This case study highlights refugees with disabilities’ access to mobile services and the benefits and challenges associated with using these services in three different humanitarian contexts. The analysis is based on a representative survey of refugees in three contexts: Bidi Bidi refugee settlement (Uganda), Kiziba refugee camp (Rwanda) and with urban refugees in Jordan. It also includes qualitative data drawn from two focus groups conducted with refugees with disabilities in Bidi Bidi and Kiziba. The survey used the Washington Group Questions (WGQs) to assess prevalence of disability amongst the refugee population
This study used a parametric bootstrap model to estimate intracluster correlation coefficient (ICC) for trachomatous inflammation-follicular (TF) in 1-9 year-olds, from 261 population-based trachoma prevalence surveys completed using standardised GTMP methodologies in Ethiopia, Mozambique, and Nigeria from 2012-2016.
Results from this study were used to draw up the most recent WHO 2018 recommendations on design effect (DE) estimates for sample size calculations for survey
American Journal of Epidemiology, 2019 Sep 11. pii: kwz196
In 2009 Ghana began to design a trachoma pre-validation surveillance plan, based on then-current WHO recommendations. The plan aimed to identify active trachoma resurgence and identify and manage trichiasis cases, through both active and passive surveillance approaches. This paper outlines and reviews the adaptations made by Ghana between 2011 and 2016
Infectious Diseases of Poverty volume 8, Article number: 78 (2019)
Background: There are multiple factors that make it difficult for learners with a mobility impairment to participate in sport, if not impossible. Unfortunately, it is not known which of these factors can be considered as the most important ones.
Objectives: The main objective was to obtain clarity on the factors that differentiate best between learners who participate in sport and those learners who are not participating.
Method: In total, 140 boys and girls with different types of mobility impairments participated. Information was obtained on inevitable factors such as age and gender, structure factors such as type of school and hostel dwelling and personal factors such as emotions and relationships with parents and peers.
Results: Four factors emerged that explained 22% of the variance in the distinctive characteristics of the group that participates in sport and the non-participating group. Age was the most important variable explaining 9% of the variance followed by trust (an emotional variable), gender and health.
Conclusion: Children with a mobility impairment should be encouraged to start participating in sport at an early age. Specific attention should be given to girls who are more reluctant to participate. Health is a factor that can inhibit sports participation; however, it should not be overemphasised. The emphasis should rather be on the development of trust, which will help adolescents with an impairment to take responsible risks in an adaptive sports environment.
African Journal of Disability, Vol 8, 2019
Background: Community-based rehabilitation (CBR) is a complex concept and strategy that has been implemented in diverse ways globally and in South Africa. Internationally, some stakeholders have described CBR as confusing, and this may influence implementation. A southern African study reports that there is insufficient evidence of the understanding of CBR in the region to influence training, policy and practice.
Objectives: The aim of this study was to investigate South African stakeholders’ knowledge of CBR.
Method: This article reports on an electronic survey that was part of a larger mixed methods study. Based on the sample of 86 respondents, descriptive statistics were used to analyse the quantitative data and thematic analysis for the qualitative data.
Results: The majority of respondents had had exposure to CBR, but almost a quarter had no knowledge of the CBR guidelines and matrix. The results revealed varying knowledge concerning the key concepts of CBR, its beneficiaries and its funders. Respondents identified persons with disabilities as having a central role in the implementation of CBR. Problems with the visibility of CBR programmes were noted, as well as misunderstandings by many therapists.
Conclusion: The implementation of CBR, and its goal of ensuring the rights of persons with disabilities, is negatively affected by the confusion attached to the understanding of what CBR is. The misunderstandings about, and lack of visibility of, CBR in South Africa may hinder its growing implementation in the country in line with new government policies.
