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Baariu JK, Kariuki SM, Newton CR. Behavioural and emotional comorbidities in school-aged children with neurological conditions in Kilifi, Kenya, and their long-term consequences. Glob Health Action 2022; 15:2034132. [PMID: 35138235 PMCID: PMC8843098 DOI: 10.1080/16549716.2022.2034132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Neurological conditions and mental health problems are common in children in low- and middle-income countries, but the risk factors and downstream impact of these problems on children with neurological conditions are not reported. Objective To determine the association of neurological conditions with behavioural and emotional problems in children, the prevalence and risk factors of behavioural and emotional problems, and long-term impact of these conditions. Methods Data on multiple neurological conditions and mental health problems were available for 1,616 children (aged 6–9 years) from Kilifi, Kenya. Neurological conditions were diagnosed using standardised tools and clinical examination. Behavioural and emotional problems assessed using Child Behaviour Questionnaire for Parents. Long-term outcomes were obtained from census data of the Kilifi Health and Demographic Surveillance System. Logistic and linear regression were used to measure associations. Results Mental health problems were higher in those with any neurological condition compared to those without (24% vs. 12%, p < 0.001). Cognitive (odds ratio (OR) = 2.39; 95% CI: 1.59–3.59), motor (OR = 3.17; 95% CI: 1.72–5.82), hearing (OR = 2.07; 95% CI:1.12–3.83) impairments, and epilepsy (OR = 4.18; 95% CI: 2.69–6.48), were associated with mental health problems. Prevalence of any mental health problem was 15%, with externalizing problems more common than internalizing problems (21% vs. 17%, p = 0.004). Longitudinal follow-up indicated that the disorders affected an individual’s future schooling (e.g. OR = 1.25; 95% CI: 0.14–1.46 following cognitive impairments), occupation (OR = 2.44; 95% CI: 1.09–5.44 following mental health problems), and access to household assets (OR = 2.78; 95% CI: 0.99–7.85 following epilepsy). Conclusions Neurological conditions in school-aged children in Kilifi are associated with mental health problems, and both disorders have long-term consequences. Preventive and therapeutic measures for these conditions are needed to improve outcomes of these children.
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Affiliation(s)
- Judy K Baariu
- Clinical Research-Neurosciences Department, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast (Cgmrc), Kilifi, Kenya.,Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, Kenya
| | - Symon M Kariuki
- Clinical Research-Neurosciences Department, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast (Cgmrc), Kilifi, Kenya.,Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Charles Rjc Newton
- Clinical Research-Neurosciences Department, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast (Cgmrc), Kilifi, Kenya.,Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
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2
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McIntyre S, Goldsmith S, Webb A, Ehlinger V, Hollung SJ, McConnell K, Arnaud C, Smithers‐Sheedy H, Oskoui M, Khandaker G, Himmelmann K. Global prevalence of cerebral palsy: A systematic analysis. Dev Med Child Neurol 2022; 64:1494-1506. [PMID: 35952356 PMCID: PMC9804547 DOI: 10.1111/dmcn.15346] [Citation(s) in RCA: 163] [Impact Index Per Article: 81.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 01/31/2023]
Abstract
AIM To determine trends and current estimates in regional and global prevalence of cerebral palsy (CP). METHOD A systematic analysis of data from participating CP registers/surveillance systems and population-based prevalence studies (from birth year 1995) was performed. Quality and risk of bias were assessed for both data sources. Analyses were conducted for pre-/perinatal, postnatal, neonatal, and overall CP. For each region, trends were statistically classified as increasing, decreasing, heterogeneous, or no change, and most recent prevalence estimates with 95% confidence intervals (CI) were calculated. Meta-analyses were conducted to determine current birth prevalence estimates (from birth year 2010). RESULTS Forty-one regions from 27 countries across five continents were represented. Pre-/perinatal birth prevalence declined significantly across Europe and Australia (11 out of 14 regions), with no change in postneonatal CP. From the limited but increasing data available from regions in low- and middle-income countries (LMICs), birth prevalence for pre-/perinatal CP was as high as 3.4 per 1000 (95% CI 3.0-3.9) live births. Following meta-analyses, birth prevalence for pre-/perinatal CP in regions from high-income countries (HICs) was 1.5 per 1000 (95% CI 1.4-1.6) live births, and 1.6 per 1000 (95% CI 1.5-1.7) live births when postneonatal CP was included. INTERPRETATION The birth prevalence estimate of CP in HICs declined to 1.6 per 1000 live births. Data available from LMICs indicated markedly higher birth prevalence. WHAT THIS PAPER ADDS • Birth prevalence of pre-/perinatal cerebral palsy (CP) in high-income countries (HICs) is decreasing. • Current overall CP birth prevalence for HICs is 1.6 per 1000 live births. • Trends in low- and middle-income countries (LMICs) cannot currently be measured. • Current birth prevalence in LMICs is markedly higher than in HICs. • Active surveillance of CP helps to assess the impact of medical advancements and social/economic development. • Population-based data on prevalence and trends of CP are critical to inform policy.
