|Year : 2013 | Volume
| Issue : 2 | Page : 133-137
Understanding the needs of persons with disabilities in rural and urban Mysore: A step towards exploring the unreached
Syed Yunus Zama1, NC Ashok2, Praveen Kulkarni2
1 Department of Community Medicine, Mysore Medical College and Research Centre, Mysore, Karnataka, India
2 Department of Community Medicine, JSS Medical College Mysore, Mysore, Karnataka, India
|Date of Web Publication||26-Jul-2013|
Department of Community Medicine, JSS Medical College, Mysore - 570 015, Karnataka
Source of Support: None, Conflict of Interest: None
Context: It is estimated that about 10% of the people in the world are disabled. The disability rate in the developed regions is 8.5% and in the developing regions is 4.8%. A disabled person who is in the prime of his/her youth has every right to equal opportunity and must therefore be offered a range of assistance. Aims: The aim of this study was to estimate the prevalence of disabilities in rural and urban areas of Mysore and to assess the needs of people with disabilities. Settings and Design: Cross-sectional study. Materials and Methods: This cross-sectional study was conducted in an urban slum of Mysore city and a rural and urban and rural field practice area of a medical school. The study included 6,000 persons who were permanently residing in the study areas. Qualitative survey using focus group discussions were conducted for assessing the needs of persons with disability. Statistical Analysis Used: Descriptive statistics such as mean, standard deviation, percentages, and Chi-square test. Results: The prevalence of disability in the urban area was 19.27% and that in the rural area was 28.07%. There was a need for sending the children with disability to general schools and also to improve the facilities related to rehabilitation through the government and Non Government Organizations (NGOs). Conclusions: The overall prevalence of disability was observed to be higher in the rural areas as compared to the urban area. Needs of persons with disabilities were pertaining to education, rehabilitation, and provision of essential services.
Keywords: Disability, focus group discussion, prevalence, rehabilitation, rural, urban
|How to cite this article:|
Zama SY, Ashok N C, Kulkarni P. Understanding the needs of persons with disabilities in rural and urban Mysore: A step towards exploring the unreached. Int J Health Allied Sci 2013;2:133-7
|How to cite this URL:|
Zama SY, Ashok N C, Kulkarni P. Understanding the needs of persons with disabilities in rural and urban Mysore: A step towards exploring the unreached. Int J Health Allied Sci [serial online] 2013 [cited 2020 Jun 1];2:133-7. Available from: http://www.ijhas.in/text.asp?2013/2/2/133/115692
| Introduction|| |
The new concept of disability of World Health Organization "explicitly contemplates an assessment of "environmental factors" including the physical environment, the social environment and the impact of attitudes, and of "personal factors," which correspond to the personality and characteristic attributes of an individual. " This includes not only physical disability, but also social, cultural, economic, and psychological disabilities.
It is estimated that about 10% of the people in the world are disabled.  The disability rate in the developed regions is 8.5% and in the developing regions is 4.8%.  Although the disability rates in the developed countries are higher, the problem in developing countries is acute due to the larger population in the developing countries.
In India, the prevalence rate of disability estimated by various studies ranged from 1% to 6.7%. ,, The National Sample Survey Organization (NSSO) of India has estimated the prevalence of disability at the national level by covering the entire nation. The prevalence rates were 1.8% in 1981, 1.9% in 1991 (covering 4 disabilities- Visual, Locomotor, Speech and Hearing), and 1.8% in 2002. Prevalence rate in rural area was higher (1.84%) compared to the urban areas (1.44%).  Census authorities have estimated the prevalence rate of disability at the national level in 2001 to be 2.1%. 
Like all human beings, individuals with disability also have varying degrees of need. They often strive hard for a high quality of life as other normal individuals. A disabled person who is in the prime of his/her youth has every right to equal opportunity and must therefore be offered a range of assistance such as examination support, specialized equipment, library assistance, note-taking in class, render sign interpreters, and parking provisions. Toilets and resting areas should be modified for the convenience of disabled persons. Only when they have such a strong support system can they hope to lead normal lives.  With this background, the present study was undertaken with the objectives to estimate the prevalence of disabilities in rural and an urban areas of Mysore and to assess the needs of people with disabilities.
