Paste your essay in here…Geo-Spatial Analysis of Health Status of the Elderly at Hingnara Gram Panchayat: An Overview
Biswajit Mandal, Assistant Professor in Geography, Nahata JNMS Mahavidyalaya,Nahata (bmgeo1981@gmail.com)
and
Dr. Biswaranjan Mistri, Associate Professor, Dept. of Geography, The University of Burdwan, Purba Barddhaman (brmistri@gmail.com)
Abstract
Health problem is an emerging issues associated with the elderly. It is growing problem of the elderly from day to day. Health status is affected by Health facility, transport facility, personal income, nutrition or BMI, education level and topographical features. These factors directly and indirectly control health condition of the elderly. For this purpose, main objectives are geo-spatial analysis of health status and its controlling factors at Hingnara gram panchayat. To measure the health status, the self reported health assessment method has been applied. The primary data has been collected from 315 elderly who are 60 years old or over. Health status of the elderly at Darappur, Raghabpur, Hariankhi and Ballavpur mouza are found to be better with high health status index (47-50). Hingnara, Maheshchadrapur, Purulia and Laxmipur are found to be in medium position with health status index (44-47). Bagrabpur has the lowest health status index (41-44). Thus, the study has been focused on geo-spatial health status of the elderly and the controlling factors have been explored.
Key words: Elderly, Health Status, Health Facility, BMI.
Introduction
Old age is the senescence stage of the human life. People aged 60 years or above are considered as elderly or old people. The ‘elderly’ often commonly used to describe the aging population is now one of the most important issue in India as well as the whole world. Aging is the process that progresses throughout one’s life and ends at death. It has been observed that aging brings about internal changes in body composition, tissue cell loss and replacement (Nasreen, 2009). Ageing is concerned as a physiological issue of human life and is accompanied by the deteriorating condition of physical functions of the human body (Nasreen, 2009). The physical ageing refers to internal and external physiological changes that take place in the individual body (Vankayalapati, 2008).
Elderly people play an important role in the community. They are considered to be philosopher, guide and mentor of the young society. Their experience and wisdom level is higher than other age groups (Khetarpal, 2004). They play an important role in any family to solve various problems. They also participate in the welfare of the village community (Vankayalapati, 2008). But, unfortunately at present they are neglected in family as well as in society.
At present, the elderly are suffering from various problems such as social and economic insecurity, health problem, malnutrition, mental disorder and loneliness along with different sorts of inhuman behaviour etc (Mehrotra and Batish, 2009). Health problems are the biggest issue for the elderly people. The health problems are growing and becoming difficult every day. It is the single most important determinant of the quality of life among elderly. At the core of the well-being and quality of life of the elderly is their health – both physical and mental (BKPAI, WB, 2011). Generally aging is a universal process associated with deteriorating health status. It is the natural and normal condition in which both health and income reduce (Mao, 2004).
There are various dimensions that control the health conditions of the elderly. The health condition of the elderly depend on some feasible factors which include transport facility, health facility, education, personal income, nutrition (BMI), expenditure for treatment, bad habits, exercise and topography etc. Nutrition is very important element which affect on aged health that is prevents easy detection of the health ageing of the elderly (Vankayalapati, 2008). Income indirectly influence on health condition of the elderly. Poor economic conditions increase diseases and ailments of the aged (Narang et al, 2001; Rajendra and Rao, 2012). Poverty and illiteracy affect the health status of aged persons (Nasreen, 2009). Health service or facility is a strong determinant of health care. To access the health care facility, income is a very crucial dependable factor (WHO, 2015). Education indirectly influence on the health condition of the aged people. Education influence occupation; better education means better job, better economic status and better health. In rural India, most of the family members have low education, hence low health status (Siva Raju, 2011). Main health risk factors of the elderly are regular smoking habit, alcohol consumption, tobacco chewing, over weight and sedentary life style (Lantz et al, 2007; Ignle and Nath, 2008; Siva Raju, 2011). These are the major determinants of morbidity and mortality (Lantz et al, 2007).
