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Htwe O, Yuliawiratman BS, Tannor AY, Nor Asikin MZ, Soh E, DE Groote W, Naicker MS, Naicker AS. Barriers and facilitators for increased accessibility to quality rehabilitation services in low- and middle- income countries: a systematic review. Eur J Phys Rehabil Med 2024; 60:514-522. [PMID: 38551518 PMCID: PMC11258907 DOI: 10.23736/s1973-9087.24.08154-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION With an increasing number of people experiencing limitations in functioning during their life course, the need for comprehensive rehabilitation services is high. In 2017, the WHO Rehabilitation 2030 initiative noted that the need for the establishment and expansion of rehabilitation services is paramount in order to obtain well-being for the population and to ensure equal access to quality healthcare for all. The organization of rehabilitation services is however facing challenges especially in low-and middle-income countries with a very small proportion of people who require rehabilitation actually getting them. Various surveys conducted in low-and -middle income countries have revealed existing gaps between the need for rehabilitation services and the actual receipt of these services. This systematic review aimed to determine the barriers and facilitators for increasing accessibility to rehabilitation services in low- and middle-income countries. Recommendations for strengthening rehabilitation service organization are presented based on the available retrieved data. EVIDENCE ACQUISITION In this systematic review, an electronic search through three primary databases, including Medline (PubMed), Scopus and Web of Science (WOS) was conducted to identify original studies reporting on barriers and facilitators for rehabilitation service organization in low-and middle-income countries. Date of search: 25th April 2021 (PubMed), 3rd May 2021 (Scopus and Web of Science). All studies including barriers or/and facilitators for rehabilitation services in low- and middle income countries which were written in English were included in the review. The articles written in other languages and grey literature, were excluded from this review. EVIDENCE SYNTHESIS Total of 42 articles were included from year 1989 to 2021. Numerous barriers were identified that related to education, resources, leadership, policy, technology and advanced treatment, community-based rehabilitation (CBR), social support, cultural influences, political issues, registries and standards of care. National health insurance including rehabilitation and funding from government and NGOs are some of the facilitators to strengthen rehabilitation service organization. Availability of CBR programs, academic rehabilitation training programs for allied health professionals, collaboration between Ministry of Heath (MOH) and Non-governmental Organizations (NGOs) on telerehabilitation services are amongst other facilitators. CONCLUSIONS Recommendations for improving and expanding rehabilitation service organization include funding, training, education, and sharing of resources.
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Affiliation(s)
- Ohnmar Htwe
- Rehabilitation Medicine Unit, Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia -
| | | | - Abena Y Tannor
- Department of Health Promotion and Disability, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Muhamad Z Nor Asikin
- Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Elaine Soh
- Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Wouter DE Groote
- Department of Rehabilitation Medicine, AZ Rivierenland, Bornem, Belgium
| | | | - Amaramalar S Naicker
- Rehabilitation Medicine Unit, Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Ahmed N, Shaikh SA, Riaz A, Midhet F, Zia N. Public sector rehabilitation services for physical disabilities in tertiary care hospitals of Karachi, Pakistan: A qualitative study. Injury 2023; 54 Suppl 4:110798. [PMID: 37573067 DOI: 10.1016/j.injury.2023.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Around the globe there are 2.4 billion people in need of rehabilitation. Disability and rehabilitation have not gained much importance in the public health arena, possibly due to limited research and awareness regarding the significance of rehabilitation. This study aimed to provide an in-depth understanding of the barriers and facilitators to the provision and utilization of rehabilitation services in public sector tertiary care hospitals of Karachi, Pakistan. METHODOLOGY This qualitative exploratory study was conducted from August to September 2015 in two tertiary care hospitals of Karachi. The criterion for hospital selection included the availability of functional rehabilitation services. Twenty-four key informant interviews were conducted with health professionals, including doctors, physiotherapists, occupational therapists, prosthetists, orthotists, as well as patients and caregivers. Qualitative content analysis was performed using a consensual qualitative research approach. Responses from key informant interviews were coded into free nodes and then categorized into themes. RESULTS Two themes emerged from the data: constraints to the provision of rehabilitation services, and barriers to the utilization of rehabilitation services. Basic infrastructure was available at both study sites; however, a lack of structured guidelines for referring patients to these services, a lack of information-sharing and guidance to the patients, and a limited supply of equipment (treatment modalities) hampered the provision of services. The barriers to rehabilitation services included cost pertaining to transport, environmental barriers, lack of support from the employer, and strain on and lack of support from caregivers. CONCLUSION Rehabilitation services require attention and investment in research and allocation of funds to strengthen the service delivery system. Hospitals, alongside the department of health, need to develop a strategic plan to set future directions and standards of available rehabilitation services.
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Affiliation(s)
- Naveed Ahmed
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
| | - Saeed Ahmed Shaikh
- Department of Orthopedic Surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Atif Riaz
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Farid Midhet
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Neill R, Shawar YR, Ashraf L, Das P, Champagne SN, Kautsar H, Zia N, Michlig GJ, Bachani AM. Prioritizing rehabilitation in low- and middle-income country national health systems: a qualitative thematic synthesis and development of a policy framework. Int J Equity Health 2023; 22:91. [PMID: 37198596 PMCID: PMC10189207 DOI: 10.1186/s12939-023-01896-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND There is a large and growing unmet need for rehabilitation - a diverse category of services that aim to improve functioning across the life course - particularly in low- and middle-income countries. Yet despite urgent calls to increase political commitment, many low- and middle-income country governments have dedicated little attention to expanding rehabilitation services. Existing policy scholarship explains how and why health issues reach the policy agenda and offers applicable evidence to advance access to physical, medical, psychosocial, and other types of rehabilitation services. Drawing from this scholarship and empirical data on rehabilitation, this paper proposes a policy framework to understand national-level prioritization of rehabilitation in low- and middle-income countries. METHODS We conducted key informant interviews with rehabilitation stakeholders in 47 countries, complemented by a purposeful review of peer-reviewed and gray literature to achieve thematic saturation. We analyzed the data abductively using a thematic synthesis methodology. Rehabilitation-specific findings were triangulated with policy theory and empirical case studies on the prioritization of other health issues to develop the framework. RESULTS The novel policy framework includes three components which shape the prioritization of rehabilitation on low- and middle-income countries' national government's health agendas. First, rehabilitation lacks a consistent problem definition, undermining the development of consensus-driven solutions which could advance the issue on policy agendas. Second, governance arrangements are fragmented within and across government ministries, between the government and its citizens, and across national and transnational actors engaged in rehabilitation service provision. Third, national legacies - particularly from civil conflict - and weaknesses in the existing health system influences both rehabilitation needs and implementation feasibility. CONCLUSIONS This framework can support stakeholders in identifying the key components impeding prioritization for rehabilitation across different national contexts. This is a crucial step for ultimately better advancing the issue on national policy agendas and improving equity in access to rehabilitation services.
