Estimating assistive product need in Cameroon and India: results of population-based surveys and comparison of self-report and clinical impairment assessment approaches.

Abstract

To estimate population need and coverage for distance glasses, hearing aids and wheelchairs in India and Cameroon, and to explore the relationship between assistive product (AP) need measured through self-report and clinical impairment assessment. Population-based surveys of approximately 4000 people each were conducted in Mahabubnagar district, India and Fundong district, Cameroon. Participants underwent standardised vision, hearing and musculoskeletal impairment assessment to assess need for distance glasses, hearing aids, wheelchairs. Participants with moderate or worse impairment and/or self-reported difficulties in functioning were also asked about their self-reported AP need. 6.5% (95% CI 5.4-7.9) in India and 1.9% (95% CI 1.5-2.4) in Cameroon of the population needed at least one of the three APs based on moderate or worse impairments. Total need was highest for distance glasses [3.7% (95% CI 2.8-4.7) India; 0.8% (95% CI 0.5-1.1), Cameroon] and lowest for wheelchairs (0.1% both settings; 95% CI 0.03-0.3 India, 95% CI 0.04-0.3 Cameroon). Coverage for each AP was below 40%, except for distance glasses in India, where it was 87% (95% CI 77.1-93.0). The agreement between self-report and clinical impairment assessment of AP need was poor. For instance, in India, 60% of people identified through clinical assessment as needing distance glasses did not self-report a need. Conversely, in India, 75% of people who self-reported needing distance glasses did not require one based on clinical impairment assessment. There is high need and low coverage of three APs in two low-and middle-income settings. Methodological shortcomings highlight the need for improved survey methods compatible with the international classification of functioning, disability and health to estimate population-level need for AP and related services to inform advocacy and planning.