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Affiliation(s)
- Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Shona Goldsmith
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Annabel Webb
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Virginie Ehlinger
- Center for Epidemiology and Research in Population health (CERPOP), InsermUniversity of ToulouseToulouseFrance
| | - Sandra Julsen Hollung
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Vestfold Hospital TrustTønsbergNorway
| | | | | | - Hayley Smithers‐Sheedy
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Maryam Oskoui
- Department of Pediatrics, Faculty of Medicine and Health SciencesMcGill UniversityMontrealCanada
| | - Gulam Khandaker
- Central Queensland Hospital and Health ServiceRockhamptonAustralia
| | - Kate Himmelmann
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
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Banks LM, Liu J, Kielland A, Tahirou AB, Harouna AKS, Mactaggart I, Dybdahl R, Mounkaila DF, Grønningsæter A. Childhood disability in rural Niger: a population-based assessment using the Key Informant Method. BMC Pediatr 2022; 22:170. [PMID: 35361177 PMCID: PMC8969242 DOI: 10.1186/s12887-022-03226-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Data on childhood disability is essential for planning health, education and other services. However, information is lacking in many low- and middle-income countries, including Niger. This study uses the Key Informant Method, an innovative and cost-effective strategy for generating population-based estimates of childhood disability, to estimate the prevalence and causes of moderate/severe impairments and disabling health conditions in children of school-going age (7-16 years) in the Kollo department of western Niger. METHODS Community-based key informants were trained to identify children who were suspected of having the impairment types/health conditions included in this study. Children identified by key informants were visited by paediatricians and underwent an assessment for moderate/severe vision, hearing, physical and intellectual impairments, as well as epilepsy, albinism and emotional distress. RESULTS Two thousand, five hundred sixty-one children were identified by key informants, of whom 2191 were visited by paediatricians (response rate = 85.6%). Overall, 597 children were determined to have an impairment/health condition, giving a prevalence of disability of 11.4 per 1000 children (10.6- 12.2). Intellectual impairment was most common (6.5 per 1000), followed by physical (4.9 per 1000) and hearing impairments (4.7 per 1000). Many children had never sought medical attention for their impairment/health condition, with health seeking ranging from 40.0% of children with visual impairment to 67.2% for children with physical impairments. CONCLUSION The Key Informant Method enabled the identification of a large number of children with disabling impairments and health conditions in rural Niger, many of whom have unmet needs for health and other services.
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Affiliation(s)
- Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - Ali Bako Tahirou
- Laboratoire d'Études Et de Recherche Sur Les Dynamiques Sociales Et Le Développement Local (LASDEL), Niamey, Niger
| | - Abdoul Karim Seydou Harouna
- Laboratoire d'Études Et de Recherche Sur Les Dynamiques Sociales Et Le Développement Local (LASDEL), Niamey, Niger
| | - Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Muhit M, Karim T, Jahan I, Al Imam MH, Das MC, Khandaker G. Epidemiology of eye diseases among children with disability in rural Bangladesh: a population-based cohort study. Dev Med Child Neurol 2022; 64:209-219. [PMID: 34468025 DOI: 10.1111/dmcn.15041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
AIM To describe the epidemiology of eye diseases among children with disability in rural Bangladesh. METHOD We established a population-based cohort of children with disability using the key informant method. Children younger than 18 years with disability (i.e. physical, visual, hearing, speech, epilepsy) were included. We used detailed ophthalmological assessments following World Health Organization (WHO) protocols by a multidisciplinary team including an ophthalmologist, optometrist, physician, and physiotherapist. Visual impairment, blindness, and severe visual impairment (SVI) were defined by following WHO categories. RESULTS Between October 2017 and February 2018, 1274 children were assessed (43.6% female; median [interquartile range] age 9y 10mo [6y -13y 7mo]). Overall, 6.5% (n=83) had blindness/SVI, and 5.6% (n=71) had visual impairment. In the group with blindness/SVI, 47% (n=39) had cortical blindness; of those, 79.5% (n=31) had cerebral palsy (CP). The other main anatomical sites of abnormalities in this group included lens (13.3%, n=11), cornea (10.8%, n=9), and optic nerve (9.6%, n=8). In the group with visual impairment, 90.1% (n=64) had refractive error. Overall, 83.1% (n=69) and 78.8% (n=56) of those with blindness/SVI and visual impairment had avoidable causes. Most children with blindness/SVI and visual impairment lacked access to education. INTERPRETATION The burden of blindness/SVI/visual impairment is high among children with disability in rural Bangladesh, mostly due to avoidable causes. Overrepresentation of CP and cortical blindness in the group with blindness/SVI and refractive error in the group with visual impairment highlights the need for integration of ophthalmology assessment, eye care, and refraction services in comprehensive health care for children with disability including CP in rural Bangladesh.