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Affiliation(s)
- Rachel Neill
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD 21205 USA
| | - Yusra Ribhi Shawar
- Department of International Health, Johns Hopkins University Blomberg School of Public Health, Baltimore, MD USA
- Paul H. Nitze School of Advanced International Studies, Johns Hopkins University, Washington, DC USA
| | - Lamisa Ashraf
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD 21205 USA
| | - Priyanka Das
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD 21205 USA
| | - Sarah N. Champagne
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD 21205 USA
| | - Hunied Kautsar
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD 21205 USA
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD 21205 USA
| | - Georgia J. Michlig
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD 21205 USA
| | - Abdulgafoor M. Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD 21205 USA
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Mkoba EM, Sundelin G, Sahlen KG, Sörlin A. The characteristics of stroke and its rehabilitation in Northern Tanzania. Glob Health Action 2021; 14:1927507. [PMID: 34340643 PMCID: PMC8344769 DOI: 10.1080/16549716.2021.1927507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/05/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Stroke causes great suffering and severe disability worldwide, and rehabilitation following a stroke seeks to restore lost functions. The extent to which stroke patients get access to rehabilitation in Tanzania is not well estimated, and drawing a current picture of the rehabilitation services for these persons is the first step in developing a more effective rehabilitation model in the country. OBJECTIVE The objective of this study was to establish the characteristics of stroke and its rehabilitation at the Kilimanjaro Christian Medical Centre (KCMC), a consultant referral hospital in northern Tanzania. METHODS This was a records-based descriptive study in which demographic, clinical, and rehabilitation information of stroke patients admitted to the KCMC between January 2012 and December 2015 was collected and audited. The means, percentages, and proportions were used to summarise the demographic, clinical, and rehabilitation patterns using SPSS version 24.0 software. The chi-squared statistic was used to examine the relationships between categorical variables, and a p-value<0.05 was considered statistically significant. RESULTS Of the 17,975 patients admitted to the KCMC during the period of the study, 753 (4.2%) had suffered a stroke, with a mean age of 68.8 ± 16.4 years. The predominant cause of stroke was hypertension, which accounted for 546 (72.5%) patients. A total of 357 (47.4%) patients had various forms of rehabilitation during the admission to hospital. Following a discharge home 240 (31.9%) patients did not return to the hospital for the continuation of rehabilitation. CONCLUSION Stroke patients at the KCMC lack access to rehabilitation therapies. Insufficient access to rehabilitation therapies may warrant the need to explore alternative approaches such as tele-rehabilitation technologies in Tanzania.
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Affiliation(s)
- Egfrid Michael Mkoba
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- Physiotherapy Department, Faculty of Rehabilitation Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gunnevi Sundelin
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Klas-Göran Sahlen
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Ann Sörlin
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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Aduayom-Ahego A. Prosthetic rehabilitation of multiple-digit amputa tions using silicone material in sub-Saharan African country Ghana. Pan Afr Med J 2020; 36:357. [PMID: 33224423 PMCID: PMC7664149 DOI: 10.11604/pamj.2020.36.357.25361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 11/23/2022] Open
Abstract
Digit loss might be due to traumatic injuries, congenital malformations and various diseases. Rehabilitation of finger amputations requires aesthetics and functional aspects. Due to limited resources in low income countries, some local professionals find it difficult to meet the patient´s needs. One of the methods of gaining total suspension is to don the residual finger with aesthetic silicone prosthesis. A 25-year-old female presented with multiple-digit amputations of both of her hands due to autoimmune disease. At first stage of the treatment, silicone prostheses of the loss fingers of both hands were planned. The impressions of the remaining fingers were taken to manufacture the silicone prostheses. The manufactured prostheses with total suspension improved patient´s social life. The patient´s residual fingers were fitted with the prostheses after which she was satisfied with the aesthetic aspects.
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Affiliation(s)
- Akouetevi Aduayom-Ahego
- Ahelite Brace, Accra, Ghana.,Dream GP Inc., Research and Development Division, Osaka, Japan.,Waseda Institute for Sport Sciences, Waseda University, Tokorozawa, Japan
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Wylie K, Davidson B, Marshall J, Bampoe JO, Amponsah C, McAllister L. Community service providers' roles in supporting communication disability rehabilitation in Majority World contexts: An example from Ghana. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:414-424. [PMID: 31438722 DOI: 10.1080/17549507.2019.1651395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: In Majority World countries, where speech-language pathology services are extremely limited, people with communication disabilities (PWCD) may seek help from a range of service providers. This qualitative research aimed to explore the nature of community services offered to people with communication disabilities who seek help in Accra, Ghana.Method: Semi-structured interviews were conducted with nine individuals from three professions: pastors (3), doctors (3), and herbalists (3) exploring services that they may offer to PWCD seeking help. Interviews were analysed using Thematic Network Analysis.Result: Six global themes described beliefs about communication disability, types of intervention, explanations provided to people with communication disabilities, promoting communication, processes for selecting treatments, and links between service providers. Interventions encompassed physical, spiritual, psychosocial and environmental approaches, with the notion of plural beliefs interwoven through a number of themes.Conclusion: In Ghana, and other Majority World contexts, service providers in sectors not commonly associated with communication disability rehabilitation may have important roles to play in supporting people with communication disabilities. Understanding the contributions of other service providers may assist the growing profession of speech-language pathology to collaborate across sectors, to develop specific, culturally responsive approaches to service development.
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Affiliation(s)
- Karen Wylie
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Bronwyn Davidson
- Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, Australia
| | - Julie Marshall
- Health Professions Department, Manchester Metropolitan University, Manchester, UK
| | - Josephine Ohenewa Bampoe
- Department of Audiology, Speech and Language Therapy, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana, and
| | - Clement Amponsah
- Department of Audiology, Speech and Language Therapy, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana, and
| | - Lindy McAllister
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
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Geberemichael SG, Tannor AY, Asegahegn TB, Christian AB, Vergara-Diaz G, Haig AJ. Rehabilitation in Africa. Phys Med Rehabil Clin N Am 2019; 30:757-768. [PMID: 31563167 DOI: 10.1016/j.pmr.2019.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In Africa, rehabilitation services are insufficient and marred with inadequate political commitments and collaborations of stakeholders. Infrastructures and expertise for rehabilitation are scarce and poorly coordinated. Community-based rehabilitation programs are fragmented and fractured and lack working partnership with rehabilitation services in health care systems. Locally responsive policy frameworks, service delivery models, and health governance practices are prerequisites for meeting rehabilitation needs of the ever-increasing number of persons with chronic disabling conditions. Concerted global efforts are required for equitable and accessible coordinated continuum of rehabilitation care at various levels of health services and the community in most Sub-Saharan African countries.