In this context, the objective of the study is to examine the health status of the aged people. The study also finds out the controlling factors that have impact on the health of the aged people. The study has been carried out at Hingnara G.P. of Chakdaha C.D. Block in Nadia district of West Bengal, India.
Key Factors of aging
The percentage of elderly people has increased during the period from 2001 to 2011 (Table 1). In the world, around 780 million (9%) persons were aged in 2001. However, the numbers of elderly has increased to 810 million (11%) in 2011 (Table 1).
In India, 2001, aged persons were about 76 million (7.44%) and in 2011 it increased to 103 million (8.57%), while in West Bengal, it is 5.7 million (7%) in 2001 and 7.7 million (8.5%) in 2011, at the same time in Nadia district, it is 0.38 million (8.29%) in 2001 and 0.48 million (9.41%) in 2011.¬¬
Table 1: Number of Aged Population (60 years and above)
Years Place
World India West Bengal Nadia Chakdaha Hingnara
Elderly (%) Elderly (%) Elderly (%) Elderly (%) Elderly (%) Elderly (%)
2001 780(9%)** 76(7.44%)* 5.7 (7%)* 0.38(8.29%)*** – –
2011 810(11%)** 103(8.57%)* 7.7(8.50%)* 0.48(9.41%)*** 9.3% 11.16%
Source: Report and Tables on Age, Census of India, 2001, 2011*
World Population Ageing, 2002, 2013**
District Statistical Handbook, Nadia, 2012***
According to WHO (World report on Ageing and Health, 2015) there are two key driver of aging population as life expectancy rate and mortality rate. These may have impact on the increasing number of elderly. The life expectancy rate and mortality rate in the world as well as in India have been shown in Table 2. Due to the development of medicare and living condition, quality of life and effective’s measures for birth control (Balamurugan & Ramathirtham, 2012).
Table 2: Life Expectancy at birth and Mortality rate in 2001 and 2011
Place Mortality Rate Life expectancy at birth
2001 2011 2001 2011
World 5.7 4.3 67.0 70.00
India 8.4 7.1 63.4 67.74
West Bengal 7.0 6.2 64.9 70.20
Nadia 7.8 6.7 65.6 71.20
Source: Registrar General, Census of India 2001, 2011
World Population Ageing, 2002, 2013
Objectives of the Study
The objectives of the study are as follows;
1. To analyse geo-spatial health status of the aged people at Hingnara G.P.
2. To investigate the controlling factors of health problems of the aged people
3. Provide feasible suggestions for improvement of the aged people.
Sample
A total number of 315 respondents (35/Mouza) have been interviewed from eight mouza and one census town (Darappur) in Hingnara Gram Panchayat. The purposive sampling method has been applied for this purpose.
Location of the Study Area
The study area, Hingnara Gram Panchayat (G.P.), is situated in Chakdaha C.D.block of Nadia district in West Bengal. The Hingnara Gram Panchayat consists of eight mouza- Raghabpur,Hariankhi,Hingnara, Ballavpur,Purulia, Maheshchandrapur,Bagrabpur and Laxmipur including one census town (Darappur) covering 1619.08 hectare area. There are 25615 inhabitants and 2860 aged people (2016). It extends from latitude 23º00'54''N to 23º04'40''N and longitude 88º37'56''E to 88º40'48''E. It is bounded on the West by Dewli and Dubra G.P. and Silinda-I and Dubra G.P. on the North and North-west; Silinda-II on the east and Haringhata block on the South.
Fig.3: The Study Area
Materials and Methods
The self reported health assessment method has been applied of this study. Each response is rated on five point scale (very good=5, good=4, normal=3, bad=2 and very bad=1). For this purpose primary data have been collected by structured questionnaire through door to door survey. The purposive sampling method has been used of this study. Finally, collected data have been analyzed by the statistical techniques as frequency distribution, percentage distribution and represented through cartograms, pie and bar graph, t-test, correlation matrix and principal components. QGIS software 2.8.1 has been used to draw maps.
Result and Discussion
Health Condition of the Elderly in Hingnara G.P.
