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Xie Y, Wu J, Li Y, Liu H, Peng Y, Zhou P, Sun Y, Kang L, Jiang C, Wu H. Requirements for and Barriers to Rehabilitation Services for Children With Disabilities in Middle- and High-Income Countries: Scoping Review. Interact J Med Res 2024; 13:e50047. [PMID: 39110502 PMCID: PMC11339577 DOI: 10.2196/50047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 02/08/2024] [Accepted: 05/29/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND The rehabilitation of children with disabilities has received considerable attention from the United Nations. However, the state of rehabilitation services for children with disabilities worldwide remains far from optimistic, even in economically affluent middle- and high-income countries. OBJECTIVE This scoping review aimed to identify the rehabilitation needs of children with disabilities and their barriers to rehabilitation services in middle- and high-income countries. METHODS A systematic search was conducted using MEDLINE and Web of Science for papers published from January 2013 to December 2023. Studies were included if they were peer-reviewed, full-text articles related to children with disabilities, reporting on their access to rehabilitation services, and conducted in countries classified by the World Bank 2023 as middle- and high-income economies. Exclusion criteria included duplicates, unavailable full texts, and studies without distinct outcomes. A total of 27 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on children, their families, or service providers. RESULTS The suitability, availability, and affordability of rehabilitation services were identified as the major needs and barriers for children with disabilities in middle- and high-income countries. This included communication barriers, a need for more personnel and facilities, and the stagnation and inadequacy of economic subsidies. CONCLUSIONS Middle- and high-income countries have relatively well-established rehabilitation infrastructure and support systems. They are nevertheless insufficient for meeting the needs of children with disabilities. More attention should be paid to these issues to improve the well-being of children with disabilities. The data provided by this review can help raise awareness of rehabilitation needs and barriers at the policy level.
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Affiliation(s)
- Yijun Xie
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Jing Wu
- Department of Fundamental Nursing, School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yao Li
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Hui Liu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Yanyan Peng
- Office of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| | - Ping Zhou
- Office of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| | - Yizhou Sun
- Office of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| | - Luyan Kang
- Office of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| | - Chenghua Jiang
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Hengjing Wu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
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Maronga-Feshete F, Pilusa S, Dreyer A. 'I'm proud of my son with CP': Cerebral palsy caregivers' experiences, Gauteng province. Afr J Disabil 2024; 13:1357. [PMID: 38962747 PMCID: PMC11219972 DOI: 10.4102/ajod.v13i0.1357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/14/2024] [Indexed: 07/05/2024] Open
Abstract
Background Caregivers of children with cerebral palsy (CP) are critical in the survival and well-being of their children. Despite the caregivers' particularly demanding responsibilities, literature on their experiences is limited. Objectives This study explored the caregivers' experiences of providing care to children with CP. Method An explorative qualitative study design using semi-structured interviews was employed. All interviews were audio-recorded, transcribed verbatim and analysed guided by Colaizzi's seven-step methodology. Results Two themes emerged: the challenges in caregiving and positive experiences of providing care. Caregivers faced financial, psychological, social and physical challenges such as stigmatisation, a lack of work accommodations, time constraints due to demands of providing care, strained family relations, isolation, exclusion, emotional and physical exhaustion in their caregiving role. Despite the challenges, they also had fulfilling, positive experiences. Caregivers became more resilient, some relationships were strengthened and awareness of the CP condition increased over time. Conclusion Caring for a child with CP is challenging. Cerebral palsy is a permanent disability; therefore, a holistic, long-term perspective to supporting caregivers is necessary to ensure they can care for their children adequately. Contribution There is a need for various support structures for caregivers to lessen the burden of care. It is necessary to establish the relationships between the support structures available and the way that these structures are viewed and consequently utilised by the caregivers. This study highlights the experiences and needs of caregivers to inform stakeholders on intervention strategies.