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Affiliation(s)
- Sisay Gizaw Geberemichael
- Department of Neurology, St. Paul's Hospital Millennium Medical College, PO Box 1271, Addis Ababa, Ethiopia.
| | - Abena Yeboaa Tannor
- Disability and Rehabilitation Studies, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, PO Box: 1934, Kumasi, Ghana
| | - Tesfaye Berhe Asegahegn
- Department of Neurology, St. Paul's Hospital Millennium Medical College, PO Box 1271, Addis Ababa, Ethiopia
| | - Asare B Christian
- Good Shepherd Rehabilitation Hospital, PO Box: 850 South 5th Street, Allentown, PA 18103, USA
| | - Gloria Vergara-Diaz
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Andrew J Haig
- The University of Michigan, Ann Arbor, MI, USA; Haig Consulting PLC, MI, USA
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Rathore F, Uddin T, Islam M, O'Connell C. Disability and rehabilitation medicine in Bangladesh: Current scenario and future perspectives. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2019. [DOI: 10.4103/jisprm.jisprm_61_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zuurmond M, O’Banion D, Gladstone M, Carsamar S, Kerac M, Baltussen M, Tann CJ, Gyamah Nyante G, Polack S. Evaluating the impact of a community-based parent training programme for children with cerebral palsy in Ghana. PLoS One 2018; 13:e0202096. [PMID: 30180171 PMCID: PMC6122808 DOI: 10.1371/journal.pone.0202096] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 07/22/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In low and middle-income settings, where access to support and rehabilitation services for children with disabilities are often lacking, the evidence base for community initiatives is limited. This study aimed to explore the impact of a community-based training programme for caregivers of children with cerebral palsy in Ghana. METHODS A pre and post evaluation of an 11-month participatory training programme ("Getting to Know Cerebral Palsy") offered through a parent group model, was conducted. Eight community groups, consisting of a total of 75 caregivers and their children with cerebral palsy (aged 18 months-12 years), were enrolled from 8 districts across Ghana. Caregivers were interviewed at baseline, and again at 2 months after the completion of the programme, to assess: quality of life (PedsQL™ Family Impact Module); knowledge about their child's condition; child health indicators; feeding practices. Severity of cerebral palsy, reported illness, and anthropometric measurements were also assessed. RESULTS Of the child-caregiver pairs, 64 (84%) were included in final analysis. There were significant improvements in caregiver quality of life score (QoL) (median total QoL 12.5 at baseline to 51.4 at endline, P<0.001). Caregivers reported significant improvements in knowledge and confidence in caring for their child (p<0.001), in some aspects of child feeding practices (p<0.001) and in their child's physical and emotional heath (p< 0.001). Actual frequency of reported serious illness over 12-months remained high (67%) among children, however, a small reduction in recent illness episodes (past 2 weeks) was seen (64% to 50% p < 0.05). Malnutrition was common at both time points; 63% and 65% of children were classified as underweight at baseline and endline respectively (p = 0.5). CONCLUSION Children with cerebral palsy have complex care and support needs which in low and middle-income settings need to be met by their family. This study demonstrates that a participatory training, delivered through the establishment of a local support group, with an emphasis on caregiver empowerment, resulted in improved caregiver QoL. Despite less effect on effect on child health and no clear effect on nutritional status, this alone is an important outcome. Whilst further development of these programmes would be helpful, and is underway, there is clear need for wider scale-up of an intervention which provides support to families.
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Affiliation(s)
- Maria Zuurmond
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David O’Banion
- School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Melissa Gladstone
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Sandra Carsamar
- Physiotherapy Department, Korle Bu Teaching Hospital, Accra, Ghana
| | - Marko Kerac
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Cally J. Tann
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Tawiah AK, Borthwick A, Woodhouse L. Advanced Physiotherapy Practice: A qualitative study on the potential challenges and barriers to implementation in Ghana. Physiother Theory Pract 2018; 36:307-315. [PMID: 29897312 DOI: 10.1080/09593985.2018.1484535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: To identify the potential challenges and barriers to the implementation of Advanced Physiotherapy Practice (APP) in Ghana. Methods: A basic interpretive qualitative study design was conducted, with a semi-structured focus group comprising eight physiotherapists and a one-to-one interview with the director of orthopedic surgery in the second largest hospital in Ghana. Participants were sampled purposefully to ensure they had a clear understanding of APP. Discussions were audio recorded, transcribed, coded and thematic analysis was performed. Findings: Four key themes were identified as potential challenges to the implementation of APP in Ghana. Theme 1 Jurisdictional Disputes: Physiotherapists believed doctors will not accept the practice, while the doctor interviewed was willing to accept the practice. Theme 2: Management Support: Support from management was identified as a potential barrier to APP implementation due to workplace culture and liability. Theme 3 Change in Law and Policy: APP could be hindered if there is no legislative support and policies in place. Theme 4 Postgraduate Training: This was identified as key to the implementation of APP since there is no such level of training in Ghana. Conclusion: Barriers to health-care programs are often not identified and addressed prior to their implementation in developing countries, leading to program failure. Addressing these four barriers and challenges could ensure the successful implementation of APP in Ghana. APP has the potential to improve access to rural health-care delivery and augment the shortage of health professionals in developing countries.