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Affiliation(s)
- Mohammad Muhit
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Tasneem Karim
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Israt Jahan
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD, Australia
| | - Manik Chandra Das
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Gulam Khandaker
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD, Australia
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Linder CL, Atijosan-Ayodele O, Chokotho L, Mulwafu W, Tataryn M, Polack S, Kuper H, Pandit H, Lavy C. Childhood musculoskeletal impairment in Malawi from traumatic and non-traumatic causes: a population- based assessment using the key informant method. BMC Musculoskelet Disord 2021; 22:1058. [PMID: 34933673 PMCID: PMC8693487 DOI: 10.1186/s12891-021-04942-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background Musculoskeletal impairment (MSI) in children is an under-recognised public health challenge. Although preventable, road injuries and other traumas continue to cause significant impairments to children worldwide. The study aimed to use the Key Informant Method (KIM) to assess prevalence and causes of MSI in children in two districts in Malawi, estimating the associated need for services provision, with a focus on traumatic aetiology. Methods The KIM was conducted in the districts of Thyolo (Southern Malawi) and Ntcheu (Central Malawi) in 2013. Five hundred key informants were trained to identify children who may have one of a range of MSI. The identified children were referred to a screening camp where they were examined by medical experts with standardised assessment protocols for diagnosing each form of impairment. Results 15,000 children were referred to screening camps. 7220 children were assessed (response rate 48%) for an impairment of whom 15.2% (1094) had an MSI. 13% of children developed MSI from trauma, while 54% had a neurological aetiology. For MSI of traumatic origin the most common body part affected was the elbow. Less than half of children with MSI (44.4%) were enrolled in school and none of these children attended schools with resources for disability. More than half of children with MSI (60%) had not received required services and 64% required further physical therapy. Conclusions The KIM method was used to identify a high prevalence of MSI among children in two districts of Malawi and estimates an unmet need for dedicated MSI services.
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Affiliation(s)
- Cortland L Linder
- Royal London Hospital, Whitechapel Rd, Whitechapel, London, E1 1FR, UK
| | | | - Linda Chokotho
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Blantyre, Malawi.