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Affiliation(s)
- Faith Maronga-Feshete
- Department of Rural Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sonti Pilusa
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Abigail Dreyer
- Department of Rural Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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D'Arcy E, Burnett T, Capstick E, Elder C, Slee O, Girdler S, Scott M, Milbourn B. The Well-being and Support Needs of Australian Caregivers of Neurodiverse Children. J Autism Dev Disord 2024; 54:1857-1869. [PMID: 36757543 PMCID: PMC9909132 DOI: 10.1007/s10803-023-05910-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
Caregivers of children with neurodiverse needs are known to experience challenges and hardship due to the increased needs of the child and the lack of support available. This study aimed to explore the support needs and well-being of caregivers of children with neurodiverse needs in Australia. Sixty-six caregivers participated in an online survey asking questions about support needs. The results highlighted five main themes that caregivers commonly experienced including: barriers to community engagement, impact on close relationships, negative impact on mental health and identity, financial hardship, and identified support needs. Findings identified multiple unmet needs existing amongst caregivers and further emphasises the importance of addressing these needs to improve the quality of life of caregivers of children with neurodiverse needs.
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Affiliation(s)
- Emily D'Arcy
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Tayah Burnett
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Emily Capstick
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Catherine Elder
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Olivia Slee
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Sonya Girdler
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Melissa Scott
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia
| | - Ben Milbourn
- Curtin Scool of Allied Health, Curtin University, 6102, Perth, Western Australia.
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Dlamini MD, Chang YJ, Nguyen TTB. Caregivers' experiences of having a child with cerebral palsy. A meta-synthesis. J Pediatr Nurs 2023; 73:157-168. [PMID: 37690430 DOI: 10.1016/j.pedn.2023.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/27/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Abstract
AIM To synthesize qualitative research findings of caregiver experiences and challenges in caring for and raising a child with cerebral palsy. DESIGN A systematic review and meta-synthesis. METHODS Four electronic databases: CINAHL, Embase, OVID Medline, and Cochrane, were systematically searched for qualitative research papers published before December 2022. Two independent reviewers assessed eligibility and further appraised the quality of methodology using the Critical Appraisal Skills Program (CASP) tool for qualitative research. A content thematic analysis approach was used to synthesize the qualitative research findings, construct core subthemes, and synthesize themes. RESULTS Sixty-seven findings were extracted from the 12 included studies. The findings were grouped into eleven sub-themes and then into five synthesized themes. The synthesized themes are 1. Need for convenient healthcare facilities, therapeutic services, and accessible public places, 2. Need for healthcare information and financial aid, 3. Psychological, and physical constraints, 4. Societal rejection and stigma, and 5. Overwhelming caring burden. CONCLUSION Caregivers face many challenges in adjusting their lifestyles to meet the needs of the child with cerebral palsy. Some adjustments reported included giving up full-time jobs and businesses to be full-time caregivers, giving up leisure activities, and confinement to one place.
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Affiliation(s)
- Maggie Dumsile Dlamini
- Department of Nursing, College of Medicine, National Cheng Kung University, No1 University Road, Tainan 70101, Taiwan; Department of Nursing, Eswatini Christian Medical University, Lomkiri Portion 69 of Farm 73, Zone 4, Mbabane, Hhohho, Swaziland
| | - Ying-Ju Chang
- Professor, Institute of Allied Health Sciences & Department of Nursing, College of Medicine, National Cheng Kung University, No 1 University Road, Tainan 70101, Taiwan; Director, Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Tram Thi Bich Nguyen
- Department of Nursing, College of Medicine, National Cheng Kung University, No1 University Road, Tainan 70101, Taiwan; Medical Simultaion Center, Duy Tan University, 254 Nguyen Van Linh, Da Nang, Viet Nam.
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Aduful AK, Boamah-Mensah F, Nyarko MY, Neizer ML, Brew YN, Williams LA, Calys-Tagoe BNL, Ackun HKM, Tette EMA. Family Needs Assessment of Patients with Cerebral Palsy Attending Two Hospitals in Accra, Ghana. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1313. [PMID: 37628312 PMCID: PMC10453618 DOI: 10.3390/children10081313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND The family represents the most essential and supportive environment for children with cerebral palsy (CP). To improve children's outcomes, it is crucial to consider the needs of families in order to offer family-centered care, which tailors services to these needs. OBJECTIVE We conducted a needs assessment to identify the family needs of patients with CP attending two hospitals in Accra. METHODS The study was a cross-sectional study involving primary caregivers of children with CP attending neurodevelopmental clinics. Structured questionnaires were used to collect data spanning an 8-month period. The data were summarized, and statistical inference was made. RESULTS Service needs identified were childcare, counseling, support groups, financial assistance, and recreational facilities. Information needs included adult education, job training/employment opportunities, education, health and social programs, knowledge about child development, and management of behavioral and feeding/nutrition problems. Reducing extensive travel time was desirable to improve access to healthcare. With the increasing severity of symptoms came the need for improved accessibility in the home to reduce the child's hardship, as well as assistive devices, recreational facilities, and respite for the caregiver(s). CONCLUSION Families of children with CP have information, service, and access needs related to their disease severity and family context.