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Affiliation(s)
| | - Alan Borthwick
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Linda Woodhouse
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Fuhs AK, LaGrone LN, Moscoso Porras MG, Rodríguez Castro MJ, Ecos Quispe RL, Mock CN. Assessment of Rehabilitation Infrastructure in Peru. Arch Phys Med Rehabil 2018; 99:1116-1123. [PMID: 29162468 PMCID: PMC5962371 DOI: 10.1016/j.apmr.2017.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 10/19/2017] [Accepted: 10/21/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess rehabilitation infrastructure in Peru in terms of the World Health Organization (WHO) health systems building blocks. DESIGN Anonymous quantitative survey; questions were based on the WHO's Guidelines for Essential Trauma Care and rehabilitation professionals' input. SETTING Large public hospitals and referral centers and an online survey platform. PARTICIPANTS Convenience sample of hospital personnel working in rehabilitation and neurology (N=239), recruited through existing contacts and professional societies. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Outcome measures were for 4 WHO domains: health workforce, health service delivery, essential medical products and technologies, and health information systems. RESULTS Regarding the domain of health workforce, 47% of physical therapists, 50% of occupational therapists, and 22% of physiatrists never see inpatients. Few reported rehabilitative nurses (15%) or prosthetist/orthotists (14%) at their hospitals. Even at the largest hospitals, most reported ≤3 occupational therapists (54%) and speech-language pathologists (70%). At hospitals without speech-language pathologists, physical therapists (49%) or nobody (34%) perform speech-language pathology roles. At hospitals without occupational therapists, physical therapists most commonly (59%) perform occupational therapy tasks. Alternate prosthetist/orthotist task performers are occupational therapists (26%), physical therapists (19%), and physicians (16%). Forty-four percent reported interdisciplinary collaboration. Regarding the domain of health services, the most frequent inpatient and outpatient rehabilitation barriers were referral delays (50%) and distance/transportation (39%), respectively. Regarding the domain of health information systems, 28% reported rehabilitation service data collection. Regarding the domain of essential medical products and technologies, electrophysical agents (88%), gyms (81%), and electromyography (76%) were most common; thickened liquids (19%), swallow studies (24%), and cognitive training tools (28%) were least frequent. CONCLUSIONS Rehabilitation emphasis is on outpatient services, and there are comparatively adequate numbers of physical therapists and physiatrists relative to rehabilitation personnel. Financial barriers seem low for accessing existing services. There appear to be shortages of inpatient rehabilitation, specialized services, and interdisciplinary collaboration. These may be addressed by redistributing personnel and investing in education and equipment for specialized services. Further examination of task sharing's role in Peru's rehabilitation services is necessary to evaluate its potential to address deficiencies.
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Affiliation(s)
| | | | - Miguel G Moscoso Porras
- School of Physical Therapy, Peruvian University of Applied Sciences, Lima, Peru; Association for the Development of Student Research in Health Sciences, San Marcos Major National University, Lima, Peru
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Kamenov K, Mills JA, Chatterji S, Cieza A. Needs and unmet needs for rehabilitation services: a scoping review. Disabil Rehabil 2018; 41:1227-1237. [PMID: 29303004 DOI: 10.1080/09638288.2017.1422036] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is a global demand for rehabilitation services but to date little attention has been paid to rehabilitation as part of the health agenda, especially in low- and middle-income countries. The objective of the scoping review was to get an overview of the needs and unmet needs for rehabilitation services described in the literature. MATERIALS AND METHODS Electronic search was performed in PubMed and REHABDATA for studies published between 2000 and 2017. RESULTS Eighty-six articles met the inclusion criteria. Results revealed a profound need for rehabilitation among different user groups with non-communicable diseases and injuries across countries. However, this need considerably outstripped the provision of services, which left many people with substantial unmet needs for rehabilitation. The main reasons for the unmet needs for rehabilitation were the absence of or unequal geographical distribution of services within a country, lack of transportation, and unaffordability of the services. CONCLUSIONS There are substantial unmet needs for rehabilitation and numerous barriers to accessing services. Efforts need to focus on building the capacity for rehabilitation research predominantly in low- and middle-income countries. The comprehensive data that this review provides is useful for raising awareness for the need of rehabilitation at policy level. Implications for rehabilitation There is a profound need for rehabilitation services due to the ageing population and growing prevalence of non-communicable diseases. This scoping review shows that the need for rehabilitation considerably outstrips the provision of services. There are substantial unmet needs for rehabilitation and numerous barriers to accessing services. Concerted global action to scale up quality rehabilitation services is needed, especially in low- and middle-income countries.
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Affiliation(s)
- Kaloyan Kamenov
- a Department for the Management of Noncommunicable Disease, Disability, Injury and Violence Prevention , World Health Organization , Geneva , Switzerland.,b Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red, CIBER , Madrid , Spain
| | - Jody-Anne Mills
- a Department for the Management of Noncommunicable Disease, Disability, Injury and Violence Prevention , World Health Organization , Geneva , Switzerland
| | - Somnath Chatterji
- c Department of Information, Evidence and Research , World Health Organization , Geneva , Switzerland
| | - Alarcos Cieza
- a Department for the Management of Noncommunicable Disease, Disability, Injury and Violence Prevention , World Health Organization , Geneva , Switzerland
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Wylie K, McAllister L, Davidson B, Marshall J, Amponsah C, Bampoe JO. Self-help and help-seeking for communication disability in Ghana: implications for the development of communication disability rehabilitation services. Global Health 2017; 13:92. [PMID: 29284504 PMCID: PMC5747098 DOI: 10.1186/s12992-017-0317-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 12/08/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In low and middle-income countries, such as Ghana, communication disability is poorly recognised and rehabilitation services for people with communication disability are limited. As rehabilitation services for communication disability develop, and the profession of speech-language pathology grows, it is important to consider how services can most appropriately respond to the needs and preferences of the community. Understanding the ways in which people currently self-help and seek help for communication disability is central to developing services that build on existing local practices and are relevant to the community. METHODS A qualitative descriptive survey was used to explore likely self-help and help-seeking behaviours for communication disability, in Accra, Ghana. The survey required participants to describe responses to hypothetical scenarios related to communication disability. A mix of theoretical sampling and convenience sampling was used. Qualitative content analysis was used to analyse data and develop categories and subcategories of reported self-help behaviours and sources of help and advice for communication disability. RESULTS One hundred and thirty-six participants completed the survey. Results indicated that community members would be likely to engage in a variety self-help strategies in response to communication disability. These included working directly with a person with a communication disability to attempt to remediate a communication impairment, altering physical and communication environments, changing attitudes or care practices, educating themselves about the communication disability, providing resources, and responding in spiritual ways. Participants indicated that they would seek help for communication disability across a range of sectors - including the Western healthcare, religious, and traditional sectors. CONCLUSIONS Understanding existing community actions to self-help and help-seek may allow emerging communication rehabilitation services, including the profession of speech-language pathology, to build on existing community practices in resource-limited contexts such as Ghana.