| | - Wakisa Mulwafu
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Blantyre, Malawi
| | - Myroslava Tataryn
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | | | - Chris Lavy
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Science, Oxford University, Oxford, UK
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Duke RE, Chimaeze T, Kim MJ, Ameh S, Burton K, Bowman R. The Effect of Insight Questions Inventory and Visual Support Strategies on Carer-Reported Quality of Life for Children With Cerebral Palsy and Perceptual Visual Dysfunction in Nigeria: A Randomized Controlled Trial. Front Hum Neurosci 2021; 15:706550. [PMID: 34867233 PMCID: PMC8636698 DOI: 10.3389/fnhum.2021.706550] [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: 05/07/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022] Open
Abstract
Structured clinical history question inventories have previously been used to try and elicit symptoms of perceptual visual dysfunction (PVD) in children with cerebral palsy (CP) in different settings. Earlier studies have suggested that PVD may affect quality of life and specific habilitational strategies, linked to inventory responses, may improve quality of life. Through an RCT, based on a community based sample of children with CP in Cross River State, Nigeria, we aimed to determine if a structured history inventory such as the Insight question inventory (IQI) and associated tailored visual support strategies (IQI VSS) for the management of those children who have PVD, can improve quality of life and is superior to standard therapy. Children with CP were recruited by the key informant method and confirmed by clinical examination. The parent reported IQI was used to identify children with PVD. Primary outcome measures were both Pediatric Quality of Life 4.0 Generic (PedsQL 4.0 Generic) and Pediatric Quality of Life 3.0 Cerebral Palsy (PedsQL 3.0 CP) scale scores. Children were enrolled with a parallel arm allocation to either IQI and IQI VSS or to standard therapy for CP. Children were followed up for 6 weeks with weekly phone call session and the questionnaires repeated at the end of the 6 weeks’ period. Results show that the children in the treatment group (n = 191) showed no significantly different change between baseline and follow up in quality of life (PedsQL 4.0 Generic p = 0.943: and PedsQL-CP 3.0 p = 0.287), compared to the control group. There was suggestion of a better improvement (p = 0.035) in the PedsQL 3.0 CP subscale of speech and communication for the intervention group. The use of IQI VSS for the treatment of PVD in children with CP in this population does not show any superiority over current standard CP management in terms of overall quality of life. However, there was some evidence of improvement in quality of life in the area of speech and communication. Further research and refinement of these management method is required. Clinical Trial Registration:www.ClinicalTrials.gov, identifier [PACTR20161200188] 6396.
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Affiliation(s)
- Roseline E Duke
- London School of Hygiene and Tropical Medicine, International Center for Eye Health, University of London, London, United Kingdom.,Children's Eye Center, Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Torty Chimaeze
- Department of Pediatrics, Pediatric Neurology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Min J Kim
- London School of Hygiene and Tropical Medicine, International Center for Eye Health, University of London, London, United Kingdom
| | - Soter Ameh
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Kathryn Burton
- Cambridgeshire Community Services, Oxfordshire, United Kingdom
| | - Richard Bowman
- London School of Hygiene and Tropical Medicine, International Center for Eye Health, University of London, London, United Kingdom
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Jahan I, Muhit M, Hardianto D, Laryea F, Chhetri AB, Smithers-Sheedy H, McIntyre S, Badawi N, Khandaker G. Epidemiology of cerebral palsy in low- and middle-income countries: preliminary findings from an international multi-centre cerebral palsy register. Dev Med Child Neurol 2021; 63:1327-1336. [PMID: 34031872 DOI: 10.1111/dmcn.14926] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 12/11/2022]
Abstract
AIM To describe the epidemiology of cerebral palsy (CP) in children from low- and middle-income countries (LMICs) using data from the Global Low- and Middle-Income Country CP register (GLM-CPR). METHOD The GLM-CPR is a multi-country initiative that combines and compares data from children with CP (<18y) in LMICs. Children with CP are registered after detailed neurodevelopmental assessment by a multidisciplinary medical team using a harmonized protocol. Data are collected on agreed core variables. Descriptive analyses are completed to report findings from participating countries. RESULTS Between January 2015 and May 2019, 2664 children were recruited from Bangladesh, Nepal, Indonesia, and Ghana (mean age [SD] at assessment: 7y 8mo [4y 8mo], 95% confidence interval 7y 6mo-7y 11mo; male [n=1615] 60.6%, female [n=1049] 39.4%). Overall, 86.6% children acquired CP prenatally and perinatally (e.g. preterm birth, birth asphyxia, neonatal encephalopathy). Median age at CP diagnosis was 3 years. Moreover, 79.2% children had spastic CP and 73.3% were classified in Gross Motor Function Classification System levels III to V. Notably, 47.3% of children never received rehabilitation services (median age at receiving rehabilitation services was 3y; 12.7% received assistive devices) and 75.6% of school-age children had no access to education. INTERPRETATION Population-based data show that the proportion of severe cases of CP is very high in LMICs. Children with CP in LMICs lack access to rehabilitation and educational services and a large proportion of children have potentially preventable risk factors, for example, birth asphyxia and neonatal infections. Delayed diagnosis, severe motor impairments, and lack of rehabilitation in most children call for urgent action to identify preventive opportunities and promote early diagnosis and intervention for children with CP in LMICs. What this paper adds The proportion of severe cases of cerebral palsy (CP) is very high in rural low- and middle-income countries (LMICs). Children with CP in LMICs lack access to rehabilitation and educational services. A large proportion of children with CP in LMICs have potentially preventable risk factors.