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Affiliation(s)
- Abena K. Aduful
- Department of Family Medicine, Korle-Bu Teaching Hospital, Accra P.O. Box GP 4236, Ghana
| | - Faye Boamah-Mensah
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana (M.L.N.)
| | - Mame Yaa Nyarko
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana (M.L.N.)
| | - Margaret L. Neizer
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana (M.L.N.)
| | - Yvonne N. Brew
- Department of Child Health, Greater Accra Regional Hospital (GARH), Accra P.O. Box GP 473, Ghana
| | - Lovia A. Williams
- Department of Child Health, Korle-Bu Teaching Hospital, Accra P.O. Box GP 4236, Ghana
| | | | - Henry K. M. Ackun
- Department of Family Medicine, Duffus Health Center, Halifax, NS B3M 3Y7, Canada
| | - Edem M. A. Tette
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana (M.L.N.)
- Department of Community Health, University of Ghana Medical School, Accra P.O. Box GP 4236, Ghana
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Mwinbam MM, Suglo JN, Agyeman YN, Kukeba MW. Family caregivers' experience of care with a child with cerebral palsy: the lived experiences and challenges of caregivers in a resource-limited setting in northern Ghana. BMJ Paediatr Open 2023; 7:e001807. [PMID: 37407248 DOI: 10.1136/bmjpo-2022-001807] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 06/22/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Caring for a child with cerebral palsy may be more emotionally and physically exhausting than caring for a typical growing child. The family caregivers' perspective of this phenomenon needs exploring to facilitate the development of services. Our study explored the challenges family caregivers face with children with cerebral palsy in a resource-limited context in northern Ghana. METHODS We conducted a qualitative study underpinned by phenomenological principles where it is believed that the reality of a phenomenon is tied to caregivers' perspectives of their own experiences. In this study, we unearthed caregivers' experiences/challenges from their own perspectives. The method of data analysis used was to allow the issues to emerge from the data (inductive process) using the content analysis approach. We recruited 13 caregivers of children with cerebral palsy from the physiotherapy unit at Tamale Teaching Hospital, and conducted individual in-depth interviews supported by an open-ended topic guide. Interviews were audio recorded, transcribed, and translated and coded inductively before conducting a content analysis of the data when grouped into themes. RESULTS We have identified barriers to managing a child with cerebral palsy, including sociocultural barriers (values, attitudes and belief systems within society), economic challenges and immediate physical care burdens. Specific barriers included discrimination and isolation, lack of family and societal support, with poor access to health information and formal education. Others were lack of information on the cause and course of cerebral palsy, caregivers' loss of jobs, increased healthcare expenditure and struggles in lifting and moving children, which resonate with evidence-based multidimensional model of caregiving process and caregiver burden. CONCLUSION Caregivers have the arduous task of caring for a child with cerebral palsy. Social support interventions and policy initiatives that seek to ameliorate caregivers' finances and make formal education accessible to this marginalised child population may be beneficial in this context.