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Affiliation(s)
- Karen Wylie
- Korle Bu Teaching Hospital, ENT Department, PO Box 77, Korle Bu, Accra, Ghana
- Faculty of Health Sciences, University of Sydney, 75 East Street, Lidcombe, NSW 2141 Australia
- Department of Audiology, Speech and Language Therapy, School of Biomedical and Allied Health Sciences, University of Ghana, PO Box 143, Korle Bu, Accra, Ghana
| | - Lindy McAllister
- Faculty of Health Sciences, University of Sydney, 75 East Street, Lidcombe, NSW 2141 Australia
| | - Bronwyn Davidson
- Department of Audiology & Speech Pathology, The University of Melbourne, 550 Swanston Street, Melbourne, VIC 3010 Australia
| | - Julie Marshall
- Health Professions Department, Manchester Metropolitan University, 53 Bonsall Street, Manchester, M15 6GX UK
| | - Clement Amponsah
- Department of Audiology, Speech and Language Therapy, School of Biomedical and Allied Health Sciences, University of Ghana, PO Box 143, Korle Bu, Accra, Ghana
| | - Josephine Ohenewa Bampoe
- Department of Audiology, Speech and Language Therapy, School of Biomedical and Allied Health Sciences, University of Ghana, PO Box 143, Korle Bu, Accra, Ghana
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Bondoc IP, Mabag V, Dacanay CA, Macapagal ND. Speech-language pathology research in the Philippines in retrospect: Perspectives from a developing country. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:628-636. [PMID: 27701895 DOI: 10.1080/17549507.2016.1226954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/17/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE There is a need for speech-language pathology (SLP) research in the Philippines, in order to fill in knowledge gaps relevant to the local context. Information about the local SLP research status remains inadequate. This study describes local SLP research done over the almost past four decades. METHOD Using a descriptive retrospective design, a search was made for all empirical research articles completed by Filipino SLPs from 1978 to 2015. RESULT A total of 250 research articles were identified and described along several parameters. A predominant number were authored by the SLPs in the academe (97.20%). There was a focus on language (27.60%) and the nature of communication/swallowing disorders (20.80%). More than half utilised quantitative exploratory research designs (69.20%). Several used survey forms to generate data (38.41%). Nearly all were unpublished (93.60%) and were unfunded (94.80%). CONCLUSION The current study revealed a dearth of research studies, limited diversity of research articles, limited research dissemination and funding concerns. It is suggested that the results of the current study can serve as a reference point to restructure research systems in the Philippines and in other developing countries, and offer data that can be used to develop a research agenda for the profession.
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Affiliation(s)
- Ivan Paul Bondoc
- a Department of Speech Pathology , College of Allied Medical Professions, University of the Philippines Manila , Manila , Philippines and
| | - Viannery Mabag
- b Department of Speech-Language Pathology , College of Rehabilitative Sciences, Cebu Doctors University , Mandaue City , Philippines
| | - Clarisse Anne Dacanay
- a Department of Speech Pathology , College of Allied Medical Professions, University of the Philippines Manila , Manila , Philippines and
| | - Natasha Daryle Macapagal
- a Department of Speech Pathology , College of Allied Medical Professions, University of the Philippines Manila , Manila , Philippines and
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McSweeney E, Gowran RJ. Wheelchair service provision education and training in low and lower middle income countries: a scoping review. Disabil Rehabil Assist Technol 2017; 14:33-45. [PMID: 29092684 DOI: 10.1080/17483107.2017.1392621] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Improving access to education and training for those providing wheelchair and seating assistive technology to meet personal posture and mobility requirements, as a basic human right, is a priority. This review considers education and training available to personnel within low and lower middle income countries (LLMIC), to ascertain where gaps in knowledge exist and identify human resource education priorities. METHOD A scoping review, mapping out existing scientific and grey literature within the field between 1993 and 2017 was conducted. The search strategy included use of online databases, manual analogue searches and key stakeholder informant advice. A content analysis process was applied to organize the literature retrieved and extract key themes. RESULTS Education and training in LLMIC appears ad hoc and limited, however, there is growing recognition as to its importance, notably by the World Health Organization and nongovernmental organizations, delivering education initiatives to a number of countries, along with the development of a credentialing test. Inconsistency exists regarding personnel responsible for wheelchair provision, with no specific professional clearly recognized to oversee the system within many LLMIC. CONCLUSIONS Education and training is required for all stakeholders involved in wheelchair provision. Advocating for programme development to enhance personnel skills, build capacity and ensure best practice is a priority. Pilot sites, delivering and credentialing appropriate wheelchair provision education and training within context should be considered. Measuring outcomes and transferable skills should be part of education programme delivery structures. Considering a new discipline responsible for oversight of wheelchair provision should be investigated. Implications for rehabilitation Education and training is an essential step in the wheelchair provision process in the bid to obtain an appropriate wheelchair via appropriate provision services. However, it is more than education and training; its a human rights issue. Mandatory education and training needs to be a requirement for all stakeholders involved in wheelchair provision. Key wheelchair personnel need to establish their central role in this arena. The study raises awareness as to the importance of working with governments to commit to building sustainable wheelchair provision infrastructures.
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Affiliation(s)
- Elizabeth McSweeney
- a Department of Clinical Therapies , Faculty of Education and Health Sciences, University of Limerick , Ireland
| | - Rosemary Joan Gowran
- a Department of Clinical Therapies , Faculty of Education and Health Sciences, University of Limerick , Ireland.,b School of Health & Sport Sciences , Faculty of Science, Health, Education & Engineering, University of the Sunshine Coast , Australia
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Agho AO, John EB. Occupational therapy and physiotherapy education and workforce in Anglophone sub-Saharan Africa countries. HUMAN RESOURCES FOR HEALTH 2017; 15:37. [PMID: 28606103 PMCID: PMC5469184 DOI: 10.1186/s12960-017-0212-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 06/02/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Sub-Saharan Africa (SSA) countries are faced with the challenge of educating a critical mass of occupational therapists (OTs) and physiotherapists (PTs) to meet the growing demand for health and rehabilitation services. The World Federation of Occupational Therapy (WFOT) and World Confederation of Physical Therapy (WCPT) have argued for the need of graduate-level training for OTs and PTs for decades. However, very few studies have been conducted to determine the availability of OT and PT training programs and practitioners in SSA countries. METHODS Initial data were collected and compiled from an extensive literature search conducted using MEDLINE and PubMed to examine the availability of OT and PT education and training programs in SSA countries. Additional data were collected, compiled, and collated from academic institutions, ministries of health, health professions associations, and licensing authorities in SSA countries. Secondary data were also collected from the websites of organizations such as the World Bank, World Health Organization (WHO), WFOT, and WCPT. RESULTS This investigation revealed that there are limited number of OT and PT training programs and that these training programs in Anglophone SSA countries are offered at or below the bachelor's level. More than half of the countries do not have OT or PT training programs. The number of qualified OTs and PTs appears to be insufficient to meet the demand for rehabilitation services. Nigeria and South Africa are the only countries offering post-entry-level masters and doctoral-level training programs in physiotherapy and occupational therapy. CONCLUSIONS Higher learning institutions in SSA countries need to collaborate and partner with other regional and foreign universities to elevate the educational training and increase the supply of PTs and OTs in the region.
