EAL

UWL: Association With Outcomes (2009)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To determine nutritional status and functional ability of the elderly in rural central Uganda and to examine factors that may impinge on these.

Inclusion Criteria:

Male and female residents of Mpigi, a district in central rural Uganda
60 to 90 years old
Known by local leader
No other family member included in study.

Exclusion Criteria:

Not a resident of Mpigi
Younger than 60 years or older than 90 years
Unknown by local leaders.

Description of Study Protocol:

Recruitment

Local leaders provided the names of potential subjects
Random selection of study participants was carried out from this group using a stratified random sampling, using age as the stratifying criterion
Only one subject per household was interviewed and measured.

Design

Cross-sectional survey.

Statistical Analysis

Data analyzed with SPSS
Frequencies, percentage distributions and independent T-tests were used to examine differences between the mean and standard deviations of various anthropometric measurements
Chi-square test was used for associations and binary logistic regression was used to test an association between one dependent variable measured at binary scale and several independent variables.

Data Collection Summary:

Timing of Measurements

One-time measurement.

Dependent Variables

Functional ability was measured through self-reported activities of daily living questionnaire
Participants were asked about their ability to bathe, dress, use the toilet, ambulate, control bladder and bowel function and feed.

Independent Variables

Weight was measured with a Tanita digital scale
Height was measured with Microtoise (CM6 IHU, Raven equipment). When height could not be obtained due to spinal curvature or poor muscle tone, it was estimated using long bone measurements.
Mid-upper arm circumference (MUAC) was measured with arm span tapes from Help Age International
Body mass index
Dietary intake was measured using seven-day food frequency questionnaire (Ugandan Demographic and Health Survey)
Self-report of illnesses over previous month
Interviewers examined participants for presence of edema, immobility, weakness, dehydration, vomiting, kyphosis and mental disability
Self-report of tobacco use, smoking or alcohol use.

Description of Actual Data Sample:

Initial N: 105 participants
Attrition (final N): 100 subjects (95.2% participation rate), 56 women and 44 men
Age: Mean age for women was 71.2 years and mean age for men was 68.7 years
Ethnicity: Not specified, assumed to be Ugandan, race black.

Other Relevant Demographics

Low literacy, 81% unable to read or write
59% of subjects had to care for young children (grandchildren)
85% of subjects relied on family support for income
60% of respondents were widowed
27% lived alone.

Anthropometrics

68% of women has BMIs less than 18.5kg/m² vs. 32% of men.

Location

Central rural Uganda, Mpigi District.

Summary of Results:

Activities of Daily Living and Reported Ill-Health Among the Elderly

Variables		Distribution (Percentage)	P-Value
Mobility			0.000
	Move freely	36.0
	Uses support	60.0
	Unable to walk (move around)	4.0
Feeding/Eating			0.222
	Feeding freely	57.0
	Feeding with problems	43.0
	Can dress themselves	68
	Continent	57.0
	Can use toilet unaided	84
	Can bathe themselves	54.0
Reported Health Problems			0.065
	Back pains	78.0
	Abdominal pain	45.0
	Joint pains	89.0
	Fever/malaria	65.0
	Visual impairment	63.0
	Mastication problem	69.0
	Coughing	45.0
	Hypertension	51.0
	Headache	37.0
	Ulcers	28.0
	Asthma	2.0
	Hearing difficulty	1.0
	Skin disease	3.0
	Flu/cold	2.0
	Chest pain	4.0
	Paralysis	4.0
	Gonorrhea	3.0
Observable Signs			0.091
	Edema	3.0
	Immobile	1.0
	Extreme weakness	81.0
	Dehydration	36.0
	Vomiting	2.0
	Kyphosis	58.0
	Mental disability	9.0
Lifestyle Habits			0.437
	Alcohol	79.0
	Smoking	18.0
	Snuff tobacco	22.0

Other Findings

The overall prevalences of undernutrition were 33.3% based on BMI (less than 18.5kg/m²) and 52% based on mid-upper arm circumference (less than 24cm)
There was a large significant difference between prevalences of malnutrition by sex: 68% of women were undernourished (BMI less than 18.5kg/m²), compared with 32.4% of men
Dietary assessment showed that intake of fish, cereals, vegetables, tubers and legumes was moderate (three to six times per week)
Evaluation of the ability of elderly people to perform basic activities of daily living showed that 33% of subjects were independent in all activities of daily living, except for mobility and feeding
The relationship between BMI and variables associated with functional ability were significant with regard to mobility, continence and feeding (P<0.05).

Author Conclusion:

This study found that a large percentage of older men and women are malnourished. This influenced their daily activities, especially mobility and feeding.
The elderly need to be incorporated into health programs and policy.

Funding Source:

Other:

Not reported

Reviewer Comments:

Exact ages of the subjects are unknown. Many subjects' ages were estimated. The authors acknowledge the low literacy level of subjects as the primary barrier to obtaining accurate ages.
Relatively small sample from one area in Africa
Most data is based on self-reporting.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	N/A
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	N/A

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		???
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	Yes
	2.2.	Were criteria applied equally to all study groups?	N/A
	2.3.	Were health, demographics, and other characteristics of subjects described?	???
	2.4.	Were the subjects/patients a representative sample of the relevant population?	???
3.	Were study groups comparable?		N/A
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	N/A
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	N/A
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	N/A
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	N/A
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		Yes
	4.1.	Were follow-up methods described and the same for all groups?	Yes
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	Yes
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	N/A
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		N/A
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	N/A
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	N/A
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		Yes
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	Yes
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	N/A
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	N/A
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	N/A
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	N/A
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		???
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	N/A
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	???
	7.5.	Was the measurement of effect at an appropriate level of precision?	???
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	???
	7.7.	Were the measurements conducted consistently across groups?	N/A
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	Yes
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	N/A
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	Yes
	8.6.	Was clinical significance as well as statistical significance reported?	Yes
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	N/A
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	No
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	No
	10.2.	Was the study free from apparent conflict of interest?	Yes