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Affiliation(s)
- Mavis Mallory Mwinbam
- Department of Nursing, Nadowli District Hospital, Upper West Region, Nadowli, Ghana
- Faculty of Paediatric Nursing, Ghana College of Nurses and Midwives (GCNM), Accra, Ghana
| | - Joseph Ngmenesegre Suglo
- Department of Nursing and Midwifery, Presbyterian University College, Abetifi, Ghana
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Yaa Nyarko Agyeman
- Department of Population and Reproductive Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Margaret Wekem Kukeba
- Department of Nursing, C K Tedam University of Technology and Applied Sciences, Navrongo, Ghana
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Smith SE, Chowdhury MK, Doherty M, Morgan DD. Serious health-related suffering experienced by children with disability and their families living in Bangladesh: A scoping review. Palliat Med 2022; 37:602-626. [PMID: 36428280 DOI: 10.1177/02692163221136896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In 2020, the International Association for Hospice and Palliative Care redefined palliative care to incorporate the concept of serious health-related suffering. An estimated 21 million children globally live with conditions which would benefit from a palliative approach to relieve suffering. Bangladesh is a lower-middle income country with isolated provision of palliative care. AIM To synthesise existing evidence describing serious health-related suffering of children with disability and their families living in Bangladesh and the intersection between this suffering, palliative care and rehabilitation. DESIGN Scoping review methodology. DATA SOURCES A search strategy related to serious health-related suffering and childhood disability was applied to online databases and grey literature. English language studies (1990-2021) were included. Papers pertaining to serious health-related suffering of typically developing children and those over eighteen years were excluded. Data which addressed the three domains of serious health-related suffering (physical, social and emotional/spiritual) were extracted. Palliative care interventions were assessed with a pre-existing checklist. RESULTS Forty-six studies were included, representing ten different methodologies. Sample sizes ranged from 11 to 2582 participants, with 87% of studies including children with cerebral palsy. Serious health-related suffering was described in 100% of the studies, only 14 of the studies described specific interventions to mitigate suffering. Convergence between palliative care and rehabilitation approaches was evident. CONCLUSION Findings document the extensive nature and burden of serious childhood health-related suffering that may be remediated by a palliative approach. They highlight the urgent need to prioritise service development and research in this area.
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Affiliation(s)
- Suzanne E Smith
- Master of Palliative Care student, Flinders University, Australia; Victorian Paediatric Rehabilitation Service, Australia
| | | | - Megan Doherty
- University of Ottawa, ON, Canada; Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Deidre D Morgan
- Research Centre for Palliative Care, Death and Dying (RePaDD), College of Nursing and Health Sciences, Flinders University, SA, Australia
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Karim T, Das MC, Muhit M, Badawi N, Khandaker G, Mohammad SS. Improving epilepsy control among children with cerebral palsy in rural Bangladesh: a prospective cohort-based study. BMJ Open 2022; 12:e052578. [PMID: 35383059 PMCID: PMC8984049 DOI: 10.1136/bmjopen-2021-052578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To define the prevalence and seizure subtypes among children with cerebral palsy (CP) in rural Bangladesh and explore barriers to optimum epilepsy control. DESIGN Prospective cohort study. SETTING The study was conducted in Shahjadpur, a rural subdistrict of Bangladesh. PARTICIPANTS Children (<18 years) with CP and epilepsy identified using the Bangladesh CP Register (BCPR) in the study site. METHODS Assessments were conducted in three focused epilepsy clinics overseen by a paediatric neurologist between December 2016 and January 2018, with intervening phone and video-conference follow-ups. Details of event type, frequency and medication compliance were collected. Antiepileptic drugs (AEDs) were prescribed based on seizure type, family income, comorbidity and medication availability. RESULTS 23.4% (170/726) of the BCPR cohort had a clinical diagnosis of epilepsy of whom 166 were assessed. Following the focused epilepsy clinics, 62.0% (103/166) children were clinically determined to have ongoing epileptic seizures. 62.1% (64/103) had generalised onset tonic clonic seizures, 27.2% (28/103) had focal onset seizures with impaired awareness and 10.7% (11/103) had other seizure types. None of the children with prolonged seizures (31/103) had an emergency seizure management plan. Non-epileptic events were being pharmacologically treated as seizures in 18.1% (30/166) children. Financial constraints were the main reason for non-compliance on follow-up. CONCLUSIONS Gaps in optimum epilepsy management in rural Bangladesh are amenable to improvement anchored with local healthcare workers. Training and clinical care focused on recognition of common seizure types, seizure mimics and rationalising use of available AEDs can be facilitated by better referral pathways and telehealth support.
