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A Study of the Severity of Disability and Nutritional Status of People With

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A Study of the Severity of Disability and Nutritional Status of People With A STUDY OF THE SEVERITY OF DISABILITY AND NUTRITIONAL STATUS OF PEOPLE WITH DISABILITIES AND THE QUALITY OF LIFE AMONG PEOPLE WITH PHYSICAL DISABILITIES AND PRIMARY CAREGIVERS OF PEOPLE WITH DISABILITIES IN KANIYAMBADI BLOCK DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENT OF THE TAMILNADU DR. M.G.R MEDICAL UNIVERSITY, CHENNAI, FOR THE DEGREE OF MD BRANCH-XV (COMMUNITY MEDICINE) EXAMINATION TO BE HELD IN APRIL, 2015 CERTIFICATE This is to certify that “A study of the severity of disability and nutritional status of people with disabilities and quality of life among people with physical disabilities and primary caregivers of people with disabilities in Kaniyambadi block” is a bona fide work of Dr. Nancy Angeline G in partial fulfillment of the requirements for the M. D Community Medicine examination (Branch-XV) of the Tamilnadu Dr. M.G.R Medical University, Chennai, to be held in April, 2015. GUIDE HEAD OF THE DEPARTMENT . Dr. Vinod Joseph Abraham. MD, MPH Dr. Jasmin Helan Prasad. MD, MPH, DNB Professor Professor & Head Department of Community Health Department of Community Health Christian Medical College, Vellore. Christian Medical College, Vellore. PLAGIARISM CERTIFICATE ACKNOWLEDGEMENTS First and foremost I want to thank my mentor, guide and professor Dr. Vinod Joseph Abraham, for helping me complete my thesis. The Head of the Department and my professor Dr. Jasmin for believing in me and giving me heart warming encouragements when I needed the most. My professor, Dr. Kurien George, for always being eager to give a second chance to me and for his enquiries into the progress of my thesis. All my professors who taught me at various periods in my postgraduation . The Health Aides who taught me hands on Community Health. The PTCHWs who accompanied me during difficult walks in villages. The residents of the block who volunteered many a times to help me find a participant’s house. Occupational therapist, Mr. Samuel Prasanna and Social worker Mrs. Gifta, for their intense help in the focus group discussion. My best friend Divya V.S. and my batchmates Sam, Rohan, Sindhu and Bose for the friendship that we shared. My mother , father and sister for their unconditional love. All the participants and their caregivers for their co-operation. Mr. Damodaran, the librarian and Mr. Williams for the help with printing. Mr. Saravanakumar and Mr. Arun for teaching me bibliography. All staff in CHAD for their support. I thank God for being with me throughout. i ACRONYMS ADL – Activities of Daily Living AOR – Adjusted Odds Ratio BMI – Body Mass Index CC – Calf circumference CHAD – Community Health And Development CI - Confidence interval CMC - Christian Medical College EQ5D – Euroqol ICC – Interclass Correlation Coefficient ICF – International Classification of Functioning, disability and health ICIDH - International Classification of Impairment, Disability and Handicap IRB – Institutional Review Board IRT – Item Response Theory MAC – Mid Arm Circumference MNA – Mini Nutritional Assessment NSSO – National Sample Survey Organization PROs – Patient Reported Outcomes PTCHW – Part Time Community Health Worker PWD – People With Disabilities act QALY – Quality Adjusted Life Years QLI – Quality of Life Index QOL – Quality Of Life SES – Socio Economic Status UPIAS – The Union of the Physically Impaired Against Segregation UN – United Nations WHO – World Health Organization WHO DAS 2.0 – World Health Organization Disability Assessment Schedule 2.0 WHO QOL-BREF – World Health Organization Quality of life Brief form ii INDEX OF TABLES AND FIGURES Table no. Title of Table Page Table 3.1 Description of ICF Components and domains 12 Table 3.2 Definitions of different types of education 24 Table 3.3 Definitions of different types of occupation 25 Description of WHO classification of adult underweight, Table 3.4 33 overweight and obesity according to BMI Table 3.5 Domains in WHOQOL-BREF and their corresponding facets 44 Table 4.1 Computation of domain scores for WHOQOL- BREF 49 Table 4.2 Percent of body weight contributed by specific body part 59 Table 4.3 Screening scores for Mini Nutritional Assessment (MNA) scale 60 Table 4.4 Scoring for malnutrition indicator scores for MNA scale 60 International classification of functioning, disability and health Table 4.5 61 (ICF) grading Table 5.1 Distribution of the people with disabilities by age 63 Table 5.2 Distribution of the people with disabilities by marital status 64 Table 5.3 Distribution of the people with disabilities by literacy status 64 Table 5.4 Distribution of the people with disabilities by education 65 Table 5.5 Distribution of the people with disabilities by occupation 65 