African Journal of Disability, Vol 8, 2019
Purpose: Albinism in Tanzania causes fierce stigmatisation. Although various stigma reduction interventions (SRI) are employed, research on their effectiveness is lacking. This research aimed to develop a tool to measure albinism-related social stigma among high school students in Tanzania. Cultural equivalence was tested for the Explanatory Model Interview Catalogue Community Stigma Scale (EMIC-CSS) and Albinism Social Distance Scale for Adolescents (ASDS-A) assessing conceptual, item, semantic, operational and measurement equivalence.
Methods: The methods used were workshops, in-depth interviews, translation and re-translation, discussions, a test (n=337) re-test (n=142) of the survey, and follow-up focus group discussions (n=25).
Results: The Scales have proven to be adequate on all equivalences other than measurement equivalence. The reproducibility statistics raise questions that can be explained by characteristics of the sample.
Conclusion and Implications: The analysis provides insights for further validation of the Scales, contributes to the discussion about a universal stigma measurement tool and demonstrates the importance of validation studies of existing and proven tools used in a different context.
Purpose: The study aimed to understand the self-perceived environmental barriers/ facilitators to community ambulation among stroke survivors in Maharashtra State, India.
Method: The Facilitators and Barriers Survey /Mobility Questionnaire (FABS/M) was used to collect information from a convenience sample of 50 individuals with stroke. Data was analysed using descriptive statistics in Statistical Package for Social Sciences (SPSS) 22.00.
Results: Curbs, gravel surfaces, rain, noise, and crowd were marked as barriers by 56%, 58%, 52%, 36% and 50% of the participants, respectively. Ramps, elevators, and flat surfaces were reported as facilitators by 42%, 70% and 82% of the participants, respectively. Participants also mentioned the absence of automatic doors and escalators in community areas (92% and 88%), specialised exercise equipment, handrails and specialised bathroom equipment at home (92%, 50% and 52%), and inaccessibility to public places (50%), as barriers to easy mobility.
Conclusions: To enhance community mobility of individuals with stroke, environmental barriers should be reduced and facilitators should be enhanced. The marked absence of facilitators in the environment should be rectified and appropriate steps should be taken to enhance ambulation.
Limitations of the study are the small sample size. Factors like balance, economic status, physical activity of the stroke individuals and severity of stroke were also not considered.
Purpose: There is very little demographic or prevalence data regarding persons with disabilities in Ethiopia, let alone data on more in-depth factors such as access to services or quality of life. This study aimed to find out about the current quality of life of persons with disabilities in Southern Nations, Nationalities, and Peoples’ Region (SNNPR), Ethiopia.
Method: The WHO CBR Indicator Survey was used to measure quality of life, and the Washington Group Short Set was included to allow disaggregation of the data by different types of functional limitations. Interviews were conducted with 966 persons with disabilities in 10 towns in SNNPR. The majority of data collectors were persons with disabilities themselves.
Results: People with disabilities who were surveyed generally regarded their health as good (65.9%). Very few had significant levels of education (16.5% were completing higher education). Only 6.7% were working for wages and 45.2% were reportedly working on their own account. Hardly any of them (2.9%) stated that their money was sufficient for their needs. Only a small group (38%) felt valued in their community. Just over half of the respondents (56.6%) were members of a Disabled Persons’ Organisation (DPO) or any other self-representing group.
Conclusion: Persons with disabilities scored relatively or extremely low in all areas of life measured with the CBR Indicator Survey (health, education, livelihood, social and empowerment). The survey will be repeated after a few years in the same communities to measure changes over time, and persons without disabilities will be included in order to draw comparisons.
Implications: Public and private organisations in SNNPR need to become more accessible and inclusive of persons with disabilities so as to improve their quality of life.
Background: There is increasing interest in the collection of globally comparable disability data. Context may influence not only the rates but also the nature of disability, thus locally collected data may be of greater use in service delivery planning than national surveys.
Objectives: The objective of this article was to explore the extent to which two areas, both under-resourced but geographically and socially distinct, differed in terms of the prevalence and patterns of disability.
