Awareness and utilization of rehabilitation services among physically disabled people of rural population of a district of Uttar Pradesh, India

Abstract

Background: People with disabilities are more vulnerable than general population to a range of problem including fatigue, depression, and social isolation and have more limited access to health care. It is among the poorest communities that poverty breeds disablement and disablement breeds poverty, a vicious cycle that the poor can least affords. Most of the disabilities can be prevented if proper preventive and rehabilitative measures of impairments are undertaken. Aims & Objectives: To study awareness and utilization of rehabilitation services among disabled. Materials and Methods: Multistage sampling technique was used in this study. For determining target sample size, population proportionate sampling was used. All the family members who are regular resident of the village were considered for the study. Disability criteria of National Sample Survey (NSS) 2002, was used. Data was analyzed for rates and proportions. Results: Prevalence of physical disabilities was 19.46 per 1000. 64.71% disabled were unaware about the availability of the rehabilitation services and unawareness was main reason for not availing rehabilitation services. Amongst physically disabled, 65.85% discontinued the treatment and 19.51% had not taken treatment at all. Conclusion: There is lack of awareness and utilization regarding the available rehabilitation services in the country. Physical disability was found to be higher among illiterates and community having low and medium standard of living.

Full text

Dhananjay K Srivastava, et al. Utilization of available rehabilitation services
International Journal of Medical Science and Public Health | 2014 | Vol 3 | Issue 9
AWARENESS AND UTILIZATION OF REHABILITATION SERVICES AMONG
PHYSICALLY DISABLED PEOPLE OF RURAL POPULATION OF A DISTRICT OF
UTTAR PRADESH, INDIA
Dhananjay K Srivastava1, Javed A Khan2, Sanjay Pandey3, Divya S Pillai4, Amit B Bhavsar4
1 Program Officer, Jhpiego—an affiliate of Johns Hopkins University, Jaipur, Rajasthan, India
2 Deputy Director, National Center for Disease Control, Delhi, India
3 Department of Community & Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
4 Senior Research Officer, Clinical Development Services Agency (CDSA), Surveillance Medical Officer, WHO - India
Correspondence to: Dhananjay K Srivastava (dhananjayshri@gmail.com)
DOI: 10.5455/ijmsph.2014.090720142 Received Date: 31.05.2014 Accepted Date: 09.07.2014
ABSTRACT
Background: People with disabilities are more vulnerable than general population to a range of problem including fatigue,
depression, and social isolation and have more limited access to health care. It is among the poorest communities that poverty breeds
disablement and disablement breeds poverty, a vicious cycle that the poor can least affords. Most of the disabili ties can be prevented
if proper preventive and rehabilitative measures of impairments are undertaken.
Aims & Objectives: To study awareness and utilization of rehabilitation services among disabled.
Materials and Methods: Multistage sampling technique was used in this study. For determining target sample size, population
proportionate sampling was used. All the family members who are regular resident of the village were considered for the study .
Disability criteria of National Sample Survey (NSS) 2002, was used. Data was analyzed for rates and proportions.
Results: Prevalence of physical disabilities was 19.46 per 1000. 64.71% disabled were unaware about the availability of the
rehabilitation services and unawareness was main reason for not availing rehabilitation services. Amongst physically disabled,
65.85% discontinued the treatment and 19.51% had not taken treatment at all.
Conclusion: There is lack of awareness and utilization regarding the available rehabilitation services in the country. Physical
disability was found to be higher among illiterates and community having low and medium standard of living.
Key Words: Physical Disability; Rehabilitation Services; Awareness; Utilization
Introduction
People with disabilities are more vulnerable than general
population to a range of problem including fatigue,
depression, and social isolation and have more limited
access to health care.[1,2] Evidences indicate that people
with disabilities smoke more, and exercise less as
compared to people not identified as having
disabilities.[3]
The inability to perform some key activities (e.g. basic
mobility, feeding, personal hygiene and safety
awareness) due to disability lead to dependency – the
need for human help (or care) beyond that customarily
required by a healthy adult. Most such help is given by
family members or other informal care givers.[4] Overall,
a country is greatly affected by the increasing number of
dependent people and would need to identify the human
and financial resources to support them. These increases
will occur more in the context of generally increasing
populations, and dependency ratios will increase
modestly to about 10%. The dependency ratio would
increase more in China (14%) and India (12%) than in
other areas with large prevalence increase.[5]
The occurrence of disability is high in developing
countries. It is among the poorest communities where
poverty breeds disablement and disablement breeds
poverty, a vicious cycle that the poor can least afford.
The majority of people with disabilities find that their
situation affects their chances of going to school, working
for a living, enjoying family life, and participating as
equals in social life. Quality of life is compromised not
only for the disabled person, but also for the family. The
presence of one person with disability in a family has
negative consequences of social stigma which affects the
entire household. Social segregation of disabled person
is also widespread. The mortality and morbidity among
disabled is much greater as compared to people without
disability.
Although most of the disabilities can be prevented if
proper preventive and rehabilitative measures of
impairments are undertaken, it is estimated that only 2%
of people with disabilities in developing countries have
access to rehabilitation and appropriate basic services.[6]
The public health community has traditionally paid little
attention to the health needs of people with
RESEARCH ARTICLE