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Affiliation(s)
- Tasneem Karim
- Discipline of Child and Adolescent Health, Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | - Manik Chandra Das
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gulam Khandaker
- Discipline of Child and Adolescent Health, Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- Dept of Public Health, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Shekeeb S Mohammad
- Discipline of Child and Adolescent Health, Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- TY Nelson Dept of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Westmead, NSW, Australia
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Mwangi LW, Abuga JA, Cottrell E, Kariuki SM, Kinyanjui SM, Newton CRJC. Barriers to access and utilization of healthcare by children with neurological impairments and disability in low-and middle-income countries: a systematic review. Wellcome Open Res 2022; 6:61. [PMID: 35299711 PMCID: PMC8902259 DOI: 10.12688/wellcomeopenres.16593.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Neurological impairments (NI) and disability are common among older children in low-and middle-income countries (LMICs). We conducted a systematic review to examine the barriers limiting access and utilization of biomedical and rehabilitative care by children and adolescents with NI in LMICs. Methods: We searched PubMed, Latin America and Caribbean Health Sciences Literature, Global Index Medicus, and Google Scholar for studies published between 01/01/1990 and 14/11/2019 to identify relevant studies. We included all studies reporting on barriers limiting access and utilization of preventive, curative, and rehabilitative care for children aged 0-19 years with NI in five domains: epilepsy, and cognitive, auditory, visual, and motor function impairment. Data from primary studies were synthesized using both qualitative and quantitative approaches. Results: Our literature searches identified 3,258 reports of which 20 were included in the final analysis. Fifteen studies (75.0%) originated from diverse settings in sub-Saharan Africa (SSA). Factors limiting access and utilization of healthcare services in >50% of the studies were: financial constraints (N=17, 85.0%), geographical and physical inaccessibility (N=14, 70.0%), inadequate healthcare resources (N=14, 70.0%), prohibitive culture and beliefs (N=12, 60.0%), and inadequate education/awareness (N=11, 55.0%). Factors reported in <50% of the studies included competing domestic roles (N=4, 20%) and a lack of confidentiality for personal information (N=2, 10.0%). Very few reports were identified from outside Africa preventing a statistical analysis by continent and economic level. Conclusions: Financial constraints, geographic and physical inaccessibility, and inadequate healthcare resources were the most common barriers limiting access and utilization of healthcare services by children with NI in LMICs. PROSPERO registration: CRD42020165296 (28/04/2020).
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Affiliation(s)
- Lucy W. Mwangi
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
| | - Jonathan A. Abuga
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Global Child Heath Group, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, AHTC, Tower C4, Paasheuvelweg 25 1105 BP Amsterdam, The Netherlands
| | - Emma Cottrell
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
| | - Symon M. Kariuki
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, Oxford OX3 7JX, UK
| | - Samson M. Kinyanjui
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, Oxford OX3 7BN, UK
| | - Charles RJC. Newton
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, Oxford OX3 7JX, UK
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Nuri RP, Aldersey HM, Ghahari S, Huque AS, Shabnam J. The Bangladeshi Rights and Protection of Persons With Disability Act of 2013: A Policy Analysis. JOURNAL OF DISABILITY POLICY STUDIES 2021; 33:178-187. [PMID: 36397763 PMCID: PMC9650720 DOI: 10.1177/10442073211066789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The government of Bangladesh enacted the Rights and Protection of Persons with
Disability Act of 2013 (the Act) in line with the United Nations Convention on
the Rights of Persons with Disabilities. This article sheds light on the Act
with particular emphasis on (a) support offered to children with disabilities
(CWDs) and their families to address their needs; and (b) the extent to which
the Act is in line with the international disability policy analysis framework.
We compared the Act with the 18 core concepts of disability policy developed by
Turnbull et al. (2001). The results affirm the government’s effort toward
Sustainable Development Goals in providing support to CWDs and their families.
They indicate a high degree of congruency of the Act with the core concepts. The
findings also highlight the need to embrace the concepts of autonomy,
confidentiality, and family-centeredness in great detail in any policy
initiatives pertaining to CWDs. Furthermore, the finding shows that
collaboration and coordination among ministries are imperative to achieve the
goal of policies related to disability. In addition, the results highlight the
need for more budgetary allocation and robust monitoring systems to track the
progress of policy initiatives. As policy implementation is affected by changes
in global contexts such as the coronavirus disease 2019 pandemic, policymakers
in Bangladesh and other low- and middle-income countries should ensure that
emergency responses are disability-inclusive and appropriate for CWDs. To ensure
a disability-inclusive response, it is critical to engage individuals with
disabilities and their families in meaningful consultations to identify their
needs.
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Weissheimer G, Mazza VDA, Teodoro FC, Szylit R, Ichikawa CRDF, Schepelski UGDFA. Family Management and socioeconomic situation of children and adolescents with neurological disorders. Rev Bras Enferm 2021; 73:e20190042. [PMID: 32578736 DOI: 10.1590/0034-7167-2019-0042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/10/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify the relation between family management and socioeconomic situation of children and adolescents with neurological disorders. METHODS a descriptive and correlational study with 141 family members who answered a questionnaire on socioeconomic and family management information. Data collection took place between May and September 2016 in a pediatric neurology center. A descriptive and analytical analysis was carried out with the use of statistical tests in order to assess the relation of the variables researched. RESULTS a higher early childhood disease time was related with higher scores of management difficulty. There was relation between the highest family income and management skills and the lowest scores of family difficulty. The highest schooling level of mothers was associated with the lowest scores of disease impact view and family difficulty. CONCLUSIONS family members with unfavorable socioeconomic situation had more difficulty with family management.
