scholarly journals Epidemiology of multimorbidity in conditions of extreme poverty: a population-based study of older adults in rural Burkina Faso

2020 ◽  
Vol 5 (3) ◽  
pp. e002096
Author(s):  
Maria Lisa Odland ◽  
Collin Payne ◽  
Miles D Witham ◽  
Mark J Siedner ◽  
Till Bärnighausen ◽  
...  

IntroductionMultimorbidity is a health issue of increasing importance worldwide, and is likely to become particularly problematic in low-income countries (LICs) as they undergo economic, demographic and epidemiological transitions. Knowledge of the burden and consequences of multimorbidity in LICs is needed to inform appropriate interventions.MethodsA cross-sectional household survey collected data on morbidities and frailty, disability, quality of life and physical performance on individuals aged over 40 years of age living in the Nouna Health and Demographic Surveillance System area in northwestern Burkina Faso. We defined multimorbidity as the occurrence of two or more conditions, and evaluated the prevalence of and whether this was concordant (conditions in the same morbidity domain of communicable, non-communicable diseases (NCDs) or mental health (MH)) or discordant (conditions in different morbidity domains) multimorbidity. Finally, we fitted multivariable regression models to determine associated factors and consequences of multimorbidity.ResultsMultimorbidity was present in 22.8 (95% CI, 21.4 to 24.2) of the study population; it was more common in females, those who are older, single, more educated, and wealthier. We found a similar prevalence of discordant 11.1 (95% CI, 10.1 to 12.2) and concordant multimorbidity 11.7 (95% CI, 10.6 to 12.8). After controlling for age, sex, marital status, education, and wealth, an increasing number of conditions was strongly associated with frailty, disability, low quality of life, and poor physical performance. We found no difference in the association between concordant and discordant multimorbidity and outcomes, however people who were multimorbid with NCDs alone had better outcomes than those with multimorbidity with NCDs and MH disorders or MH multimorbidity alone.ConclusionsMultimorbidity is prevalent in this poor, rural population and is associated with markers of decreased physical performance and quality of life. Preventative and management interventions are needed to ensure that health systems can deal with increasing multimorbidity and its downstream consequences.

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e020913 ◽  
Author(s):  
Andrés Cabrera-León ◽  
Miguel Ángel Cantero-Braojos ◽  
Llenalia Garcia-Fernandez ◽  
Juan Antonio Guerra de Hoyos

ObjectivesTo estimate the prevalence of disabling chronic pain (DCP) in Spanish adults, to analyse its characteristics, to determine its multimorbidity and to identify its associated factors.Settings2011 Andalusian Health Survey, a cross-sectional population survey based on face-to-face home interviews.Participants6507 people aged 16 years or older and living in Andalusia, Spain.OutcomesThe response variable was disabling chronic pain. Multivariate multinomial logistic regression models were used to analyse the association of factors with disabling chronic pain. The sample design was considered throughout the statistical analysis.ResultsThe prevalence of disabling chronic pain in the Spanish adult population was 11.36% (95% CI 11.23 to 11.49), while that of non-disabling chronic pain was 5.67% (95% CI 5.57 to 5.77). Disabling chronic pain was associated with high multimorbidity (especially in women (51%) and in the elderly (70%) with three or more additional chronic diseases), as well as with disadvantaged social status (such as female gender (OR=2.12), advanced age (OR10-year increase=1.28), unemployment (OR=1.33), manual work (OR=1.26), low income (OR=1.14) and reduced emotional social support (OR=1.04)). Other influential factors were tobacco consumption (OR=1.42), sleeping ≤7 hours (OR=1.2)], environmental or work conditions (OR=1.16) and quality of life (ORmental=1.21, ORphysical=2.37).ConclusionsThe population with disabling chronic pain was associated with multimorbidity, vulnerable social status and an impaired quality of life. In contrast, the population with non-disabling chronic pain showed almost no differences when compared with the population without chronic pain. The association between DCP and mental disorders highlights the need for psychosocial services in the management of chronic pain.


Gerontology ◽  
2018 ◽  
Vol 65 (3) ◽  
pp. 216-228 ◽  
Author(s):  
Marina Peball ◽  
Philipp Mahlknecht ◽  
Mario Werkmann ◽  
Kathrin Marini ◽  
Franziska Murr ◽  
...  

Background: Sarcopenia and frailty are found in up to one-third of the general elderly population. Both are associated with major adverse health outcomes such as nursing home placement, disability, decreased quality of life, and death. Data on the frequency of both syndromes in Parkinson’s disease (PD), however, are very limited. Objective: We aimed to screen for sarcopenia and frailty in PD patients and to assess potential associations of both geriatric syndromes with demographic and clinical parameters as well as quality of life. Methods: In this observational, cross-sectional study, we included 104 PD patients from a tertiary center and 330 non-PD controls from a population-based cohort aged > 65 years. All groups were screened for sarcopenia using the SARC-F score and for frailty using the Clinical Frailty Scale of the Canadian Study of Health and Aging (CSHA CFS). Prevalence rates of sarcopenia and frailty were also assessed in 18 PD patients from a population-based cohort aged > 65 years. Moreover, PD patients from the tertiary center were evaluated for motor and non-motor symptoms, quality of life, and dependency. Results: The prevalence of sarcopenia was 55.8% (95% CI: 46.2–64.9%) in PD patients from the tertiary center and 8.2% (5.7–11.7%; p < 0.001) in non-PD controls. Frailty was detected in 35.6% (27.0–45.2%) and 5.2% (3.2–8.1%; p < 0.001). Prevalence rates for sarcopenia and frailty were 33.3% (16.1–56.4%; p = 0.004) and 22.2% (8.5–45.8%; p = 0.017) in the community-based PD sample. Both sarcopenia and frailty were significantly associated with longer disease duration, higher motor impairment, higher Hoehn and Yahr stages, decreased quality of life, higher frequency of falls, a higher non-motor symptom burden, institutionalization, and higher care levels in PD patients from a tertiary center compared to not affected PD patients (all p < 0.05). Conclusions: Both frailty and sarcopenia are more common in PD patients than in the general community and are associated with a more adverse course of the disease. Future studies should look into underlying risk factors for the occurrence of sarcopenia and frailty in PD patients and into adequate management to prevent and mitigate them.