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Affiliation(s)
- Israt Jahan
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | | | | | | | - Hayley Smithers-Sheedy
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Gulam Khandaker
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD, Australia
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Sanders R, Gascoyne B, Appleby P, Rashida SA, Jolley E. Eye Health Service Uptake among People with Visual Impairment and Other Functional Difficulties in Bangladesh: A Cross-Sectional Study with Short-Term Follow Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9068. [PMID: 34501657 PMCID: PMC8431586 DOI: 10.3390/ijerph18179068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 11/17/2022]
Abstract
People with visual impairments are disproportionately likely to also have other impairments. However, little is known about whether these other impairments affect access to eye health services. This study among cataract and refractive error patients in four districts in Bangladesh explores the relationship between self-reported difficulties in hearing, mobility, self-care, communication and cognition domains, eye health service uptake, and location of initial eye health assessment. Cataract and refractive errors were diagnosed through ophthalmic clinical assessment, and the Washington Group Short Set (WG-SS) was used to ascertain difficulties in other functional domains. Univariate and multivariate analyses were used to examine the relationship between functional difficulties and uptake of cataract and refractive error services. We found that people with self-reported functional difficulties were less likely to take up refractive error services compared to people with same need but with no functional difficulties, and that they were more than twice as likely to access surgical services after attending an outreach camp compared with a hospital facility. Since a high proportion of people attending eye health assessment services have difficulties in a range of functional domains, strategies to improve the uptake of hospital-based health services are urgently required.
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Affiliation(s)
- Ruth Sanders
- Sightsavers, Haywards Heath RH16 3BZ, UK; (B.G.); (P.A.); (S.A.R.); (E.J.)
| | - Ben Gascoyne
- Sightsavers, Haywards Heath RH16 3BZ, UK; (B.G.); (P.A.); (S.A.R.); (E.J.)
| | - Paul Appleby
- Sightsavers, Haywards Heath RH16 3BZ, UK; (B.G.); (P.A.); (S.A.R.); (E.J.)
| | - Syeda Asma Rashida
- Sightsavers, Haywards Heath RH16 3BZ, UK; (B.G.); (P.A.); (S.A.R.); (E.J.)
- Bangladesh Office-Sightsavers, Banani, Dhaka 1213, Bangladesh
| | - Emma Jolley
- Sightsavers, Haywards Heath RH16 3BZ, UK; (B.G.); (P.A.); (S.A.R.); (E.J.)
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9
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Al Imam MH, Jahan I, Das MC, Muhit M, Smithers-Sheedy H, McIntyre S, Badawi N, Khandaker G. Rehabilitation status of children with cerebral palsy in Bangladesh: Findings from the Bangladesh Cerebral Palsy Register. PLoS One 2021; 16:e0250640. [PMID: 33939721 PMCID: PMC8092763 DOI: 10.1371/journal.pone.0250640] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/08/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the rehabilitation status and factors associated with rehabilitation service utilisation among children with cerebral palsy (CP) in Bangladesh. MATERIALS AND METHODS This is a population-based surveillance study conducted among children with CP registered in the Bangladesh CP Register (BCPR), the first population-based register of children with CP aged <18 years (y) in Bangladesh. Children with CP were identified from the community using the key informant method and underwent a detailed neurodevelopmental assessment. Socio-demographic, clinical and rehabilitation status were documented. Unadjusted and adjusted analyses with a 95% confidence interval (CI) were used to identify potential predictors of rehabilitation service uptake. RESULTS Between January 2015 and December 2019, 2852 children with CP were registered in the BCPR (mean (standard deviation, SD) age: 7 y 8 months (mo) (4 y 7 mo), 38.5% female). Of these, 50.2% had received rehabilitation services; physiotherapy was the most common type of service (90.0%). The mean (SD) age at commencement of rehabilitation services was 3 y 10 mo (3 y 1 mo). The odds of not receiving rehabilitation was significantly higher among female children (adjusted odds ratio (aOR) 1.3 [95% CI: 1.0-1.7], children whose mothers were illiterate and primary level completed (aOR 2.1 [95% CI: 1.4-3.1] and aOR 1.5 [95% CI: 1.1-2.1], respectively), fathers were illiterate (aOR 1.9 [95% CI: 1.3-2.8]), had a monthly family income ~US$ 59-118 (aOR: 1.8 [95% CI: 1.2-2.6]), had hearing impairment (aOR: 2.3 [95% CI: 1.5-3.5]) and motor severity (i.e. Gross Motor Function Classification System level III (aOR: 0.6 [95% CI: 0.3-0.9]) and level V (aOR: 0.4 [95% CI: 0.2-0.7])). CONCLUSIONS Rehabilitation status was poor among the majority of the children with CP in the BCPR cohort, limiting their opportunities for functional improvement. A community-based rehabilitation model focusing on socio-demographic and clinical characteristics should be a public health priority in Bangladesh.