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Affiliation(s)
| | | | | | - Regina Szylit
- Universidade de São Paulo. São Paulo, São Paulo, Brazil
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Umar AB, Yakasai AM, Danazumi MS, Shehu UT, Badaru UM, Kaka B. Assessment of family needs of children with cerebral palsy in Northern-Nigeria: A cross-sectional study. J Pediatr Rehabil Med 2021; 14:265-274. [PMID: 34092657 DOI: 10.3233/prm-200696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE This study aimed to identify the needs and priorities of parents of children with cerebral palsy (CP) in order to improve care by increasing family participation in rehabilitation programmes. METHODS This cross-sectional questionnaire-based study was conducted between January to March 2019. Convenience sampling was used to recruit 43 family members (18 years and above) of children with CP who came to the physiotherapy departments for rehabilitation services for their children. Fisher's exact test was used to analyse the association between socio-demographic characteristics and each of the need items. RESULTS Five different items were identified to be the family needs that were most frequently met: a) 'need for active involvement in the child's treatment and therapies' (n= 40; 93.0%), b) 'need for the provision of standard medical care (n= 39; 90.7%), c) 'need for questions to be answered honestly' (n= 38; 88.4%), d) 'need for healthcare professionals to respect the child's wishes' (n= 36; 83.7%), e) 'need for mothers to discuss their feelings (depression, stress etc.) with someone who has similar experience' (n= 36; 83.7%). Conversely, three items were the most unmet family needs: a) 'need to have professionals to consult whenever the child needs help' (n= 39; 90.7%), b) 'need to be informed about the child's prognosis' (n= 41; 95.3%), and c) 'need to have financial support to provide the child with adequate care' (n= 43; 100%). CONCLUSION All participants overwhelmingly reported that their financial needs were their highest priority. The multiple needs of families of children with disabilities must be assessed and considered in rehabilitation services when treating children with CP.
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Affiliation(s)
- Abdullahi B Umar
- Department of Physiotherapy, Sir. Muhammad Sanusi Specialist Hospital, Kano, Nigeria
| | - Abdulsalam M Yakasai
- Department of Physiotherapy, University of KwaZulu-Natal, Durban, South Africa.,Medical Rehabilitation Therapist Board of Nigeria, Kano Zonal Office, Kano, Nigeria
| | - Musa S Danazumi
- Department of Physiotherapy, Federal Medical Center, Nguru Yobe, Nigeria.,Department of Physiotherapy, Faculty of Medicine, Bayero University, Kano, Nigeria
| | - Usman T Shehu
- Department of Public Health, University of Salford, Manchester, UK
| | - Umaru M Badaru
- Department of Physiotherapy, Faculty of Medicine, Bayero University, Kano, Nigeria
| | - Bashir Kaka
- Department of Physiotherapy, Faculty of Medicine, Bayero University, Kano, Nigeria
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Abstract
OBJECTIVE Caregiver burden of parents of children with disabilities is negatively associated with parental quality of life and psychosocial well-being and has been identified as a public health concern. Reviews have consolidated the experiences of these parents, but little is understood about the unique challenges faced by parents of children with cerebral palsy (CP). We aim to conduct an in-depth synthesis of the experiences and needs of parents of children with CP to better support them. METHODS Six electronic databases were searched systematically for qualitative research, and a thematic synthesis was performed. RESULTS Seventeen studies from 1988 to 2019 encapsulating the experiences of 226 parents were included in this review. Four themes and 11 subthemes were identified: (1) self: the caregiver-parent trajectory (coming to terms with the fact, physical and emotional demands, and a nice outlet), (2) family: maintaining the family unit (juggling multiple children and parenting as a co-occupation), (3) society: social repercussions (facing public discrimination, rejection by extended family, and loss of freedom), and (4) parents' wish list (open communication and caring attitudes, funding and health care accessibility, social integration, and inclusivity). Apart from emotional adaptation and physical childcare difficulty, parents indicated a need for more information on health care services, funding, better attitudes and empathy from health care providers, properly trained educators, disability-friendly fixtures, and more public awareness. CONCLUSION The findings in this review provide insight into the true experiences and needs of parents caring for children with CP and will aid clinicians in the development of family-centered care pathways for these patients.