Method: A cross-sectional descriptive survey design was utilised, using stratified cluster sampling in two under-resourced communities in the Western Cape, South Africa. Nyanga is an informal urban settlement in Cape Town and Oudtshoorn is a semi-rural town. The Washington Group Short Set of questions was used to identify persons with disabilities (PWD), and a self-developed questionnaire obtained socio-demographic information.
Results: The overall prevalence of disability was 9.7% (confidence intervals [CIs] 9.7–9.8) and the proportion of PWD was significantly different between the two sites (Chi-Sq = 129.5, p < 0.001). In the urban area, the prevalence rate of any disability was 13.1% (CIs 12.0–14.3) with 0.3% (CIs 0.1–0.6) reporting inability to perform any function at all. In contrast, the semi-rural community had a lower overall prevalence rate of 6.8% (CIs 6.0% – 7.8%) but a higher rate of those unable to perform any function: 1% (CIs 0.07–1.4). Disability was associated with gender, age, unemployment and lower income status in both areas.
Conclusion: Deprived areas tend to show higher disability prevalence rates than the National Census estimates. However, the discrepancy in prevalence and patterns of disability between the two under-resourced areas indicates the need for locally specific data when planning health interventions.
African Journal of Disability, Vol 8, 2019
Background: Individuals with disabilities experience difficulty in using various everyday technologies such as computers and smartphones.
Objectives: To propose a conceptual framework that will lead to the development of practical and user friendly assistive technology.
Method: A literature review of challenges faced by individuals with physical disabilities was carried out. Interviews with adults with physical disabilities in Kampala, Uganda, and Port Elizabeth, South Africa, identified three main challenges with regard to using technology: using a mobile phone, controlling an electronic environment and using a computer.
Results: The challenges identified can be solved by taking into consideration the needs of individuals with disabilities. However, the design of new technologies and interaction techniques, such as natural hand gestures and voice, as input mechanisms has able-bodied individuals in mind. Individuals with disabilities are considered as an afterthought. The main reason for this is that individuals with a disability are a minority and hence it may not make economic sense for technology innovators to cater for their unique needs. A lack of practical guidelines on how to design for individuals with disabilities is another reason why designing for individuals with disabilities is often an afterthought.
Conclusion: This article proposes a conceptual framework that can be used by researchers and technology designers in order to design products that could cater for the unique needs of individuals with disabilities. The article also emphasises the importance of exploring alternative interaction techniques, as they could enable individuals with disabilities to fully utilise technologies such as smart phones, computers and smart home electronics.
African Journal of Disability, Vol 8, 2019
This report describes the findings of a rapid assessment of avoidable blindness (RAAB) conducted in Muchinga Province, Zambia in 2017.
The prevalence of blindness was just over 4% and the major cause was cataract, followed by glaucoma. Only 37% of people who require cataract surgery have received it, meaning there is an urgent need to scale up access to cataract surgical services in the province.
In addition to the standard RAAB questionnaire, an additional two sets of questions were administered to the participants to understand their disability and socioeconomic status: the Washington Group Short Set of Questions on Disability (WGSS) and the Equity Tool (ET)
Evidence suggests that people with disabilities are the most marginalised and vulnerable group within any population. However, little is known about the extent of inequality between people with and without disabilities in contexts where the majority of persons experience extreme poverty and hardship. This includes in Liberia, where very little is understood about the lives of disabled people in general. This study uses a multidimensional wellbeing framework to understand perceived relative inequality associated with disability by assessing several facets of wellbeing across and within households containing disabled members (N = 485) or households with no disabled members (N = 538) in Liberian communities (Total individuals surveyed, N = 2020). Statistical comparisons (adjusted for age, sex, education and wealth differences and clustered at the household, village and county level) reveal that disabled Liberians are managing similarly to non-disabled Liberians in terms of income and education, but experience many perceived relative inequalities including in life satisfaction, transport access, political participation and social inclusion.