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Affiliation(s)
- Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Israt Jahan
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Manik Chandra Das
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
- Grace Centre for Newborn Intensive Care, Sydney Children’s Hospital Network, Westmead, New South Wales, Australia
| | - Gulam Khandaker
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
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10
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Duke RE, Torty C, Okorie U, Kim MJ, Eneli N, Edadi U, Burton K, Tann C, Bowman R. Pattern of comorbidities in school-aged children with cerebral palsy in Cross River State, Nigeria. BMC Pediatr 2021; 21:165. [PMID: 33832457 PMCID: PMC8028192 DOI: 10.1186/s12887-021-02637-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/25/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND To describe the pattern of comorbidities in school-aged children with cerebral palsy (CP) and to identify which, if any, were associated with poor school attendance. A cross-sectional study, using the key informant methodology, between December 2017 and July 2018 was conducted in Cross River State, Nigeria. Assessments, confirmation of CP and identification of systemic comorbidities using standard tools and questionnaires were performed. Children confirmed to have CP between the ages 4 to 15 years were included. RESULTS Three hundred and eighty-eight children were confirmed to have CP, 59% males. The mean age was 9.2 years ± SD 4.0; 28% were non-ambulatory (gross motor function classification system (GMFCS) level IV-V) and spastic CP was seen in 70%. Comorbidities included Speech impairment 85%, feeding difficulties 86%, and swallowing difficulties 77%, learning difficulties 88%, abnormal behaviour 62%, visual acuity impairment 54%, objective perceptual visual disorders 46%, communication difficulties 45%, epilepsy 35%, hearing impairment 12% and malnutrition 51%. Learning difficulties (OR 10.1, p < 0.001; CI: 3.6-28.1), visual acuity impairment (OR 2.8, p = 0.002; CI: 1.5-5.3), epilepsy (OR 2.3, p = 0.009; CI:1.2-4.3) manual ability classification scale 4-5 (OR 4.7,p = 0.049; CI:1.0-22.2) and CP severity (GMFCS V-VI) OR 6.9 p = 0.002, CI: 2.0-24.0.) were seen as increasing the likelihood of poor school attendance. CONCLUSION Comorbidities were common, and some were associated with limited school attendance. A multidisciplinary tailored approach to care, with application of available therapeutic interventions for comorbidities is suggested. This may be useful in reducing barriers to school attendance.
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Affiliation(s)
- Roseline E. Duke
- London School of Hygiene & Tropical Medicine, International Centre for Eye Health, London, UK
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar Children’s Eye Centre, Calabar, Cross River State Nigeria
| | - Chimaeze Torty
- Department of Paediatrics, Neurology Unit, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Uche Okorie
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar Children’s Eye Centre, Calabar, Cross River State Nigeria
| | - Min J. Kim
- London School of Hygiene & Tropical Medicine, International Centre for Eye Health, London, UK
| | - Nnena Eneli
- Department of Physiotherapy, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ukam Edadi
- Primary Health Care Development Agency, Calabar, Cross River State Nigeria
| | | | - Cally Tann
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Bowman
- London School of Hygiene & Tropical Medicine, International Centre for Eye Health, London, UK
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11
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Koly KN, Martin-Herz SP, Islam MS, Sharmin N, Blencowe H, Naheed A. Parent mediated intervention programmes for children and adolescents with neurodevelopmental disorders in South Asia: A systematic review. PLoS One 2021; 16:e0247432. [PMID: 33705420 PMCID: PMC7951928 DOI: 10.1371/journal.pone.0247432] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 02/07/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Parent-mediated programmes have been found to be cost effective for addressing the needs of the children and adolescents with Neurodevelopmental Disorders (NDD) in high-income countries. We explored the impact of parent-mediated intervention programmes in South Asia, where the burden of NDD is high. METHODS A systematic review was conducted using the following databases; PUBMED, MEDLINE, PsycINFO, Google Scholar and Web of Science. Predefined MeSH terms were used, and articles were included if published prior to January 2020. Two independent researchers screened the articles and reviewed data. OUTCOMES MEASURES The review included studies that targeted children and adolescents between 1 and 18 years of age diagnosed with any of four specific NDDs that are commonly reported in South Asia; Autism Spectrum Disorder (ASD), Intellectual Disability (ID), Attention Deficit Hyperactivity Disorder (ADHD) and Cerebral Palsy (CP). Studies that reported on parent or child outcomes, parent-child interaction, parent knowledge of NDDs, or child activities of daily living were included for full text review. RESULTS A total of 1585 research articles were retrieved and 23 studies met inclusion criteria, including 9 Randomized Controlled Trials and 14 pre-post intervention studies. Of these, seventeen studies reported effectiveness, and six studies reported feasibility and acceptability of the parent-mediated interventions. Three studies demonstrated improved parent-child interaction, three studies demonstrated improved child communication initiations, five studies reported improved social and communication skills in children, four studies demonstrated improved parental knowledge about how to teach their children, and four studies reported improved motor and cognitive skills, social skills, language development, learning ability, or academic performance in children. CONCLUSION This systematic review of 23 studies demonstrated improvements in parent and child skills following parent-mediated intervention in South Asia. Additional evaluations of locally customized parent-mediated programmes are needed to support development of feasible interventions for South Asian countries.
