Multiple Chronic Diseases and Their Linkages with Functional health and Subjective Wellbeing among adults in the low-middle income countries: An Analysis of SAGE Wave1 Data, 2007/10

This paper examines the prevalence and determinants of multiple chronic diseases and their association with the self-rated health, functional health and quality of life among adults in six SAGE countries: China, India, Russia, South Africa Mexico and Ghana. We use ADL and IADL activities as measures of functional health and WHOQoL index as a measure of quality of life. Poisson regression models are estimated to understand the social determinants of multiple chronic diseases. Logit models and OLS are estimated to examine the association between multiple chronic morbidities and self-rated health, functional health and quality of life. Russia had the highest prevalence of multi-morbidity (32.8%, 95%CI=25.5-41.1) followed by South Africa (22%, 95%CI=17.7-26.9); the other four countries had prevalence of multi-morbidity around 21%. Measures of socioeconomic status: education and wealth were found negatively associated with the number of chronic diseases. Higher number of chronic conditions was associated with the poorer self rated health, functional health and WHOQoL

Socioeconomic and age gradients of health of Indian adults: an assessment of self-reported and performance-based measures of health

Objectives: This paper describes the age patterns of socioeconomic gradients of health of Indian adults for multiple health indicators encompassing the multidimensional nature of health. Methods: Cross-sectional data on 11,230 Indians aged 18-plus from the WHO-SAGE India Wave 1, 2007 is used. Multivariate logit models were estimated to examine the effects of socioeconomic status (education and household wealth) and age on four health measures: self-rated health, self-reporting functioning, chronic diseases, and performance-based health indicators. Findings: Socioeconomic status was positively associated with each health measure but with considerable heterogeneity across age groups. SES relationship with biomarkers (hypertension and COPD) was inconclusive. SES effects are significant while adjusting for background characteristics and health risk factors. The age patterns of SES gradient of health depict divergence with age, however, no conclusive age pattern emerged for performance-based health indicators. Discussion: Overall, results in this paper dispelled the conclusion of negative SES-health association found in some previous Indian studies and reinforced the hypothesis of positive association of SES with health for Indian adults. Higher prevalence of negative health outcomes and SES disparities of health outcomes among older age-groups highlight need for inclusive and focused health care interventions for older adults across socioeconomic spectrum

Socioeconomic and age gradients of health of Indian adults: an assessment of self-reported and performance-based measures of health

Objectives: This paper describes the age patterns of socioeconomic gradients of health of Indian adults for multiple health indicators encompassing the multidimensional nature of health. Methods: Cross-sectional data on 11,230 Indians aged 18-plus from the WHO-SAGE India Wave 1, 2007 is used. Multivariate logit models were estimated to examine the effects of socioeconomic status (education and household wealth) and age on four health measures: self-rated health, self-reporting functioning, chronic diseases, and performance-based health indicators. Findings: Socioeconomic status was positively associated with each health measure but with considerable heterogeneity across age groups. SES relationship with biomarkers (hypertension and COPD) was inconclusive. SES effects are significant while adjusting for background characteristics and health risk factors. The age patterns of SES gradient of health depict divergence with age, however, no conclusive age pattern emerged for performance-based health indicators. Discussion: Overall, results in this paper dispelled the conclusion of negative SES-health association found in some previous Indian studies and reinforced the hypothesis of positive association of SES with health for Indian adults. Higher prevalence of negative health outcomes and SES disparities of health outcomes among older age-groups highlight need for inclusive and focused health care interventions for older adults across socioeconomic spectrum

Multiple Chronic Diseases and Their Linkages with Functional health and Subjective Wellbeing among adults in the low-middle income countries: An Analysis of SAGE Wave1 Data, 2007/10

This paper examines the prevalence and determinants of multiple chronic diseases and their association with the self-rated health, functional health and quality of life among adults in six SAGE countries: China, India, Russia, South Africa Mexico and Ghana. We use ADL and IADL activities as measures of functional health and WHOQoL index as a measure of quality of life. Poisson regression models are estimated to understand the social determinants of multiple chronic diseases. Logit models and OLS are estimated to examine the association between multiple chronic morbidities and self-rated health, functional health and quality of life. Russia had the highest prevalence of multi-morbidity (32.8%, 95%CI=25.5-41.1) followed by South Africa (22%, 95%CI=17.7-26.9); the other four countries had prevalence of multi-morbidity around 21%. Measures of socioeconomic status: education and wealth were found negatively associated with the number of chronic diseases. Higher number of chronic conditions was associated with the poorer self rated health, functional health and WHOQoL

The impact of multimorbidity on adult physical and mental health in low- and middle-income countries: what does the study on global ageing and adult health (SAGE) reveal?