PLoS ONE 14(7)
This article presents the results of a survey on personal assistance (PA) for disabled people, conducted among PA users and members of the independent living movement in Europe. The survey was developed and implemented in the spirit of emancipatory disability research, and was informed by the social model of disability and the independent living philosophy. Participants were asked to assess a series of characteristics of PA in terms of their impact on users’ choice and control. Their responses help identify which characteristics of PA are considered to be enablers of choice and control, which characteristics are perceived as barriers and which characteristics elicit disagreement or lack of consensus among PA users and members of the independent living movement in Europe. Plans for using the results of the survey to develop a tool for evaluating PA schemes are also discussed.
It is commonly assumed that there is a lack of disability data, and development actors tend to attribute lack of data as the reason for failing to proactively plan for the inclusion of people with disabilities within their programming. However, it is an incorrect assumption that there is a lack of disability data. There is now a growing amount of disability data available. Disability, however, is a notoriously complex phenomenon, with definitions of disability varying across contexts, as well as variations in methodologies that are employed to measure it. Therefore, the body of disability data that does exist is not comprehensive, is often of low quality, and is lacking in comparability. The need for comprehensive, high quality disability data is an urgent priority bringing together a number of disability actors, with a concerted response underway. We argue here that enough data does exist and can be easily disaggregated as demonstrated by Leonard Cheshire’s Disability Data Portal and other studies using the Washington Group Question Sets developed by the Washington Group on Disability Statistics. Disaggregated data can improve planning and budgeting for reasonable accommodation to realise the human rights of people with disabilities
Sustainability 2019, 11(11), 3091
Purpose: This is a survey of peer-reviewed articles focussed on the causes and consequences of stigma towards persons with physical disability in Ghana.
Method: After a systematic search of the online databases EBSCOhost, ProQuest, PubMEd and Web of Science for peer-reviewed articles on disability in Ghana, 26 articles were chosen for critical review. The three main selection criteria were: the articles had to be peer-reviewed, they had to be based on interviews with Ghanaians in the field, and they had to discuss stigma and human rights. For analysis, the content of the articles was grouped under two sections: major themes (human rights, causes of stigma, consequences of stigma) and policy recommendations (economics, medical services/healthcare, affirmative action, attitudes and awareness-raising, inclusion of cultural beliefs).
Results: This review found that most of the studies attribute stigma to negative attitudes towards Ghanaians with disability, and many highlight beliefs among Ghanaians that disability is caused by spiritual and supernatural forces. The consequences, according to most authors, are social, economic and political exclusion. Policy recommendations include improving government policy, increasing funding for disability programmes, changing public attitudes, and paying attention to Ghanaian culture and tradition in designing disability interventions. While these are valid points, the authors of this paper are of the opinion that the literature also suffers from lack of a deep understanding of the historical and socio-cultural roots of supernatural beliefs in Ghana.
Conclusion: The 26 studies discussed in this review show that since 2006 very good work has been produced on disability in Ghana, especially by Ghanaian disability scholars.
It is hypothesised, however, that a full understanding of disability and stigma in Ghana must be based on deeper research into the roots of the beliefs that drive stigma. Future work therefore should focus on deepening the analysis of cultural beliefs towards disability in Ghana, in order to understand fully the roots of culturally-based disability stigma. More research into the economic causes and consequences of disability is also recommended, without which a full analysis of cultural stigma will not be possible.
The unmet need for rehabilitation is profound and is likely to worsen as population health shifts towards longer lives lived with more ill-health and disability. The WHO Global Action Plan on Disability and the Rehabilitation 2030 framework  call for quality evidence to inform targeted responses.
The intent of this work is to examine six IDSCs (Integrated Disability Service Centres) in detail but to use the results to inform new activities through the network of more than 100 Integrated Disability Service Centres, with potential to influence practice in other services. As such, results of this work have the potential to directly inform policy decisions concerning future investments in rehabilitation services in Bangladesh and bring awareness to key stakeholders on current challenges and potential solutions.
