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A new look at population health through the lenses of cognitive, functional and social disability clustering in eastern DR Congo: a community-based cross-sectional study

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Bwenge Malembaka, Espoir [UCL] Karemere, Hermès Balaluka, Ghislain Bisimwa Lambert, Anne-Sophie [UCL] Muneza, Fiston Deconinck, Hedwig [UCL] Macq, Jean [UCL]

and its covariates at primary healthcare level in DR Congo. METHOD: We conducted a community-based cross-sectional study in adults with diabetes or hypertension, mother-infant pairs with child malnutrition, their informal caregivers and randomly selected neighbours in rural and sub-urban health zones in South-Kivu Province, DR Congo. We used the WHO Disability Assessment Schedule 2.0 (WHODAS) to measure functional, cognitive and social disability. The study outcome was health status clustering derived from a principal component analysis with hierarchical clustering around the WHODAS domains scores. We calculated adjusted odds ratios (AOR) using mixed-effects ordinal logistic regression. RESULTS: Of the 1609 respondents, 1266 had WHODAS data and an average age of 48.3 (SD: 18.7) years. Three hierarchical clusters were identified: 9.2% of the respondents were in cluster 3 of high dependency, 21.1% in cluster 2 of moderate dependency and 69.7% in cluster 1 of minor dependency. Associated factors with higher disability clustering were being a patient compared to being a neighbour (AOR: 3.44; 95% CI: 1.93-6.15), residency in rural Walungu health zone compared to semi-urban Bagira health zone (4.67; 2.07-10.58), female (2.1; 1.25-2.94), older (1.05; 1.04-1.07), poorest (2.60; 1.22-5.56), having had an acute illness 30 days prior to the interview (2.11; 1.24-3.58), and presenting with either diabetes or hypertension (2.73; 1.64-4.53) or both (6.37; 2.67-15.17). Factors associated with lower disability clustering were being informally employed (0.36; 0.17-0.78) or a petty trader/farmer (0.44; 0.22-0.85). CONCLUSION: Health clustering derived from WHODAS domains has the potential to suitably classify individuals based on the level of health needs and dependency. It may be a powerful lever for targeting appropriate healthcare service provision and setting priorities based on vulnerability rather than solely presence of disease.

Document type Article de périodique (Journal article)
Access type Accès libre
Publication date 2019
Language Anglais
Journal information "BMC Public Health" - Vol. 19, no. 1, p. 14p. (2019)
Peer reviewed yes
Publisher Springer Nature
e-issn 1471-2458
Publication status Publié
Affiliation UCL - SSS/IRSS - Institut de recherche santé et société
Keywords Public Health ; Environmental and Occupational Health ; Health clustering ; WHODAS ; Medico-psychosocial ; Disability ; Esatern DR Congo
Links
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Bibliographic reference Bwenge Malembaka, Espoir ; Karemere, Hermès ; Balaluka, Ghislain Bisimwa ; Lambert, Anne-Sophie ; Muneza, Fiston ; et. al. A new look at population health through the lenses of cognitive, functional and social disability clustering in eastern DR Congo: a community-based cross-sectional study. In: BMC Public Health, Vol. 19, no. 1, p. 14p. (2019)
Permanent URL http://hdl.handle.net/2078.1/212620