| Materials and Methods|| |
This cross-sectional study was conducted in an urban slum of Mysore city and a rural area (Suttur village) under the urban and rural field practice area of a medical school for the period of 6 months. The sample size was calculated based on the NSSO - 2002 estimated the prevalence of disability 1.8% with 20% relative allowable error was 5,455 rounded off to 6,000. This was allocated in equal proportion of 3000 to urban and rural areas respectively. According to National Family Health Survey-3, the average family size was found to be 4.5 ≈ 5 thus 1200 households were included in the study of which 600 from urban and rural areas respectively. In both urban and rural areas, the houses were enumerated and numbered. From this, 600 households were selected by using simple random sampling method (lottery method). All the members residing in the houses were included for the study and those houses which were locked at the time of survey were revisited on three consecutive days before excluding from the study.
The details regarding socio-demographic characteristics and presence of disability in any of the household members collected from an adult responsible respondent in the family using a pre-tested semi structured questionnaire by interview technique. NSSO definitions on disability were adopted for identifying disabilities. Those persons suspected with disability were evaluated by simple tests to confirm the presence of any disability.
Needs of people with disabilities were assessed using qualitative research technique viz. by focus group discussions. The focus groups selected were: the persons with disability, the family members of persons with disability, their neighbors, community leaders, and health-care providers with minimum of six members in each group (convenient sample). Members in focus groups were selected by group wise line listing of persons and selecting six out of each group by lottery method. A list of topics concerned with attitude of the family members, neighbors, and the community toward persons with disabilities and the rehabilitation needs of the people with disabilities. For analyzing the focus group discussion the responses to each topic were categorized as most satisfactory, satisfactory, and not satisfactory depending on the number of participants who had a similar response to a particular topic.
Data were entered in Microsoft excel-07 spreadsheet and analyzed using descriptive statistical measures such as mean, standard deviation, and percentages. Inferential statistical tests like z test for difference between two proportions was applied and the differences were found statistically significant at the significance level of 0.05.
| Results|| |
Among 5832 subjects screened, the overall prevalence rate of disability was observed to be 140 (24/1000 population). The prevalence rate was 52 (19.27/1000 population) in urban areas and 88 (28.07/1000) in rural areas respectively.
Age specific prevalence rates in the age group of 46-60 years was higher in the rural area 49.38/1000 compared to urban area 25.47/1000; however, this difference was not statistically significant. Sex specific prevalence rate was more among males in the rural area (31.95/1000) compared to an urban area (19/1000), which was found to be statistically significant. Among females, there was a marginally higher prevalence rate in the rural area (24.05/1000 persons) as compared to the urban area (19.54/1000 persons). However, this difference was not statistically significant.
Among type of disabilities, it was observed that in the rural areas visual disability was the highest 9.57/1000 followed by loco-motor 7.01/1000 and hearing disabilities 6.7/1000, whereas among urban areas prevalence of loco-motor disabilities was the highest 5.55/1000 followed by visual and hearing disabilities 4.80/1000. There was statistically significant difference between prevalence rate of visual disabilities among urban and rural areas [Table 1].
|Table 1: Prevalence rate of disability according to socio‑demographic variables|
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Section 1: Urban area [Table 2]
Group 1: Persons with disabilities
They expressed that the attitude of parents/family members and neighbors toward them to be good. They preferred general schools for education, and were not satisfied with the government services and the NGO participation. The foremost rehabilitation need expressed by them was related to educational support through sending them to general schools, special training for teachers to take care of children with disabilities and assistance in transportation to schools.
Group 2: Parents/family members of people with disability
Attitude toward the disabled was found to be satisfactory; they wanted the children with disabilities to be integrated in general schools with normal children. They opined that the participation of the government and NGOs was not satisfactory. The most important need according to them was the need for awareness programs - related to welfare and rehabilitation.
Group 3: Neighbors
Attitude toward the disabled was good. The most important need according to them was related to educational support - teachers training, fee concessions, and integrating the disabled children with normal children in sports and other social activities.
Group 4: Community leaders
Their attitude toward the persons with disabilities was good and their response to the need for general school was satisfactory and mentioned that the role of government and NGOs was not satisfactory. In their view, the most important needs were related to improvement in rehabilitation services - by establishment of a rehabilitation center for a specified population.
Group 4: Health-care providers
They preferred regular schools for the disabled, felt that the government services were not satisfactory and the NGO participation was minimal and needs further improvement. The most important needs expressed by them were related to improvement in rehabilitation services - by establishment of community based rehabilitation center in each area.