Distribution of the people with disabilities by the total monthly Table 5.6 66 family income in Rupees Distribution of the people with disabilities by the education of the Table 5.7 66 head of the household iii Table No. Title of table Page Distribution of the people with disabilities by the occupation of the Table 5.8 67 head of the household Table 5.9 Distribution of the study population by socio-economic status 67 Table 5.10 Distribution of the study population by type of house 68 Table 5.11 Distribution of the study population by type of family 68 Table 5.12 Distribution of the study population by religion 68 Table 5.13 Distribution of impairments among the people with disabilities 69 Distribution of the people with disabilities by number of Table 5.14 69 impairments Table 5.15 Distribution of the people with disabilities by type of disability 70 Table 5.16 Distribution of cause of disability among the people with disability 70 Table 5.17 Distribution of the people with disabilities by type of co-morbidity 71 Table 5.18 Distribution of the people with disabilities by use of aids 72 Distribution of different types of aids used by the people with Table 5.19 72 physical disabilities Distribution of people with disabilities by receipt of disability Table 5.20 72 pension Table 5.21 Distribution of males with disabilities by use of alcohol or tobacco 73 Distribution of Body Mass Index (BMI) of persons with disabilities Table 5.22 73 as per the WHO classification Distribution of primary caregivers of the people with disabilities by Table 5.23 74 age Distribution of primary caregivers by their relation with the person Table 5.24 75 with disability Description of duration of disability among the people with Table 5.25 75 disability Duration of caregiving and the primary caregiver’s relation with the Table 5.26 76 person with disability Prevalence of malnutrition (by Mini Nutritional Assessment scale Table 5.27 76 screening scores) among the people with disability iv Table No. Title of table Page Percentage of malnutrition among the people with disability as per Table 5.28 77 the malnutrition indicator score Distribution of the people with disabilities by the number of meals Table 5.29 77 taken in a day Distribution of the people with disabilities by their view on Table 5.30 77 nutritional status Distribution of the people with disabilities by Mid-Arm Table 5.31 78 Circumference (MAC) Distribution of the people with disabilities by Calf circumference Table 5.32 78 (CC) Table 5.33 Distribution of the people with disabilities by decline in food intake 78 Table 5.34 Distribution of the people with disabilities by protein consumption 79 Distribution of the people with physical disabilities by their self rate Table 5.35 79 of quality of life Description of domain wise scores of quality of life among the Table 5.36 80 people with physical disabilities Distribution of the people with physical disabilities by their Table 5.37 80 satisfaction with health Distribution of the people with physical disabilities by their Table 5.38 81 frequency of negative feelings Distribution of primary caregivers of the people with disabilities by Table 5.39 81 their self rating of quality of life Description of domain wise scores of quality of life among the Table 5.40 82 primary caregivers of people with disabilities Description of primary caregivers of people with disabilites by their Table 5.41 82 satisfaction with health Distribution of the primary caregivers of people with disabilities by Table 5.42 82 their frequency of negative feelings Description of domain wise scores of Disability Assessment Table 5.43 83 Schedule (DAS) among the people with disabilities Distribution of the people with disabilities by the number of days in Table 5.44 which he/she was totally unable to carry out usual activities in the 84 past one month Distribution of people with visual disabilities by International Table 5.45 Classification of Functioning, disability and health (ICF) grading of 85 difficulty in seeing Distribution of people with hearing/speech disabilites by ICF Table 5.46 85 grading of difficulties in hearing v Table no. Title of table Page Distribution of people with disabilities by ICF grading of difficulty Table 5.47 86 in employment Distribution of people with disabilities by ICF grading of difficulty Table 5.48 86 in community life Effect of socio-economic status on the quality of life of people with Table 5.49 88 physical disabilities Factors affecting the physical domain of quality of life of people Table 5.50 89 with physical disabilites Factors affecting the psychological domain of quality of life of Table 5.51 90 people with physical disabilities Factors affecting the social domain of quality of life of people with Table 5.52 91 physical disabilities Factors affecting the environmental domain of quality of life of Table 5.53 92 people
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