Dhananjay K Srivastava, et al. Utilization of available rehabilitation services
International Journal of Medical Science and Public Health | 2014 | Vol 3 | Issue 9
disabilities.[7]According to WHO, people with disabilities
tend to seek more healthcare than people without
disabilities. They also have more unmet needs. Recent
surveys by WHO says that between 76 to 85% of people
with disabilities in developing countries receive no care.
The purpose of this study is to understand the awareness
and utilization level of health care services and
rehabilitation services among people with disabilities.
Materials and Methods
A cross sectional observational study was conducted
amongst rural population of Mau district in Uttar
Pradesh during February 2007 to June 2007. Mau is the
bastion of textile weavers in Eastern Uttar Pradesh. On
the basis of NSSO – 2002 and Census – 2001, prevalence
of disability at 2% was taken for sample size calculation.
With a 95% confidence coefficient and 30% allowable
error, the sample size was 2091for this study. Multistage
sampling technique was used in this study.
In the first stage, out of total nine community
development blocks four blocks were selected by
random number method. For determining target sample
size for each block, Population Proportionate Sampling
(PPS) was used. In the second stage, one village was
selected from the block wise list of villages by using
random number table. In third stage, the hamlets/tolas
of the village were enlisted and numbered serially. From
this list a hamlet/tola was selected. If any hamlet/tola
population was below the target sample size, another
tola was added to it.
In a family, all the members who are regular resident of
the village, were considered for the face to face
interview. Informed consent was taken prior to the
interview. All the disabled subjects were counseled and
informed about the available health care services and
rehabilitation. In case of female participant, interview
was conducted in the presence of another family
members or peer.
Disability criteria of National Sample Survey (NSS) 2002
was used which was based on functional limitation.
However, mental disability was not included in the
current study considering the infeasibility for assessing
the same. The interview schedule was translated and re-
translated in the local dialect and field tested / piloted,
before interviewing the study participants. Data was
analyzed for rates and proportions.
Results
This study covered 2107 subjects. To achieve the target
sample size of 2091; 285 families were surveyed in 4
villages of a district. The prevalence of physical
disabilities assessed among the study population was
19.46 per 1000 (n = 41). The most prevalent physical
disability was loco-motor disability (10.44 per 1000)
followed by hearing (4.27 per 1000), visual (3.80 per
1000) and speech disability (0.95 per 1000).
Table-1: Prevalence of physical disability (n= 41)
Type of Physical Disability
N (%)
Prevalence per 1000
Loco-motor
22* (53.66)
10.44
Hearing
9 (21.95)
4.27
Visual
8 (19.51)
3.80
Speech
2@ (4.88)
0.95
Total
41 (100)
19.46
* One loco-motor disabled person had speech disability also; @ One speech
disabled person had deafness also.
Table-2: Reasons for not taking treatment n=41
Reasons
A
B
C
D
Sub Total
(%)
Total
(%)
Financial
Problem
Stopped
0
4
3
0
7 (17.07)
10
(24.39)
Not taking
2
1
0
0
3 (7.32)
Ignorance
Stopped
0
0
1
0
1 (2.44)
6
(14.63)
Not taking
0
3
2
0
5 (12.19)
No
Improvement
Stopped
14*
0
3
2@
19 (46.34)
19
(46.34)
Not taking
0
0
0
0
0
Still continuing treatment
6
0
0
0
6 (14.63)
Total
22
8
9
2
41(100)
A: Loco-motor; B: Visual; C: Hearing; D: Speech; * One loco-motor
disabled person had speech disability also; @ One speech disabled person
had deafness also.
Table-3: Status of disability registration; n = 41
Status of
Certification
Loco-
motor
Visual
Hearing
Speech
Total
Yes
10*
0
0
0
10 (24.39%)
No
12
8
9
2@
31 (75.61%)
Total
22
8
9
2
41 (100%)
* One loco-motor disabled person had speech disability also; @ One speech
disabled person had deafness also.
Table-4: Status of rehabilitation services; n = 41
Type of
Disability
Availed
Not
Availed
Medical
Vocational
Social
Psycho
social
Total
Loco-
motor
5
0
0
0
5
17*
Visual
1
0
0
0
1
7
Hearing
1
0
0
0
1
8
Speech
-
0
0
0
0
2@
Total
7
0
0
0
7
(17.07%)
34
(82.93%)
* One loco-motor disabled person had speech disability also; @ One speech
disabled person had deafness also.
Among the study participants with loco-motor
disabilities, 65.85% (n = 14) discontinued the treatment
and 19.51% (n = 2) had not taken any treatment at all.
Other study participants with visual, hearing and speech
disabilities stopped their treatment or never took
treatment for their disabilities. Overall, 24.39% disabled