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Nuri RP, Batorowicz B, Aldersey HM. Family support and family and child-related outcomes among families impacted by disability in low- and middle-income countries: A scoping review. J Child Health Care 2020; 24:637-654. [PMID: 31648535 DOI: 10.1177/1367493519883456] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is a growing interest in understanding the relationship between family support and family or child-related outcomes in high-income countries. However, this has received little attention in low- and middle-income countries. The purpose of this review was to explore the relationship between family support and family and child-related outcomes among families affected by disability in low- and middle-income countries. We conducted a scoping review of five databases using search terms related to 'family', 'support', 'child', and 'disability'. A total of 13 articles met the inclusion criteria. Families of children with disabilities received most of their support from informal sources (e.g. immediate family members, friends, and parents support groups). Parental stress was most often evaluated as the family outcome and was negatively linked to emotional support and childcare assistance from immediate family members. Movement and mobility therapy offered by rehabilitation professionals was found to improve children's walking patterns. Positive attitudes from community members were key facilitators to participation of children with disabilities in social activities. The review calls for urgent attention to research in low- and middle-income countries, particularly the extent of support families are receiving from government-led support systems.
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Affiliation(s)
- Reshma Parvin Nuri
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Beata Batorowicz
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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15
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Nuri RP, Aldersey HM, Ghahari S, Huque AS. Experience of families in accessing government-led support for children with disabilities in Bangladesh. Disabil Rehabil 2020; 44:1354-1366. [DOI: 10.1080/09638288.2020.1804000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
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Abdullahi A, Isah A. Caregiver's perspectives on facilitators and barriers of active participation in cerebral palsy rehabilitation in North West Nigeria: a qualitative study. BMC Health Serv Res 2020; 20:615. [PMID: 32631316 PMCID: PMC7336653 DOI: 10.1186/s12913-020-05487-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 07/01/2020] [Indexed: 11/18/2022] Open
Abstract
Background Cerebral Palsy (CP) refers to the permanent disorders involving postural and movement control as a result of injury to the developing brain. As a result of impairment in postural and movement control, children with CP usually have problems in carrying out activities of daily living (ADL). This makes them dependent on help from their caregivers. Thus, for effective rehabilitation of children with CP, active participation of their caregivers is important. This study seeks to explore the facilitators and barriers of active participation of caregivers in the rehabilitation of children with CP in Kano, Nigeria. Methods The study design used was qualitative in-depth interview. The participants were caregivers of children with CP at Hasiya Bayero Paediatric Specialists Hospital, Kano. The caregivers were interviewed face-to-face, and their responses were audio-recorded with a tape recorder, supplemented with note taking. The data generated was analyzed using constant comparative analysis. Results Forty young caregivers (mean age, 27.17 ± 4.46 years) participated in the study. They expressed encouragement from the therapist managing the child, family support, empathy, improvement in the conditions of other children with CP, cooperation of the child during home programs family support and improvement in the child’s condition as factors that facilitate their active participation in the rehabilitation of the children. However, they mentioned occupation, financial resources and the number of children the caregiver has are the barriers to their active participation in the rehabilitation of the children. Conclusions Both the facilitators and barriers of active participation of caregivers in the rehabilitation of children with CP need to be recognized in order to help caregivers reinforce or overcome them respectively. In addition, economically sustainable and accessible rehabilitation services are needed for all children with CP. Similarly, sharing caregiving rehabilitation tasks amongst family members could facilitate caregiver active participation.