In the study area, health condition of the elderly is not good. After analysis of the responses from the respondents (elderly) and photo copies of medical prescription made by medical practitioners along with detailed discussion as well as cross checking with local doctors a grim picture of the health condition of the aged has been found. 60% elderly have been suffering from poor health. Health condition of the remaining elderly population are normal (24.5%), good (9.5%) and very good (5.7%). It indicates that the physical condition of the aged is not satisfactory (Fig.4). They are suffering from various chronic diseases and acute disease such as arthritis and rheumatism, gastric, respiratory problems, diabetes; blood pressure (high and low) heart problems etc. They are also suffering from various physical disability related to problems of eye, ear, speech, chewing and walking etc. Fig.4: Health Condition of the Elderly
Nutritional Status or Body Mass Index
The miserable health condition indicates that they do not consume nutritious food, fruits and milk due to financial crunch. In this context, the nutritional condition has been measured by the Body Mass Index (BMI).According to World Health Organization (WHO, 2013), the BMI has been categorized into four ranges as 18.5 (underweight), 18.5-24.9 (healthy), 25-29.9 (overweight) and above 30 (obese).With respect to WHO’s standard, 30.2% of the elderly people are under underweight (BMI<18.5), 42.5% healthy (BMI 18.5-24.9) and 24.4% overweight (BMI 25-29.9) and 2.9% Obese (BMI >30) (Fig.5).
Fig.5: Distribution of BMI of the Elderly
Composite Health Facility Index (CHFI)
Health service or facility is a strong determinant of health care that improves elderly health. It is more associated with increasing age. Elderly health care or facility mainly depends on income level. To access the health care facility, income is a very crucial dependable factor (WHO, 2015).
In this study, composite index of health facilities which are more related with health status of Hingnara Gram Panchayat have been studied. The Composite Health Facilities Index (CHFI) indicates health service accessibility that affects the health status of this area. According to Composite Health Facilities Index (CHFI) can be categorized into four groups in this area:
a.Low Health Facility Index(HFI) regions, b. Moderate Health Facility Index(HFI) regions and c. High Health Facility Index(HFI) regions.
a. Low HFI regions(0-9): Raghabpur, Purulia and Bagrampur are the under developed ones with low proportion of health facilities. In these three mouzas, primary health centre, medical store, dispensary and doctors are not available. Remoteness of the area, swamp land, low road connectivity etc all these are main causes for the low HFI of these mouzas. For this reason health status (HS) is also low. Fig.6: Composite Health Facility Index Map
b. Moderate HFI (9-18) regions: Hingnara, Ballavpur, Maheshchandrapur and Laxmipur mouza have moderate health facilities. Very few number (3) of primary health centres; medical store, dispensary and doctors are available here. The remoteness, swamp area, medium road connectivity and locality etc all these are main cause for the medium HFI of these mouzas. On the other hand, health status (HS) is satisfactory because of accessibility of treatment facility. Fig.9: Distribution of Health Facility Centre
c. High HFI (18-27) regions: The mouza Hariankhi and Census Town (CT) Darappur have high HFI. Since it is located in the middle area of Hingnara GP, road connectivity and accessibility are greater here. Also because of its geographical location primary health centre, medical store, dispensary and doctors are easily available. As Darappur is a Census Town, many other advantages are found here; and that is why health facility is high.