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Affiliation(s)
- Augustine O. Agho
- Office of Academic Affairs, Old Dominion University, Norfolk, VA United States of America
| | - Emmanuel B. John
- Department of Physical Therapy, Chapman University, Irvine, CA United States of America
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Wylie K, McAllister L, Davidson B, Marshall J. Communication rehabilitation in sub-Saharan Africa: A workforce profile of speech and language therapists. Afr J Disabil 2016; 5:227. [PMID: 28730052 PMCID: PMC5433457 DOI: 10.4102/ajod.v5i1.227] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 05/31/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There is an urgent global need to strengthen rehabilitation services for people with disabilities. In sub-Saharan Africa, rehabilitation services for people with communication disabilities continue to be underdeveloped. A first step in strengthening services for people with a communication disabilities is to understand the composition and conditions of the current workforce. OBJECTIVES This research describes a sample of the speech and language therapists (SLTs) working in SSA (excluding South Africa). This study explores the characteristics of this workforce, including their demographics, education, experience and geographical stability. METHOD A mixed-methods survey was used to collect data from SLTs within Anglophone countries of SSA. Completed surveys were received from 33 respondents working in 44 jobs across nine countries. Analysis included descriptive and non-parametric inferential statistics. This study reports on a subset of descriptive and quantitative data from the wider survey. RESULTS A background profile of SLTs across the region is presented. Results indicated that the workforce of SLTs comprised a mix of local and international SLTs, with university-level education. Local SLTs were educated both within and outside of Africa, with more recent graduates trained in Africa. These data reflected the local emergence of speech and language therapy training in SSA. CONCLUSION This sample comprised a mix of African and international SLTs, with indications of growing localisation of the workforce. Workforce localisation offers potential advantages of linguistic diversity and stability. Challenges including workforce support and developing culturally and contextually relevant SLT practices are discussed.
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Affiliation(s)
- Karen Wylie
- ENT Department, Korle Bu Teaching Hospital, Australia
- Faculty of Health Sciences, University of Sydney, Australia
| | | | - Bronwyn Davidson
- Department of Audiology & Speech Pathology, the University of Melbourne, Australia
| | - Julie Marshall
- Health Professions Department, Manchester Metropolitan University, United Kingdom
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Borg J, Östergren PO. Users' perspectives on the provision of assistive technologies in Bangladesh: awareness, providers, costs and barriers. Disabil Rehabil Assist Technol 2014; 10:301-8. [PMID: 25347347 DOI: 10.3109/17483107.2014.974221] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this work was to contribute to a better understanding of challenges and solutions to equitable provision of assistive technologies in resource limited environments by (i) describing sources of awareness, types of providers and costs of assistive technologies; (ii) describing common reasons for not possessing assistive technologies; and (iii) comparing these sources, providers, costs and reasons among younger and older men and women living in urban and rural settings. METHODS Descriptive and analytic statistics were used to analyze cross-sectional data from a total sample of 581 hearing aid users, wheelchair users, individuals with hearing impairments not using hearing aids and individuals with ambulatory impairments not using wheelchairs living in eight districts of Bangladesh. RESULTS Major sources of awareness, types of providers and costs paid varied between users of different types of assistive technology. Lack of affordability was the main reason for not possessing assistive technology. Outcome differences were found between younger and older groups, men and women, and literate and illiterate respondents, while no differences related to place of living were identified. CONCLUSIONS Age, gender, type of impairment and socioeconomic status need to be considered when planning and implementing equitable provision of assistive technologies. Implications for Rehabilitation Provision of assistive technologies needs to be made affordable as lack of affordability was the major reason for not possessing such technologies. To ensure equitable provision of assistive technology, services ought to consider age, gender, impairment and socioeconomic status of their target groups. This includes offering a range of products of different sizes provided by culturally appropriate personnel at affordable cost, which to many may be at no or reduced cost. To cater to the assistive technology needs among the most vulnerable groups, assistive technology providers may learn from CBR strategies, such as, awareness raising and service delivery at community level, the use of local resources, collaboration and coordination, and the consideration of cultural factors.
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Affiliation(s)
- Johan Borg
- Division of Social Medicine and Global Health, Lund University , Malmö , Sweden
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Implementing the World Report on Disability in West Africa: challenges and opportunities for Ghana. Am J Phys Med Rehabil 2014; 93:S50-7. [PMID: 24356083 DOI: 10.1097/phm.0000000000000023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Disability issues have taken a prominent role on international stages in recent years. Beginning with the May 2005 World Health Assembly Resolution 58.23 and culminating in the June 2011 World Bank and World Health Organization World Report on Disability, comprehensive disability analyses from nations at various stages of development can now be accessed and used by relevant stakeholders in health, policy, and aide arenas. The implementation of this landmark report is critical for the advancement of social inclusion in diverse countries, including those with limited resources. However, activating the World Report on Disability in resource-limited countries remains a significant challenge because of threadbare data and cultural, institutional, and physical barriers to social inclusion. This review summarizes current national disability data and describes challenges and opportunities for the implementation of the World Report on Disability in Ghana. As a structural point of departure, the article uses the three broad categories of challenges outlined by the World Health Organization: attitudinal, physical, and institutional.
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Matityahu A, Elliott I, Marmor M, Caldwell A, Coughlin R, Gosselin RA. Time intervals in the treatment of fractured femurs as indicators of the quality of trauma systems. Bull World Health Organ 2013; 92:40-50. [PMID: 24391299 DOI: 10.2471/blt.13.120436] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 08/08/2013] [Accepted: 08/23/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate the use of time intervals in the treatment of fractured femurs as indicators of the quality of trauma systems. METHODS Time intervals from injury to admission, admission to surgery and surgery to discharge for patients with isolated femur fractures in four low- and middle-income countries were compared with the corresponding values from one German hospital, an Israeli hospital and the National Trauma Data Bank of the United States of America by means of Student's t-tests. The correlations between the time intervals recorded in a country and that country's expenditure on health and gross domestic product (GDP) were also evaluated using Pearson's product moment correlation coefficient. FINDINGS Relative to patients from high-income countries, those from low- and middle-income countries were significantly more likely to be male and to have been treated by open femoral nailing, and their intervals from injury to admission, admission to surgery and surgery to discharge were significantly longer. Strong negative correlations were detected between the interval from injury to admission and government expenditure on health, and between the interval from admission to surgery and the per capita values for total expenditure on health, government expenditure on health and GDP. Strong positive correlations were detected between the interval from surgery to discharge and general government expenditure on health. CONCLUSION The time intervals for the treatment of femur fractures are relatively long in low- and middle-income countries, can easily be measured, and are highly correlated with accessible and quantifiable country data on health and economics.