Dhananjay K Srivastava, et al. Utilization of available rehabilitation services
International Journal of Medical Science and Public Health | 2014 | Vol 3 | Issue 9
were not able to take treatment or had to stop their
treatment because of financial crisis. No improvement
(46.34%) and financial problems (17.07%) were given as
reasons for discontinuing the treatment. Among those
who didnt take treatment due to financial reason
(7.32%) 50% were visually disabled and12.19% of them
were not taking treatment due to ignorance which covers
60% visually disabled.
Figure-1: Status of disabled currently under medical supervision;
n = 41
Figure-2: Source of availed rehabilitation services; n = 7
Figure-3: Reason for not availing rehabilitation services; n = 34
Those who registered at district hospital, in 24.39%
cases, were having loco-motor disability. No one with
visual, hearing or speech disability was registered.
Rehabilitation services were not availed in 82.93% cases
and others (17.07%) sought only medical type of
rehabilitation services. Other types of rehabilitation
services, like vocational, social or psychosocial, were not
availed by any disabled. In 71.43% cases, rehabilitation
services were availed by family itself that is without any
support from the government or other agencies.
Rehabilitation services through NGOs were only in
28.57% cases.
Unawareness was the main reason for not availing
rehabilitation services (64.71%). Financial problem,
negligence and non – cooperation from family members
contribute 14.71%, 8.82% and 11.76% respectively for
not being offered rehabilitation services to disabled.
Discussion
In developing countries, it was estimated that not more
than 2% - 3% of the disabled could benefit from
rehabilitation services.[8] Significant disparities in health
and medical care utilization were found for adult with
developmental disabilities relative to non-disabled
adults.[9] There is considerable need for the
improvement of facilities, services and opportunities for
the disabled.[10]
In the Somerset health district, 53 of the 181 disabled
subjects had unmet needs for aids to allow independence
in activities of daily living. This study shows that the
needs of severely physically disabled adults in a
community, especially those with progressive disorders,
are being monitored inadequately by health
professionals.[11] The treatment seeking behaviour of
disabled persons reflects a wider differential according
to different background characteristics.[12] Another study
in rural Bangladesh showed that around 81% of the
disabled had utilized some kind of healthcare, while
more than half consulted unqualified practitioners of
modern medicine.[13]
A study conducted in Tamil Nadu found that 98% of the
visually disabled did not use spectacles, and only 1.5% of
them expressed the need for spectacles. 96% of the
hearing disabled did not use hearing aids. Only 3% of the
disabled expressed the need for hearing and other aids
like crutches, tricycles and callipers.[14] Chopra A et al.
observed in the COPARD study conducted in rural India,
that only 21 % of the patients had never visited the
doctor.[15]

Dhananjay K Srivastava, et al. Utilization of available rehabilitation services
International Journal of Medical Science and Public Health | 2014 | Vol 3 | Issue 9
In the sample of companies selected for the study, the
rate of employment of disabled persons was only 0.4% of
the total work force, only 13% of what The People with
Disabilities Act prescribes as desirable. Many public
sector companies also do not employ disabled persons,
even though it is legally binding on them to fill 3% in all
categories of jobs with disabled people.[16]
Disler PB et al. observed that 80% of the study
population had no contact with health services in black
residential area of the Cape Peninsula.[17] Osman and
Rampal observed that 42 (85.7%) of the 49 cases had
received treatment in a Malay Community in Tanjung
Karang, Kuala Selangor.[18] Various studies have
observed different reasons for non-utility of
rehabilitative services. Patel SK states that treatment
seeking behaviour of disabled persons depends not only
on socio-economic factors but also on cultural factors,
area of residence, literacy status, sex etc.[12]
Limitations: The study was questionnaire based.
Medical examination and record analysis for the cases
were not done, which might have result in losing
valuable data. This could have been captured if all means
of data collection had been adopted. Precise
measurement of disability was done in the present study,
so this wouldnt give any estimate about severity or
extent of physical disability.
Quality of life in the disabled was not included in the
study so there is a gap on how the disabled fare in
Activities of Daily Living. Income and expenditure survey
in the disabled were not included in the study so there is
a gap regarding their dependency status.
Conclusion
Majority of disabled population in this study was
illiterate and belonged to lower and backward caste.
They were not aware of the available rehabilitation
services and very poor access to available rehabilitation
services. Thus it is recommended that an awareness
program be devised and implemented to make the
disabled aware of the available rehabilitation services.
There should be a comprehensive health care package
for the disabled such as special medical camps at the
village level for cataract operations and periodic medical
care for the other types of disabilities special
arrangement to accommodate them in small scale
industries which can be home based or industrial based
according to their capacity.
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Cite this article as: Srivastava DK, Khan JA, Pandey S, Pillai DS, Bhavsar AB. Awareness and utilization of rehabilitation services among physically
disabled people of rural population of a district of Uttar Pradesh, India. Int J Med Sci Public Health 2014;3 (Online First). DOI:
10.5455/ijmsph.2014.090720142
Source of Support: Nil
Conflict of interest: None declared