Table 3: Road Connectivity Index at Hingnara GP
Mouza Alpha Index Beta Index Gamma Index Cyclomatic Number Average
Laxmipur 0.29 0.83 0.33 2 0.8625
Bagrampur 0.33 1 0 1 0.5825
Maheshchandrapur 0.18 0.87 0.33 2 0.8450
Purulia 0.5 1 0.67 2 1.0425
Ballavpur 0.22 1.17 0.33 2 0.9300
Hingnara 0.1 1.12 0.31 1 0.6325
Raghabpur 0.67 1.33 0.33 2 1.0825
Hariankhi 0.63 1.33 0.6 1 0.8900
Darappur 0.62 1.3 0.33 2 1.0625
Source: https://wb.gov.in/portal/web/quest/district/agricultul,2018
Fig.8: Road Connectivity Index Map
Spatial Distribution of Health Status and its causality of various Mouza
Health status is varying from mouza to mouza of Hingnrara G.P. because, it is controlled by various factors such as topography (Relative Relief, Dissection Index), personal income (PI), Body Mass Index (BMI), transport facility (Road Connectivity Index), health facility (CHFI) and education level (EL). Health status can be categorized into three types;
1. High Health Status or HHS (47-50),
2. Medium Health Status or MHS (44-47) and
3. Low Health Status or LHS (41-44)
Darappur, Raghabpur, Hariankhi and Ballavpur mouza are found to have high health status (47-50). Hingnara, Maheshchadrapur, Purulia and Laxmipur are found to have medium health status (44-47).Bagrabpur mouza has the lowest health status (41-44). Impact of nutritional factor is a more affective factor at Darappur that is why health status is high in this area. At Raghabpur mouza, Hariankhi mouza and Ballavpur mouza, main influencing factors are personal income (r=0.23, not significant), health facility (r=.46 significant) respectively.
On the other hand, Hingnara, Maheshchadrapur, purulia and Laxmipur are found to have medium health status index (44-47).At Hingnara, Maheshchadrapur, Purulia and Laxmipur mouza main influencing factors are Nutrition or BMI (r=0.14, not significant), health facility (r=.46, 1% significant), personal income (r=.50, 1% significant) respectively. At Bagrabpur mouza which has the lowest health status (41-44), Personal income (r=.39) is the main controlling factor.
Fig.9: Spatial Distribution of Health Status
Topography
The Hingnara gram panchayat is almost plain land. But some areas are a little bit higher (7-9m). From the Relative Relief (RR) and Dissection Index (DI) map, it is seen that northern and southern part are relatively higher than other areas. Apart from, Hariankhi Nala (Fig.12) is flowing through north-west to south-east in this area and the land slopes from north to south east(Fig.10 and 11).
Fig.10: Relative Relief Map
Fig.11: Dissection Index Map
Fig.12: Drainage Network Map
Relation between Health Status and Relative Relief
Health status and relative relief are negatively related(r=-0.80) and it is significant at 1% level in 8 degree of freedom (calculated‘t’ value is 3.53 and tabulated‘t’ value is 3.36 (Fig.13).Topography influences health condition. This area is plain land. But since some areas are a little bit higher, transport facility and health facility are not well developed in these areas. For this reason, health condition of the elderly is not good here.
Fig.13: Relation between health status and physical feature
Relation between Health Status and Road Connectivity Index
Health status and road connectivity index are positively related(r=0.66) and it is significant at 5% level in 8 degree of freedom (calculated ‘t’ value is 1.32 and tabulated ‘t’ value is 1.31(Fig.14).The road network accessibility influences health condition. Health condition is better where road connectivity is greater. If road is well accessible, it is very easy to go for treatment and developed transport network means communication is well and transport cost is also reasonable.
Fig.14: Health status and Road Connectivity Index
Relation between Health Expenditure and Health Status of the Elderly
Health expenditure and health status are negatively related(r=- 0.86) and it is significant at 1% level in 314 degree of freedom (calculated‘t’ value is 4.04 and tabulated’t’ value is 2.58) (Fig.15). The elderly who expend more money for medical treatment, have good health conditions, but those who spent less money for medical treatment their health conditions are very bad. For this reason, the health expenditure is low, at the same time health condition is not good.
Fig.15: Health Expenditure and Health Status
Inter-relation between Health Status and Its Controlling Factors
There are numerous feasible factors which directly affect health condition among elderly people which include topographical feature and socio-economic status.
In this study area, health facility, Personal Income (PI), Body Mass Index (BMI), Education Level (EL) and Topography (relative relief and dissection index) etc are main influencing factors. These factors directly and indirectly affected on elderly health condition. This has been shown by correlation matrix (Table 4) and principal component analysis (Table 5).The correlation matrix show the relationship between health status and its controlling factors. Here Composite Health Facility Index (CHFI) is positively related with health status(r=.66). So health facility plays an important role as a controlling factor of health status. On the other hand, BMI is another important factor that controls health status(r=.55).
