Islay Mactaggart

Disability in post-earthquake Haiti: prevalence and inequality in access to services

Abstract Purpose: To assess the prevalence of disability and service needs in post-earthquake Haiti, and to compare the inclusion and living conditions of people with disabilities to those without disabilities. Methods: A population-based prevalence survey of disability was undertaken in 2012 in Port-au-Prince region, which was at the centre of the earthquake in 2010. Sixty clusters of 50 people aged 5 + years were selected with probability proportionate to size sampling and screened for disability (Washington Group short set questionnaire). A case-control study was undertaken, nested within the survey, matching cases to controls by age, gender and cluster. There was additional case finding to identify further children with disabilities. Information was collected on: socioeconomic status, education, livelihood, health, activities, participation and barriers. Results: The prevalence of disability was 4.1% (3.4–4.7%) across 3132 eligible individuals. The earthquake was the second leading cause of disability. Disability was more common with increasing age, but unrelated to poverty. Large gaps existed in access of services for people with disabilities. Adults with disabilities were less likely to be literate or work and more likely to visit health services than adults without disabilities. Children with disabilities were less likely to be currently enrolled at school compared to controls. Children and adults with disabilities reported more activity limitations and participation restriction. Conclusion: Further focus is needed to improve inclusion of people with disabilities in post-earthquake Haiti to ensure that their rights are fulfilled. Implications for Rehabilitation Almost one in six households in this region of Haiti included a person with a disability, and the earthquake was the second leading cause of disability. Fewer than half of people who reported needing medical rehabilitation had received this service. The leading reported barriers to the uptake of health services included financial constraints (50%) and difficulties with transport (40%). People with disabilities did not participate equally in education or employment and had poorer access to health care.

Assessing the prevalence of sensory and motor impairments in childhood in Bangladesh using key informants

Objectives The study was conducted to determine whether trained key informants (KI) could identify children with impairments. Design Trained KI identified children with defined impairments/epilepsy who were then examined by a medical team at a nearby assessment centre (Key Informant Methodology: KIM). A population-based household randomised sample survey was also conducted for comparing the prevalence estimates. Setting Three districts in North Bangladesh. Participants Study population of approximately 258 000 children aged 0–<18 years, within which 3910 children were identified by KI, 94.8% of whom attended assessment camps. In the household survey, 8120 children were examined, of whom 119 were identified with an impairment/epilepsy. Main outcome measures Prevalence estimates of severe visual impairment (SVI), moderate/severe hearing impairment (HI), substantial physical impairment (PI) and epilepsy. Results Overall prevalence estimates of impairments, including presumed HI, showed significant differences comparing KIM (9.0/1000 (95% CI 8.7 to 9.4)) with the household survey (14.7/1000 (95% CI 12.0 to 17.3)). Good agreement was observed for SVI (KIM 0.7/1000 children: survey 0.5/1000), PI (KIM 6.2/1000 children: survey 8.0/1000) and epilepsy (KIM 1.5/1000 children: survey 2.2/1000). Prevalence estimates for HI were much lower using KIM (2/1000) compared to the survey (6.4/1000). Excluding HI, overall prevalence estimates were similar (KIM: 7.5/1000 children (95% CI 7.2 to 7.8) survey: 8.4/1000 (95% CI 6.4 to 10.4)). Conclusions KIM offers a low cost and relatively rapid way to identify children with SVI, PI and epilepsy in Bangladesh. HI is underestimated using KIM, requiring further research.

Measuring Disability in Population Based Surveys: The Interrelationship between Clinical Impairments and Reported Functional Limitations in Cameroon and India.

Purpose To investigate the relationship between two distinct measures of disability: self-reported functional limitations and objectively-screened clinical impairments. Methods We undertook an all age population-based survey of disability in two areas: North-West Cameroon (August/October 2013) and Telangana State, India (Feb/April 2014). Participants were selected for inclusion via two-stage cluster randomised sampling (probability proportionate to size cluster selection and compact segment sampling within clusters). Disability was defined as the presence of self-reported functional limitations across eight domains, or presence of moderate or greater clinical impairments. Clinical impairment screening comprised of visual acuity testing for vision impairment, pure tone audiometry for hearing impairment, musculoskeletal functioning assessment for musculoskeletal impairment, reported seizure history for epilepsy and reported symptoms of clinical depression (depression adults only). Information was collected using structured questionnaires, observations and examinations. Results Self-reported disability prevalence was 5.9% (95% CI 4.7–7.4) and 7.5% (5.9–9.4) in Cameroon and India respectively. The prevalence of moderate or greater clinical impairments in the same populations were 8.4% (7.5–9.4) in Cameroon and 10.5% (9.4–11.7) in India. Overall disability prevalence (self-report and/or screened positive to a moderate or greater clinical impairment) was 10.5% in Cameroon and 12.2% in India, with limited overlap between the sub-populations identified using the two types of tools. 33% of participants in Cameroon identified to have a disability, and 45% in India, both reported functional limitations and screened positive to objectively-screened impairments, whilst the remainder were identified via one or other tool only. A large proportion of people with moderate or severe clinical impairments did not self-report functional difficulties despite reporting participation restrictions. Conclusion Tools to assess reported functional limitation alone are insufficient to identify all persons with participation restrictions and moderate or severe clinical impairments. A self-reported functional limitation tool followed by clinical screening of all those who report any level of difficulty would identify 94% of people with disabilities in Cameroon and 95% in India, meeting the study criteria.