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Affiliation(s)
- Auwal Abdullahi
- Department of Physiotherapy, Bayero University Kano, PMB 3011, Gwarzo road, Kano, Nigeria.
| | - Auwal Isah
- Department of Physiotherapy, Aminu Kano Teaching Hospital, Kano, Nigeria
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Nuri RP, Ghahari S, Aldersey HM, Huque AS. Exploring access to government-led support for children with disabilities in Bangladesh. PLoS One 2020; 15:e0235439. [PMID: 32614867 PMCID: PMC7332059 DOI: 10.1371/journal.pone.0235439] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/15/2020] [Indexed: 12/20/2022] Open
Abstract
While access to support for individuals with disabilities has attracted international attention, children with disabilities and their families continue to face a range of barriers that limit their timely access to the needed support, including health service. This is even worse for children with disabilities living in resource poor settings like Bangladesh. The objective of this study was to determine the extent to which families of children with disabilities have knowledge about and access to government support for their children with disabilities in Bangladesh. We employed a cross-sectional study among 393 families of children with disabilities who sought services from the Centre for the Rehabilitation of the Paralysed for their children with disabilities in Bangladesh. We used chi-square test to measure the association between categorical variables and, Mann-Whitney U-test to compare mean across different sub-groups. Overall, family members of children with disabilities have limited knowledge about and access to government support. We found a significant association between knowledge and access to government support (p<0.001). Family members with children with disabilities aged younger than six years had less access to government support (p<0.001). We thus concluded with an urgent call on government agencies and service providers to provide relevant and timely information to families of children with disabilities to enable them to access the needed support.
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Affiliation(s)
- Reshma Parvin Nuri
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
- * E-mail:
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
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Power R, Muhit M, Heanoy E, Karim T, Galea C, Badawi N, Khandaker G. Depression, anxiety and stress among caregivers of adolescents with cerebral palsy in rural Bangladesh. Disabil Rehabil 2019; 43:2123-2130. [PMID: 34275406 DOI: 10.1080/09638288.2019.1692378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Prior studies indicate high risk of mental health problems among caregivers of adolescents with cerebral palsy although limited consideration is given to caregivers in low- and middle-income countries. This study aimed to compare the burden of depression, anxiety and stress among caregivers of adolescents with cerebral palsy to caregivers of adolescents without disability in rural Bangladesh; and to identify factors unique to low- and middle-income countries that predict caregiver's mental health. METHODS Observational study comparing caregivers of adolescents with cerebral palsy identified through the Bangladesh Cerebral Palsy Register and caregivers of adolescents without disability from neighboring dwellings. Caregiver mental health was assessed using the Depression, Anxiety and Stress Scale-21, adolescent mental health using the Strengths and Difficulties Questionnaire and adolescent health-related quality of life using Kidscreen-27. Hierarchical multivariable regression analysis was performed. RESULTS Participants were 154 caregivers of adolescents with cerebral palsy and 173 caregivers of adolescents without disability, matched on adolescent age and sex. Caregivers of adolescents with cerebral palsy reported significantly higher risk of depression and stress than caregivers of adolescents without disability (Effect Size 0.1 to 0.2, p < 0.05) although no difference on anxiety. Caregiver age, adolescent mental health, household overcrowding and adolescent hearing impairment were significant predictors of depression, anxiety and/or stress (0.1 to 2.2, p < 0.05). CONCLUSIONS Caregivers of adolescents with cerebral palsy in rural Bangladesh are at high risk of depression and stress. Initiatives to improve caregiver mental health are required; we recommend initiatives address adolescent mental health problems and include poverty reduction measures to improve social and economic capital. Improved understanding of the factors predicting caregiver depression, anxiety and stress unique to low and middle-income countries are necessary to guide policies and public health infrastructure development.Implications for rehabilitationCaregivers of adolescents with cerebral palsy in rural Bangladesh are at significantly higher risk of depression and stress than caregivers of adolescents without disability.We recommend interventions to improve caregiver mental health give specific consideration to older caregivers, those whose adolescent report mental health problems, families living in crowded households, and/or whose child has hearing impairment.We recommend interventions include poverty reduction measures to improve social and economic capital and target both caregivers and adolescents with CP to enhance long term outcomes.
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Affiliation(s)
- Rosalie Power
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Mohammad Muhit
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,CSF Global, Dhaka, Bangladesh
| | - Eamin Heanoy
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,CSF Global, Dhaka, Bangladesh
| | - Tasneem Karim
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,CSF Global, Dhaka, Bangladesh.,Cerebral Palsy Alliance Research Institute, University of Sydney, Sydney, Australia
| | - Claire Galea
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Cerebral Palsy Alliance Research Institute, University of Sydney, Sydney, Australia
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Cerebral Palsy Alliance Research Institute, University of Sydney, Sydney, Australia
| | - Gulam Khandaker
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,CSF Global, Dhaka, Bangladesh.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
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