional survey of 5,430 adults aged 50 and over using a shortened version of the SAGE questionnaire to assess self-reported assessments (scales of 1–5) of performance, function, disability, quality of life and well-being. Self-reported responses were calibrated using anchoring vignettes in eight key domains of mobility, self-care, pain, cognition, interpersonal relationships, sleep/energy, affect, and vision. WHO Disability Assessment Schedule Index and WHO health scores were calculated to examine for associations with socio-demographic variables. Results: Disability in all domains increased with increasing age and decreasing levels of education. Females and the oldest old without a living spouse reported poorer health status and greater disability across all domains. Performance and functionality self-reports were similar across all SES quintiles. Self-reports on quality of life were not significantly influenced by socio-demographic variables. Discussion: The study provides standardised and comparable self-rated health data using anchoring vignettes in an older population. Though expectations of good health, function and performance decrease with age, self-reports of disability severity significantly increased with age, more so if female, if uneducated and living without a spouse. However, the presence or absence of spouse did not significantly alter quality of life self-reports, suggesting a possible protective effect provided by traditional joint family structures in India, where older people are social if not financial assets for their children

Evaluating the sustainability, scalability, and replicability of an STH transmission interruption intervention: The DeWorm3 implementation science protocol.

Hybrid trials that include both clinical and implementation science outcomes are increasingly relevant for public health researchers that aim to rapidly translate study findings into evidence-based practice. The DeWorm3 Project is a series of hybrid trials testing the feasibility of interrupting the transmission of soil transmitted helminths (STH), while conducting implementation science research that contextualizes clinical research findings and provides guidance on opportunities to optimize delivery of STH interventions. The purpose of DeWorm3 implementation science studies is to ensure rapid and efficient translation of evidence into practice. DeWorm3 will use stakeholder mapping to identify individuals who influence or are influenced by school-based or community-wide mass drug administration (MDA) for STH and to evaluate network dynamics that may affect study outcomes and future policy development. Individual interviews and focus groups will generate the qualitative data needed to identify factors that shape, contextualize, and explain DeWorm3 trial outputs and outcomes. Structural readiness surveys will be used to evaluate the factors that drive health system readiness to implement novel interventions, such as community-wide MDA for STH, in order to target change management activities and identify opportunities for sustaining or scaling the intervention. Process mapping will be used to understand what aspects of the intervention are adaptable across heterogeneous implementation settings and to identify contextually-relevant modifiable bottlenecks that may be addressed to improve the intervention delivery process and to achieve intervention outputs. Lastly, intervention costs and incremental cost-effectiveness will be evaluated to compare the efficiency of community-wide MDA to standard-of-care targeted MDA both over the duration of the trial and over a longer elimination time horizon

Psychosocial stress associated with sanitation practices : experiences of women in a rural community in India

This study examined sources of psychosocial stress related to the use of toilet facilities or open defecation by women and adolescent girls at home, public places, workplaces and in schools in a rural community in Pune, India. The mixed methods approach included focus group discussions among women, key informant interviews, free listing and a community survey of 306 women. Nine per cent of the study households and most seasonal migrant women workers lacked access to toilets. Fear for personal safety, injury or accidents, lack of cleanliness, indignity, shame and embarrassment due to a lack of privacy were significant sources of stress related to open defecation. Seasonal migrant women workers perceived the lack of privacy as a significant source of psychosocial stress but did not fear for their personal safety or injuries, despite their general lack of access to toilet facilities. Women resorting to open defecation feel stressed and harassed by community leaders trying to enforce open defecation-free policies. Our study highlights the need for sanitation programs to consider the specific needs of women with regard to latrine maintenance, safety and privacy offered by sanitation installations. Specific strategies to address the sanitation and hygiene issues of seasonal migrant populations are also required.</jats:p

Demographic surveillance over 12 years helps elicit determinants of low birth weights in India.

BackgroundLow birth weight is an important predictor of maternal and child health. Birth weight is likely to be affected by maternal health, socioeconomic status and quality of health care facilities.ObjectiveTo assess trends in the birth weight, the proportion of low birth weight, maternal factors and health care facilities for delivery in villages of Western Maharashtra from the year 2004 to 2016 and to analyze factors associated with low birth weight for total birth data of 2004-2016.MethodsData collected for 19244 births from 22 villages in Vadu Health and Demographic Surveillance System (HDSS), Pune, Maharashtra, India from the year 2004 to 2016 were used for this analysis.ResultsThere was an overall increase in the annual mean birth weight from 2640.12 gram [95% CI 2602.21-2686.84] in the year 2004 to 2781.19 gram [95% CI 2749.49-2797.95] in the year 2016. There was no secular trend to show increase or decrease in the proportion of low weight at birth. Increasing maternal age (>18 years) compounded with better education, reduced parity and increasing number of institutional deliveries were significant trends observed during the past decade. Low birth weight was found to be associated with female gender, first birth order, poor maternal education and occupation as cultivation.ConclusionChanges in maternal age, education, occupation, and increased institutionalized deliveries contributed in to increasing birth weights in rural Maharashtra. Female gender, first birth order, poor maternal education and occupation of cultivation are associated with increased risk of low birth weight