Assessing health and rehabilitation needs of people with disabilities in Cameroon and India

Abstract Purpose: To assess the association between disability and serious health problems, and the access and uptake of health and rehabilitation services in Cameroon and India. Methods: We undertook a population-based case–control study, nested within a survey in Fundong Health District, North West Cameroon (August–October 2013) and in Mahbubnagar District, Telangana State, India (February–April 2014). Disability was defined as the presence of self-reported difficulties in functioning or clinical impairments. One control without disability was selected per case, matched by age, gender and cluster. Information was collected using structured questionnaires on: socioeconomic status, health, access to health services and rehabilitation. Results: Cases with disability were significantly more likely to report a serious health problem in the last year compared to controls in both India (OR = 3.2, 95% CI 2.1–4.8) and Cameroon (OR = 1.9, 1.4–2.7). The vast majority of people sought care when seriously ill, and this did not vary between cases and controls. Awareness and use of rehabilitation services was extremely low in both Cameroon and India. Conclusions: Further focus is needed to improve awareness of rehabilitation services among people with disabilities in India and Cameroon to ensure that their rights are fulfilled and to achieve the goal of Universal Health Coverage. Implications for Rehabilitation People with and without disabilities equally seek health care in India and Cameroon. However, people with disabilities experience more frequent serious health problems than people without. Extremely few people with disabilities were aware of rehabilitation services despite their existence in the study settings.

Disability and social protection programmes in low- and middle-income countries: a systematic review

Abstract This paper systematically reviews the evidence on whether persons with disabilities in low- and middle-income countries are adequately included in social protection programmes, and assesses the financial and non-financial impacts of participation. Overall, we found that access to social protection appears to fall far below need. Benefits from participation are mostly limited to maintaining minimum living standards and do not appear to fulfil the potential of long-term individual and societal social and economic development. However, the most notable finding of this review is that there is a dearth of high-quality, robust evidence in this area, indicating a need for further research.

Social protection for people with disabilities in Tanzania: a mixed methods study

Abstract People with disabilities are more vulnerable than others to poverty and exclusion from key services, such as health and education. Consequently, they particularly need social protection, yet may have difficulties accessing these programmes. This study aims to assess the need for, and inclusion in, social protection programmes among people with disabilities compared to those without, in three districts in Tanzania. Using a mixed methods approach, our study finds that although the need for social protection programmes was higher among people with disabilities compared to the general population, this was not matched by higher enrolment. People with disabilities were aware of social protection programmes in their area but were not targeted specifically, and benefit packages offered by the programmes were not adapted to their needs. Modifying mainstream social protection schemes to be inclusive of people with disabilities may therefore be an important step towards addressing poverty alleviation goals, including those set out in the recently adopted sustainable development goals (Goal 1, target 3).

Livelihood opportunities amongst adults with and without disabilities in Cameroon and India: A case control study.

Proven links between disability and poverty suggest that development programmes and policies that are not disability-inclusive will leave persons with disabilities behind. Despite this, there is limited quantitative evidence on livelihood opportunities amongst adults with disabilities in Low and Middle Income Countries. This study adds to the limited evidence base, contributing data from one African and one Asian Setting. We undertook a population-based case–control study of adults (18+) with and without disabilities in North-West Cameroon and in Telangana State, India. We found that adults with disabilities were five times less likely to be working compared to age-sex matched controls in both settings. Amongst adults with disabilities, current age, marital status and disability type were key predictors of working. Inclusive programmes are therefore needed to provide adequate opportunities to participate in livelihood prospects for adults with disabilities in Cameroon and India, on an equal basis as others. These findings are of crucial importance at this stage of the Sustainable Development Agenda, to ensure that the mandate of inclusive development is achieved.

A population-based survey of visual impairment and its correlates in Mahabubnagar district, Telangana State, India

ABSTRACT Purpose: To estimate the prevalence and correlates of visual impairment in Mahabubnagar district, Telangana, India. Methods: Fifty-one clusters of 80 people (all ages) were sampled with probability proportionate to size. Households within clusters were selected through the compact segment sampling. Visual acuity (VA) was measured with a tumbling “E” chart. An Ophthalmic Assistant or Vision Technician examined people with VA<6/12 in either eye. Other impairments (hearing, physical) were clinically assessed and self-reported functional difficulties measured using the Washington Group Extended Set. People with visual impairment and age-sex matched controls with normal vision were interviewed about poverty, employment and education. Results: 4,125 people were enumerated and 3,574 screened (86.6%). The prevalence of visual impairment (VA<6/12) was 8.0% (95% CI = 6.9–9.4%) and blindness was 0.4% (0.2–0.9%), and both increased rapidly with age. Uncorrected refractive error was the leading cause of visual impairment, and cataract the leading cause of blindness. Cataract surgical coverage (proportion of all cataracts that had received surgery) was relatively low (41% of people at VA<6/60), while the post-surgery outcomes were good (81% of operated eyes had presenting VA≥6/18). Among the 287 people with visual impairment, 15% had a moderate/severe physical impairment or epilepsy and 25% had a moderate/severe hearing impairment. Self-reported difficulties in vision were relatively closely related to visual acuity. People with visual impairment were more likely to be in the poorest quartile (OR = 1.9, 95% CI = 1.0–3.4) or unemployed (5.0, 2.2–10.0), compared to controls. Conclusions: Visual impairment was common in Mahabubnagar district, was mostly avoidable, and was correlated with poverty markers.

Prevalence and causes of hearing impairment in Fundong Health District, North West Cameroon

To estimate the prevalence and causes of hearing impairment in Fundong Health District, North‐West Cameroon.

Prevalence and causes of musculoskeletal impairment in Fundong District, North-West Cameroon: results of a population-based survey.

Epidemiological data on musculoskeletal conditions such as degenerative joint diseases and bone fractures are lacking in low‐ and middle‐income countries. This survey aimed to estimate the prevalence and causes of musculoskeletal impairment in Fundong Health District, North‐West Cameroon.