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Affiliation(s)
- Amir Matityahu
- San Francisco General Hospital, University of California in San Francisco, 2550 Twenty-third Street, Building 9, 2nd Floor, San Francisco, CA 94110, United States of America (USA)
| | | | - Meir Marmor
- Orthopaedic Trauma Institute, University of California, San Francisco, USA
| | - Amber Caldwell
- Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, USA
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Harkins CS, McGarry A, Buis A. Provision of prosthetic and orthotic services in low-income countries: a review of the literature. Prosthet Orthot Int 2013; 37:353-61. [PMID: 23295896 DOI: 10.1177/0309364612470963] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Disability is inextricably linked to poverty. A total of 80% of the disabled population lives in low-income countries. The demand for prosthetic and orthotic services in these countries is increasing, and a variety of methods to provide services are currently used. OBJECTIVES To assess current models of provision to facilitate sustainable, evidence-based prosthetic and orthotic services. STUDY DESIGN Literature review. METHODS A literature search was performed through Medline (Ovid), PubMed, ISI Web of Knowledge, EMBASE and RECAL Legacy using combinations of subject heading and text word searching strategies. Full-text publications were critically appraised and ranked according to the Scottish Intercollegiate Guidelines Network guidelines. RESULTS Three areas were deemed pertinent to the research question. Studies were grouped into one or more of these categories based on the issues addressed: instigators, types of service provision, demographics and region-specific issues. It was found that many complex factors influence prosthetic and orthotic services in low-income countries. Demographic and regional idiosyncrasies require prosthetic and orthotic services to be tailored to address the specific needs of individual countries. CONCLUSIONS The lack of and quality of available research made efficacy of methods used to provide services in low-income countries difficult to determine.
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Affiliation(s)
- Colette S Harkins
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, UK
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Tannor AY. Millenium development goals and rehabilitation in Ghana. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2013. [DOI: 10.12968/ijtr.2013.20.10.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Abena Yeboaa Tannor
- Family Medicine and Physiotherapy Departments, Komfo Anokye Teaching Hospital, Ghana
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Bunning K, Gona JK, Odera-Mung'ala V, Newton CR, Geere JA, Hong CS, Hartley S. Survey of rehabilitation support for children 0-15 years in a rural part of Kenya. Disabil Rehabil 2013; 36:1033-41. [PMID: 23991677 PMCID: PMC4086233 DOI: 10.3109/09638288.2013.829524] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose Information regarding the nature, availability and distribution of rehabilitation services for children with disabilities across developing countries is scarce, and data that do exist are of variable quality. If planning and development are to progress, information about service provision is vital. The aim was to establish the scope and nature of rehabilitation support available to children with disabilities (0–15 years) and their families in rural Kenya. Method A comprehensive sample comprising service provision in the health and special education sectors was established. Non-governmental and community-based organisations were also included. A survey of rehabilitation services was conducted through examination of service-related documentation and key informant interviews with the heads of services. Results Rehabilitation comprised hospital-based occupational therapy, physiotherapy and orthopaedic technology; and seven special education establishments plus an education assessment resource centre. There was one non-government organisation and one community-based organisation relevant to children with disabilities. Activities focused on assessment, diagnosis and raising community awareness. Provision was challenged by inadequate staffing, resources and transport. Government funding was supplemented variously by donations and self-sufficiency initiatives. Rehabilitation approaches appeared to be informed by professional background of practitioner, rather than the needs of child. Service documentation revealed use of inconsistent recording methods. Conclusions The data highlight the challenges of rehabilitation, demanding greater investment in personnel and their training, more material resources, improved access to the community and better recording mechanisms.
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Affiliation(s)
- Karen Bunning
- Faculty of Medicine & Health, School of Allied Health Professions, University of East Anglia , Norwich, Norfolk , UK
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Amosun SL, Nyante GG, Wiredu EK. Perceived and experienced restrictions in participation and autonomy among adult survivors of stroke in Ghana. Afr Health Sci 2013; 13:24-31. [PMID: 23658564 DOI: 10.4314/ahs.v13i1.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Many stroke survivors do not participate in everyday life activities. OBJECTIVE To assess the perceived and experienced restrictions in participation and autonomy among adult stroke survivors in Ghana. METHOD The "Impact on Participation and Autonomy Questionnaire" (IPAQ) instrument was administered in a survey of 200 adult stroke survivors to assess perceived restrictions in participation and autonomy, followed by in-depth interviews with a sub-sample on the restrictions they experienced in participation. RESULTS Perceived restrictions in participation were most prevalent in the domains of education and training (3.46±0.79), paid or voluntary work (2.68±0.89), helping and supporting other people (2.20±0.82), and mobility (2.12±0.79). There were significant differences in two domains between survivors who received physiotherapy and those who received traditional rehabilitation. Over half of the survivors also perceived they would encounter severe problems in participation in the domains of paid or voluntary work, mobility, and education and training. The sub-sample of stroke survivors (n=7) mostly experienced restrictions in participation and autonomy in going outside the house, working, and in fulfilling family roles. CONCLUSION If these perceptions and experiences are not addressed during rehabilitation, they could further inhibit the full participation and social integration of stroke survivors.
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Affiliation(s)
- S L Amosun
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, South Africa.
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Magnusson L, Ahlström G. Experiences of providing prosthetic and orthotic services in Sierra Leone – the local staff’s perspective. Disabil Rehabil 2012; 34:2111-8. [DOI: 10.3109/09638288.2012.667501] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Reinhardt JD, Li J, Gosney J, Rathore FA, Haig AJ, Marx M, DeLisa JA. Disability and health-related rehabilitation in international disaster relief. Glob Health Action 2011; 4:7191. [PMID: 21866223 PMCID: PMC3160807 DOI: 10.3402/gha.v4i0.7191] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 06/22/2011] [Accepted: 06/23/2011] [Indexed: 11/22/2022] Open
Abstract
Background Natural disasters result in significant numbers of disabling impairments. Paradoxically, however, the traditional health system response to natural disasters largely neglects health-related rehabilitation as a strategic intervention. Objectives To examine the role of health-related rehabilitation in natural disaster relief along three lines of inquiry: (1) epidemiology of injury and disability, (2) impact on health and rehabilitation systems, and (3) the assessment and measurement of disability. Design Qualitative literature review and secondary data analysis. Results Absolute numbers of injuries as well as injury to death ratios in natural disasters have increased significantly over the last 40 years. Major impairments requiring health-related rehabilitation include amputations, traumatic brain injuries, spinal cord injuries (SCI), and long bone fractures. Studies show that persons with pre-existing disabilities are more likely to die in a natural disaster. Lack of health-related rehabilitation in natural disaster relief may result in additional burdening of the health system capacity, exacerbating baseline weak rehabilitation and health system infrastructure. Little scientific evidence on the effectiveness of health-related rehabilitation interventions following natural disaster exists, however. Although systematic assessment and measurement of disability after a natural disaster is currently lacking, new approaches have been suggested. Conclusion Health-related rehabilitation potentially results in decreased morbidity due to disabling injuries sustained during a natural disaster and is, therefore, an essential component of the medical response by the host and international communities. Significant systematic challenges to effective delivery of rehabilitation interventions during disaster include a lack of trained responders as well as a lack of medical recordkeeping, data collection, and established outcome measures. Additional development of health-related rehabilitation following natural disaster is urgently required.