Research was conducted during March-October 2018 in Kurigram, Tangail, Manikgonj, Dhaka and Narsingdi districts of Bangladesh to map out the current trends and determinants of good coordination
between health and rehabilitation, emphasising quantitative measures of: timeliness, continuity, acceptability, availability and integration
Handicap International (HI) commissioned a study on on explosive hazard victim reporting and data management processes in Iraq. The overall objectives of the study were to:
- Understand what explosive hazard victim reporting and data management processes exist in Iraq;
- Identify who is collecting such information, for which reasons and how it is being shared, and how it is being officially used;
- Identify whether international victim data collection good practices and reporting standards are being followed up, and make concrete recommendations to help meet the standards;
- Understand the successes, shortfalls, and challenges in data collection and information sharing;
- Identify the needs of the data collection community in terms of ensuring sufficient victim reporting and data collection;
- Identify if and how the data on victims is being collected and used by government authorities and the international fora.
Desk research was carried out and data collection took place in March 2019 in Erbil, Baghdad and Ninewa governorates in Iraq. In total, the qualitative researcher spent 3 days in Erbil, 4 days in Baghdad, and 6 days in Ninewa governorate to conduct interviews through a snowball approach. In total, 22 interviews were conducted with a variety of stakeholders, including humanitarian mine action actors, government officials, hospital directors, police and community leaders. This report provides an overview of the main findings.
This study explores participation of people with disabilities in social protection programmes, with Tanahun District of Nepal as the study setting. This research uses mixed methods to assess coverage (through direct survey), how coverage varies amongst people with disabilities (e.g. by gender, impairment type), as well as challenges and facilitators to enrolling in or using relevant social protection programmes. This research benefits from a population-based study design and from the use of the Washington Group question sets
The European Journal of Development Research (2019) 31:929–956
To learn more about the current status of IECD (inclusive early childhood development) and ECI (early childhood intervention) programs, three international organizations collaborated to conduct a global survey: RISE Institute; UNICEF; and the Early Childhood Development Task Force (ECDtf), which is within the Global Partnership on Children with Disabilities (GPcwd). This large survey was designed in 2016, was conducted in 2017, and the report was prepared in 2018.
The main objectives of the survey were to:
- Map current implementation of IECD and ECI programs and related activities;
- Describe key IECD and ECI program features;
- Identify gaps and challenges in providing accessible IECD and ECI services;
- Document factors associated with successful implementation and scale-up;
- Generate recommendations to inform future policy and program development and national planning and implementation efforts.
The online survey targeted a range of programs, and activities including IECD and ECI services; rehabilitation and habilitation services; humanitarian, emergency, and child Global Survey of Inclusive ECD and ECI Programs 8 protection services; advocacy campaigns; and research and evaluation projects.
Program respondents provided information on 426 programs that were implemented in 121 countries.
Background: Because resources are limited in low- and middle-income countries (LMIC), the development of outcome measures is of interest. Wheelchair outcome measures are useful to support evidence-based practice in wheelchair provision.
Objectives: The Wheelchair Interface Questionnaire (WIQ) is being developed to provide a professional perspective on the quality of the interface between a wheelchair and its user. This article discusses the development of the WIQ and its face and content validity.
Method: During field studies in Kenya, we sought to include professional report data on the wheelchair–user interface that could be analysed to inform design changes. None of the existing measures was focused on the interface between users and their wheelchairs. The WIQ was developed to meet this need. To investigate face and content validity, 24 experienced wheelchair professionals participated in a study that included two rounds of an online survey and a focus group in Kenya.
Results: Responses were categorised by topic and the WIQ was modified following each iteration. Participants affirmed the usefulness of a brief professional report measure to provide a snapshot of the user–wheelchair interface. Participants emphasised the importance of brevity, wide applicability and provision of specific feedback for wheelchair modification or design changes. The focus group agreed that the final version provided useful data and was applicable to virtually all wheelchair users in LMIC.
Conclusion: These preliminary studies indicate initial face and content validity of the WIQ as a method for providing a professional perspective on the interface between a user and his or her wheelchair.
African Journal of Disability, Vol 8, 2019
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