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Affiliation(s)
- Kamrun Nahar Koly
- Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Susanne P. Martin-Herz
- Department of Pediatrics, Division of Developmental Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Md. Saimul Islam
- Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nusrat Sharmin
- Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Department of Psychology, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Dhaka, Bangladesh
| | - Hannah Blencowe
- Maternal Adolescent Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aliya Naheed
- Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- * E-mail:
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Duttine A, Smythe T, Calheiros de Sa MR, Ferrite S, Moreira ME, Kuper H. Juntos: A Support Program for Families Impacted by Congenital Zika Syndrome in Brazil. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:846-857. [PMID: 33361247 PMCID: PMC7784063 DOI: 10.9745/ghsp-d-20-00018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 11/04/2020] [Indexed: 11/29/2022]
Abstract
Development of Juntos, a community-based family support program for caregivers of children with congenital Zika syndrome, contained innovative approaches such as using mothers as facilitators, fast-track learning, and de-isolation of families affected by Zika. Background: The 2015–2016 Zika virus outbreak in Brazil was unprecedented and resulted in the birth of more than 3,000 children with congenital Zika syndrome (CZS). These children experience multiple complex health conditions and have limited services to support them and their family’s needs. Program Development and Piloting: An existing family support program for children with cerebral palsy (Getting to Know Cerebral Palsy) was adapted to the Zika context in Brazil through expert consultation. The program was pilot tested at 2 sites among 6 groups of caregivers (total of 48 families) from August 2017 to June 2018. Group observation and focus group discussions with facilitators and participants at the end of each session informed fast-track learning, which was used to tailor the program for future groups. Fast-track learning—adjusting the intervention in real time based on gathered feedback—was found to be a helpful process to inform and hone the program from its initial concept. Program Description: The intervention, Juntos, is a facilitated participatory group program for caregivers of children who have CZS. The group sessions are cofacilitated by a parent of a child who has CZS and an allied health professional. The group meets for 10 sessions that last 4 hours. Each session includes an icebreaker, activities, and group discussions. Content covers practical information on caring for a child with a developmental disability including that caused by Zika. Psychosocial support forms an important component, and families are guided from the first week to define and develop their own communities of support. Six pilot groups were successfully run in Rio de Janeiro and Greater Salvador, Bahia. The groups gave positive feedback on acceptability and demand. Conclusions: The program has the potential to be an important tool for community health and social support services in South America in response to Zika. The program can also be applied to children with neurodevelopmental disabilities other than those caused by the Zika virus, which could be important in ensuring families of children with CZS are less isolated.