Section 2: Rural area [Table 3]
Group 1: Persons with disabilities
They expressed that the attitude of parents/family members toward them to be satisfactory. The response to general schools for education was satisfactory. They felt that the government services and NGO participation to be inadequate. The most important needs according to them were related to improvement in rehabilitation services - by identifying and listing the disabled in every village, appointment of disabled welfare officers for specified population, etc.
Group 2: Parents/family members
Attitude toward the people with disability was satisfactory; they expressed that the disabled children be sent to general schools and mentioned that the government and NGO participation to be inadequate. In their opinion, the needs which were less fulfilled were related to rehabilitation services - by increasing the monthly allowance for the disabled, increase in the reservation quota, etc.
Group 3: Neighbors
Overall attitude of neighbors toward the disabled was poor. They felt that the disabled children be sent to separate schools. They perceived that the participation of Government and NGO to be poor. The important needs expressed were related to educational support - free education, scholarships, to cover disability in the schools/colleges curriculum, etc.
Group 3: Community leaders
Overall attitude of community leaders towards the disabled was poor. They felt that persons with disabilities are a burden to the family and the society. They said that general schools to be better for children with disability and were not satisfied with the services provided by the government and NGOs in their area. The foremost rehabilitation need identified by the community leaders' were related to strengthening the rehabilitation services - by increasing the monthly allowances, need for disabled welfare center for each village, etc.
Group 4: Health-care providers
They felt that the special schools are better for the disabled children, due to the negative attitude and inferiority complex in general schools and regarding the government and NGO participation, they mentioned it was inadequate. The most important needs according to them were related to awareness programs - by disabled welfare meetings regularly in every village, telecasting films on successful disabled to be telecast regularly, awareness by mass media, etc.
| Discussion|| |
Primary outcome measure, prevalence of disability in the urban area was 19.27% and that in the rural area was 28.07%. There was a need for sending the children with disability to general schools and also to improve the facilities related to rehabilitation through the government and NGOs. The secondary outcome measures viz. Age and sex specific prevalence rates were higher among 46-60 year age group and males respectively.
Overall prevalence rate of disability observed in the present study was (24/1000 population), which was higher than the national estimate of 18/1000 as per NSSO - 2002. In the present study the prevalence rate in the rural and urban areas were 28.07/1000 and 19.27/1000 respectively. As per NSSO - 2002 estimates, the prevalence rate of disability observed in the rural (18.46/1000) and urban (14.49/1000) areas in NSSO (2002) were also lower than the findings of the present study. The rural-urban differences in both studies were similar showing that the prevalence rate in the rural area was higher than the urban area.
Age specific prevalence rate in both the urban and rural areas were higher in the age group of 46-60 years. Similar observations were recorded in NSSO - 2002. The sex specific prevalence rate was higher in males among rural area compared to the urban area this in par with the findings in NSSO (2002) where the prevalence rate was higher among the rural males compared to urban.
It was observed that the attitude toward the persons with disability was good in the urban area as compared to the rural area. The need for integrating children with disabilities to general schools along with providing special training to teachers was more expressed by the urban participants. Regarding the role of Government and NGOs in rehabilitation, the responses were similar in both the areas. Though there was minimal participation of the government and NGOs in the urban areas, in the rural areas, there was an urgent need to enhance the rehabilitation services by government and NGO participation. It was also noted that the awareness of the participants in rural areas about government schemes was poor - with many of them being only aware of the monthly allowance to persons with disabilities and travel concessions. In a study conducted by Maya Thomas et al. it was reported that the persons with disability expressed their need toward being a part of general schools like other children, improving the governmental and NGO participation toward health vocational and educational rehabilitation and limiting the discrimination in the society toward people living with disabilities.  Strength of the present study is that it includes both the qualitative and quantitative measures to give an overall picture of magnitude of the problem as well as what is the gap between that is needed by the people with disability and what is being provided them. This gives a basic frame-work for the policy makers to design and implement the people friendly services based on the felt needs of the people with disabilities. More over the study is of its kind as community based burden surveys for assessments of disability along with need assessment are rarely available in the published literature. There is a need for further research including larger sample size at different regions in the state and country at large are needed for better generalizability of results as India is a country with wide regional and socio-cultural inequalities.
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[Table 1], [Table 2], [Table 3]