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Affiliation(s)
- Jan D Reinhardt
- International Society of Physical and Rehabilitation Medicine-ISPRM, Rehabilitation Disaster Relief Committee, Assenede, Ghent, Belgium.
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Crowley C(C, Baigorri M. Effective Approaches to International Work: Substance and Sustainability for Speech-Language Pathology Student Groups. ACTA ACUST UNITED AC 2011. [DOI: 10.1044/gics1.1.27] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
International opportunities for speech language pathologists and audiologists are on the rise. Opportunities range from single trips offering clinical services to long-term commitments including developing speech-language treatment programs in developing countries. This article provides a brief overview of the types of international programs available. It then focuses on international opportunities for speech-language pathology students with a particular focus on the authors' international programs in Bolivia and Ghana.
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Weinrich M, Stuart M. Coverage policy for neurorehabilitation: an international perspective. Neurorehabil Neural Repair 2011; 25:531-9. [PMID: 21427275 DOI: 10.1177/1545968310397207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coverage policy ultimately determines the delivery of services. This article summarizes the authors' effort to ascertain the extent of publically available information on coverage for neurorehabilitation services internationally. OBJECTIVE Present available data on neurorehabilitation coverage and examine the needs for further research in this area. METHODS Review of published literature, review of government Web sites, survey of World Federation of NeuroRehabilitation (WFNR) program chairs, and attendees of the 2010 World Congress of NeuroRehabilitation. RESULTS A wide variation in coverage was found internationally. Data are not routinely accessible. CONCLUSIONS Informed policy requires current data. There is an opportunity for the WFNR to provide leadership in policy for neurorehabilitation services by assembling and maintaining current data on coverage policy internationally.
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Affiliation(s)
- Michael Weinrich
- National Center for Medical Rehabilitation Research, Eunice Kennedy Shriver Institute for Child Health and Human Development, National Institutes of Health, Bethesda, MD 20852, USA.
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Borg J, Lindström A, Larsson S. Assistive technology in developing countries: a review from the perspective of the Convention on the Rights of Persons with Disabilities. Prosthet Orthot Int 2011; 35:20-9. [PMID: 21515886 DOI: 10.1177/0309364610389351] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The 'Convention on the Rights of Persons with Disabilities' (CRPD) requires governments to meet the assistive technology needs of citizens. However, the access to assistive technology in developing countries is severely limited, which is aggravated by a lack of related services. OBJECTIVES To summarize current knowledge on assistive technology for low- and lower-middle-income countries published in 1995 or later, and to provide recommendations that facilitate implementation of the CRPD. STUDY DESIGN Literature review. METHODS Literature was searched in web-based databases and reference lists. Studies carried out in low- and lower-middle-income countries, or addressing assistive technology for such countries, were included. RESULTS The 52 included articles are dominated by product oriented research on leg prostheses and manual wheelchairs. Less has been published on hearing aids and virtually nothing on the broad range of other types of assistive technology. CONCLUSIONS To support effective implementation of the CRPD in these countries, there is a need for actions and research related particularly to policies, service delivery, outcomes and international cooperation, but also to product development and production. CLINICAL RELEVANCE The article has a potential to contribute to CRPD compliant developments in the provision of assistive technology in developing countries by providing practitioners with an overview of published knowledge and researchers with identified research needs.
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Affiliation(s)
- Johan Borg
- Department of Health Sciences, Lund University, Malmö, Sweden.
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Rathore FA, New PW, Iftikhar A. A report on disability and rehabilitation medicine in Pakistan: past, present, and future directions. Arch Phys Med Rehabil 2011; 92:161-6. [PMID: 21187218 DOI: 10.1016/j.apmr.2010.10.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 10/01/2010] [Accepted: 10/01/2010] [Indexed: 11/28/2022]
Abstract
Disability is a stigma in Pakistan, and cultural norms are a hindrance to the integration of the disabled into the community. Additional barriers to addressing the needs of the disabled include the lack of reliable disability epidemiologic data, inadequate funding and poor health care infrastructure, and workforce shortages. The aim of this report is to present an overview of Physical Medicine and Rehabilitation (PM&R) in Pakistan, covering its origins, current status, and future directions. An electronic literature search (1950-2009) was conducted using the Medline, ScienceDirect, Springer Link, CINAHL, and Google Scholar databases. The key words used were "disability," "persons with disability" (PWDs), "rehabilitation," "Pakistan," "developing countries," "stroke," "spinal cord injury," "causes," "attitudes," "physiotherapy," "occupational therapy," and "speech therapy." Only publications in English involving physical disability were selected. Statistical data were obtained from the Federal Bureau of Statistics. Interviews with pioneers of rehabilitation medicine in Pakistan, PWDs, and their families were conducted. The origins of PM&R in Pakistan date to the 1960s, but the formal training program began only in 1997. There are only a few rehabilitation departments, and none have all the standard components of a rehabilitation team. The number of practicing rehabilitation consultants is 38. There are an estimated 1000 physical therapists and 150 occupational therapists. There is a need to increase the number of rehabilitation facilities significantly, staff them appropriately, and make them accessible to all who need them, including rural and remote regions. Discrimination should be addressed by education and legislation.
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Affiliation(s)
- Farooq A Rathore
- Department of Rehabilitation Medicine, Combined Military Hospital, Panoaqil Cantt, Pakistan.
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Haig AJ, Jayarajan S, Maslowski E, Yamakawa KS, Tinney M, Beier KP, Juang D, Chan L, Boggess T, Loar J, Owusu-Ansah B, Kalpakjian C. Development of a Language-Independent Functional Evaluation. Arch Phys Med Rehabil 2009; 90:2074-80. [DOI: 10.1016/j.apmr.2009.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 04/23/2009] [Accepted: 05/18/2009] [Indexed: 10/20/2022]
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