BACKGROUND: Chronic diseases contribute a large share of disease burden in low- and middle-income countries (LMICs). Chronic diseases have a tendency to occur simultaneously and where there are two or more such conditions, this is termed as 'multimorbidity'. Multimorbidity is associated with adverse health outcomes, but limited research has been undertaken in LMICs. Therefore, this study examines the prevalence and correlates of multimorbidity as well as the associations between multimorbidity and self-rated health, activities of daily living (ADLs), quality of life, and depression across six LMICs. METHODS: Data was obtained from the WHO's Study on global AGEing and adult health (SAGE) Wave-1 (2007/10). This was a cross-sectional population based survey performed in LMICs, namely China, Ghana, India, Mexico, Russia, and South Africa, including 42,236 adults aged 18 years and older. Multimorbidity was measured as the simultaneous presence of two or more of eight chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, and vision impairment. Associations with four health outcomes were examined, namely ADL limitation, self-rated health, depression, and a quality of life index. Random-intercept multilevel regression models were used on pooled data from the six countries. RESULTS: The prevalence of morbidity and multimorbidity was 54.2 % and 21.9 %, respectively, in the pooled sample of six countries. Russia had the highest prevalence of multimorbidity (34.7 %) whereas China had the lowest (20.3 %). The likelihood of multimorbidity was higher in older age groups and was lower in those with higher socioeconomic status. In the pooled sample, the prevalence of 1+ ADL limitation was 14 %, depression 5.7 %, self-rated poor health 11.6 %, and mean quality of life score was 54.4. Substantial cross-country variations were seen in the four health outcome measures. The prevalence of 1+ ADL limitation, poor self-rated health, and depression increased whereas quality of life declined markedly with an increase in number of diseases. CONCLUSIONS: Findings highlight the challenge of multimorbidity in LMICs, particularly among the lower socioeconomic groups, and the pressing need for reorientation of health care resources considering the distribution of multimorbidity and its adverse effect on health outcomes

Multi-Morbidity, Functional Limitations, and Self-Rated Health Among Older Adults in India

This article describes the prevalence of multi-morbidity and its association with self-rated and functional health using Longitudinal Aging Study in India (LASI), Pilot survey, 2010 data, on 1,683 older adults aged 45+. The prevalence of multi-morbidity is assessed as count of self-reported chronic diseases for an older adult. Limitations in activities of daily living (ADL) are used as a measure of functional health. Zero-inflated Poisson regression is estimated to examine the covariates of multi-morbidity. Moreover, logit models are used to assess the association of multi-morbidity with functional health and self-rated health. Results depict a large prevalence of multi-morbidity, limitations in ADL and poor self-rated health with pronounced state variations. Prevalence of multimorbidity was higher at higher level of education, wealth, and caste. However, educational status of older adults is seen to be negatively associated with prevalence of ADL limitations and poor self-rated health. Household wealth and caste showed no clear association with limitations in ADL and poor self-rated health. Multi-morbid older adults were found with substantially high risk of ADL limitations and poor self-rated health

Monotone Bartlett-type correction for some test statistics under nonnormality (Asymptotic Statistical Theory)

Exposure to air pollution produced by cooking is common in developing countries, and represents a potentially avoidable cause of lung disease. Cross-sectional data were collected by the World Health Organization's Study on Global AGEing and Adult Health conducted in India between 2007 and 2010. Exposure to biomass cooking was also associated with a decrease in forced expiratory volume in 1 s (FEV1) (-70 ml, 95%CI -111 to -30) and FEV1/FVC (forced vital capacity) ratio (-0.025, 95%CI -0.035 to -0.015) compared to those who were not exposed. These associations were predominantly observed in males (P < 0.05 for interaction analyses). Intervention studies using non-biomass fuels in India are required to ascertain potential respiratory health benefits

Infection prevention preparedness and practices for female sterilization services within primary care facilities in Northern India

Background: In 2014, 16 women died following female sterilization operations in Bilaspur, a district in central India. In addition to those 16 deaths, 70 women were hospitalized for critical conditions (Sharma, Lancet 384,2014). Although the government of India’s guidelines for female sterilization mandate infection prevention practices, little is known about the extent of infection prevention preparedness and practice during sterilization procedures that are part of the country’s primary health care services. This study assesses facility readiness for infection prevention and adherence to infection prevention practices during female sterilization procedures in rural northern India. Method: The data for this study were collected in 2016–2017 as part of a family planning quality of care survey in selected public health facilities in Bihar (n = 100), and public (n = 120) and private health facilities (n = 97) in Uttar Pradesh. Descriptive analysis examined the extent of facility readiness for infection prevention (availability of handwashing facilities, new or sterilized gloves, antiseptic lotion, and equipment for sterilization). Correlation and multivariate statistical methods were used to examine the role of facility readiness and provider behaviors on infection prevention practices during female sterilization. Result: Across the three health sectors, 62% of facilities featured all four infection prevention components. Sterilized equipment was lacking in all three health sectors. In facilities with all four components, provider adherence to infection prevention practices occurred in only 68% of female sterilization procedures. In Bihar, 76% of public health facilities evinced all four components of infection prevention, and in those facilities provider’s adherence to infection prevention practices was almost universal. In Uttar Pradesh, where only 55% of public health facilities had all four components, provider adherence to infection prevention practices occurred in only 43% of female sterilization procedures. Conclusion: The findings suggest that facility preparedness for infection prevention does play an important role in provider adherence to infection prevention practices. This phenomenon is not universal, however. Not all doctors from facilities prepared for infection prevention adhere to the practices, highlighting the need to change provider attitudes. Unprepared facilities need to procure required equipment and supplies to ensure the universal practice of infection prevention