2005 ◽  
Vol 19 (2) ◽  
pp. 150-155 ◽  
Author(s):  
Edgard Michel-Crosato ◽  
Maria Gabriela Haye Biazevic ◽  
Edgard Crosato

The aim of this study was to verify the prevalence of dental fluorosis in schoolchildren aged 6 to 15 and its possible association with the impacts on their daily activities. This study is observational, cross-sectional and analytical. A total of 513 schoolchildren from the city of Pinheiro Preto, SC, took part in this study. The children were examined by three calibrated dentists, after obtaining a kappa > 0.80. To assess the prevalence of fluorosis, clinical examinations were performed according to the methodology set forth by the 4th edition of the WHO. To assess the impact of fluorosis on their daily activities, a modified OIDP (Oral Impacts on Daily Performance) was adopted. The statistical analysis used was the Chi-squared test with a 5% significance level. Of the total number of children examined, 262 (51.1%) were of the female gender and 251 (48.9%) were of the male gender. In regard to the prevalence of fluorosis, 94 (18.3%) of the children presented this condition, while 419 children (81.7%) presented a normal condition. In regard to the severity of fluorosis, few children presented severe alterations. No association was found between dental fluorosis and gender (p = 0.646), between fluorosis and socioeconomic status (p = 0.848) or between fluorosis and access to public water supply system (p = 0.198). The activities that most affected children's daily performance were: oral hygiene (40.9%) and food intake or enjoying food (40.4%). None of the daily activities could be associated with the occurrence of dental fluorosis. The prevalence of dental fluorosis was consonant with the standards found for locations with optimum fluoride content in the water supply. The questionable and very slight levels of fluorosis were the most frequently found, without influence in the quality of life of the schoolchildren participating in the study.


2011 ◽  
Vol 11 (1) ◽  
Author(s):  
Tsung-Jung Ho ◽  
David C Christiani ◽  
Tso-Chiang Ma ◽  
Tsong-Rong Jang ◽  
Chih-Hui Lieng ◽  
...  

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e023013 ◽  
Author(s):  
Deogratius Bintabara ◽  
Keiko Nakamura ◽  
Kaoruko Seino

ObjectiveThis study was performed to explore the factors associated with accumulation of multiple problems in accessing healthcare among women in Tanzania as an example of a low-income country.DesignPopulation-based cross-sectional survey.SettingNationwide representative data for women of reproductive age obtained from the 2015–2016 Tanzania Demographic and Health Survey were analysed.Primary outcome measuresA composite variable, ‘problems in accessing healthcare’, with five (1-5) categories was created based on the number of problems reported: obtaining permission to go to the doctor, obtaining money to pay for advice or treatment, distance to a health facility and not wanting to go alone. Respondents who reported fewer or more problems placed in lower and higher categories, respectively.ResultsA total of 13 266 women aged 15–49 years, with a median age (IQR) of 27 (20–36) years were interviewed and included in the analysis. About two-thirds (65.53%) of the respondents reported at least one of the four major problems in accessing healthcare. Furthermore, after controlling for other variables included in the final model, women without any type of health insurance, those belonging to the poorest class according to the wealth index, those who had not attended any type of formal education, those who were not employed for cash, each year of increasing age and those who were divorced, separated or widowed were associated with greater problems in accessing healthcare.ConclusionThis study indicated the additive effects of barriers to healthcare in low-income countries such as Tanzania. Based on these results, improving uptake of health insurance and addressing social determinants of health are the first steps towards reducing women’s problems associated with accessing healthcare.


2019 ◽  
Vol 72 (3) ◽  
pp. 728-736
Author(s):  
Michelly Guedes de Oliveira Araújo ◽  
Michelinne Oliveira Machado Dutra ◽  
Carla Carolina Silva Leite Freitas ◽  
Tatiane Gomes Guedes ◽  
Francisco Stélio de Souza ◽  
...  

ABSTRACT Objective: To assess the quality of life and the burden of female caregivers. Method: Descriptive, cross-sectional, quantitative study carried out with 224 informal caregivers from March to July 2016. Three instruments were used: a characterization form for the caregiver, the WHOQOL-Bref questionnaire and the Zarit Burden Interview. The following tests were used: Cronbach’s Alpha, Kolmogorov-Smirnov, Kruskal-Wallis, Spearman and Mann-Whitney. Results: The mean age of caregivers was 51.8 years with a standard deviation of 13.7. They were predominantly married, had a low income and low level of education, were first-degree relatives, had been providing care for one to five years and presented some pathology. The associations of quality of life that presented statistical significance were: income, marital status, number of people living with the caregiver and time of care. Conclusion: The burden was negatively correlated with QOL, that is, the greater the burden, the more impaired will be the life of these caregivers.


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