Table 4: Interrelation of the health status and health controlling factors at Hingnara G.P. (Correlation Matrix)
Correlation Matrix HS RR DI TF BMI CHFI PI EL
HS 1
RR -0.80124 1
DI 0.655406 -0.31353 1
TF 0.660508 -0.26337 0.615726 1
BMI -0.1713 0.159597 0.371683 0.188602 1
CHFI 0.658454 -0.47966 0.532328 0.170916 -0.38826 1
PI -0.58004 0.53390 -0.43014 -0.00702 0.45739 -0.7859 1
EL -0.43469 0.276107 -0.14804 -0.54202 -0.19789 -0.1306 -0.24085 1
HS=Health Status, RR=Relative Relief, DI=Dissection Index, TF=Transport Facility, BMI=Body Mass Index, CHFI=Composite Health Facility Index, PI= Personal Income, EL= Education Level.
Table 5: Finding of Main Components of Health Status
Axis 1 Axis 2 Axis 3 Axis 4 Axis 5 Axis 6 Axis 7 Axis 8
HS 0.5027 0.07127 -0.136 -0.05961 0.2045 0.07978 -0.5119 0.6402
RR -0.3958 0.06655 0.2601 0.7236 -0.2001 -0.2118 -0.245 0.3204
DI 0.3781 0.2315 0.5714 0.1096 -0.03811 0.1567 -0.4063 -0.5233
TF 0.307 0.4474 -0.05456 0.4355 0.4973 -0.07731 0.5096 -0.0036
BMI -0.09126 0.5329 0.4691 -0.455 -0.25 -0.1385 0.2518 0.3681
CHFI 0.4178 -0.2617 0.08034 0.2435 -0.5656 0.4242 0.3962 0.1854
PI -0.3692 0.4304 -0.2265 0.03549 0.02117 0.7829 -0.1118 0.00344
EL -0.1849 -0.4461 0.5536 -0.06013 0.5352 0.3259 0.1423 0.2091
PCA
Eigen value 3.6914 2.0387 1.0499 0.6014 0.4598 0.1040 0.04809 0.00637
% variance 46.144 25.485 13.125 7.5177 5.7475 1.3009 0.60117 0.60117
Source: Calculation and computation by researchers, 2018
The table 5 shows that Hingnara GP, health facility index (CFHI) is the most influencing factor on the health status of the elderly with 46.144% explanation of variance in the first factors loading (Eigen value is 3.6914).On the other hand, second factor loading (with 25.485 variance explanation) is holding the control of BMI as a determining factor for health status of the elderly. Relative Relief (RR) and Dissection Index (DI) are the next most influencing factors to health status of the elderly with 13.125% explanation of variance (Eigen value is 1.0499) and with 7.5177% explanation of variance (Eigen value is 0.6014) in the third and fourth factors loading respectively.
Conclusion
It is revealed that health status of the elderly is not good. The health condition of the elderly is affected by various factors directly and indirectly. In this situation, there is urgent need of efforts on the part of the government to ensure guaranteed income, health care, social services, recreation and other requirements of the aged which will go a long way to reduce the problems of the elderly. In addition, non-government organizations may also come forward for the welfare of the elderly.
The present miserable condition of the elderly can be improved by some following feasible steps.
1. The local government should provide compatible perennial work in throughout the year for the aged.
2. The old age pension should be provided to all elderly people who belong to BPL and they should be brought within Indira Awas Yojana (IAY) to remove the housing problems.
3. The Annapurna and Antyodya scheme should properly be executed for all the aged.
4. The medical treatment for the aged should be provided free of cost and new health centre should be established in nearer location and or mobile medical unit should be arranged.
5. The local government should start help line for the aged people and awareness level of young generation as well as common people should be increased.
6. Finally, the offspring should not forget the natural route for expecting to secure enjoyable spring season in their elderly life, else problems of the aged will gradually increase which will be more critical for the humanity in future.
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