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Affiliation(s)
- Antony Duttine
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Silvia Ferrite
- Department of Speech and Hearing Sciences, Federal University of Bahia, Salvador, Brazil
| | - Maria Elisabeth Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz, Rio de Janeiro, Brazil
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
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13
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Bright T, McCormick I, Phiri M, Mulwafu W, Burton M, Polack S, Mactaggart I, Yip JLY, Swanepoel DW, Kuper H. Rationale and feasibility of a combined rapid assessment of avoidable blindness and hearing loss protocol. PLoS One 2020; 15:e0229008. [PMID: 32053650 PMCID: PMC7018009 DOI: 10.1371/journal.pone.0229008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/28/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose This study has two main objectives: 1) to assess the value of combining the rapid assessment of avoidable blindness (RAAB) and the recently developed rapid assessment of hearing loss (RAHL) based on existing population-based data from Cameroon andIndia; 2) to test the feasibility of a combined RAAB-RAHL protocol. Methods A secondary data analysis of population-based disability surveys in India and Cameroon (in 2013–2014) was conducted, focussing on people aged 50+. Hearing impairment (HI) was defined as pure tone average of ≥41dB (better ear).Visual impairment (VI) was defined as presenting visual acuity of <6/18 (better eye). The relationship between HI and VI was examined. The feasibility of a combined RAAB-RAHL survey was assessed within a RAHL conducted among adults aged 50+ in Malawi in 2018. Outcomes included: time taken, costs, number of people examined in a day, and qualitative feedback from participants and field teams. Results The prevalence of combined VI and HI among people aged 50+ was 4.4% (95% confidence interval (CI) 3.0, 6.4) in India and 4.8% (95%CI 3.0, 8.0) in Cameroon. Among participants with VI, approximately a third in India (29.3%) and Cameroon (35.1%) also had HI. A quarter of participants in India (25.4%) and Cameroon (26.9%) who had HI also had VI. In Malawi, the total time taken to complete both RAAB and RAHL assessments was approximately 27 minutes per participant. It was feasible to complete 30 participants per day for a team of four people. The estimated cost of a combined RAAB-RAHL approach in comparison to two separate impairment surveys is up to 37% less depending on the method of combination. Conclusion The substantial overlap between VI and HI supports a combined rapid survey of the two impairments. The pilot study of a combined RAAB-RAHL survey demonstrates feasibility and lower cost compared to conducting two standalone impairment surveys. A combined RAAB-RAHL approach could maximize limited resources to increase prevalence data for both vision and hearing impairment.
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Affiliation(s)
- Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel St, London, United Kingdom
- * E-mail:
| | - Ian McCormick
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel St, London, United Kingdom
| | - Mwanaisha Phiri
- Audiology Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Wakisa Mulwafu
- Department of Surgery, College of Medicine, Blantyre, Malawi
| | - Matthew Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel St, London, United Kingdom
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel St, London, United Kingdom
| | - Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel St, London, United Kingdom
| | - Jennifer L. Y. Yip
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel St, London, United Kingdom
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel St, London, United Kingdom
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14
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Wadhwani M, Vashist P, Singh SS, Gupta V, Gupta N, Saxena R. Prevalence and causes of childhood blindness in India: A systematic review. Indian J Ophthalmol 2020; 68:311-315. [PMID: 31957718 PMCID: PMC7003592 DOI: 10.4103/ijo.ijo_2076_18] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/24/2019] [Accepted: 08/13/2019] [Indexed: 12/03/2022] Open
Abstract
Childhood blindness is one of the priority targets of Vision 2020-Right To Sight due to its impact on the psychological and social growth of the child. An extensive search was performed to locate research papers on childhood blindness prevalence and its causes in the community based and blind schools, respectively, conducted from 1990 onward up to the present. Cross references were also manually searched along with expert consultation to enlarge the reference data. A total of five community-based studies on the prevalence including two refractive error studies conducted all over India in children less than 16 years were found. The causes of childhood blindness from the available blind school studies revealed that causes of childhood blindness have mainly shifted from corneal causes to whole globe abnormalities. This article highlights that though with the availability of proper healthcare facilities, the trend is changing for the causes but still a lot of effort in the form of timely neonatal eye care facilities, pediatric surgical services and proper refraction strategies is required.
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Affiliation(s)
- Meenakshi Wadhwani
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Praveen Vashist
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Suraj Senjam Singh
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Vivek Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Noopur Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Rohit Saxena
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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15
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Jahan I, Karim T, Al Imam MH, Das MC, Ali KM, Muhit M, Khandaker G. Childhood Disability and Nutrition: Findings from a Population-Based Case Control Study in Rural Bangladesh. Nutrients 2019; 11:nu11112728. [PMID: 31717926 PMCID: PMC6893671 DOI: 10.3390/nu11112728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 11/21/2022] Open
Abstract
Background: Evidence regarding the complex relationship between childhood disability and malnutrition is limited in low and middle income countries. We aimed to measure the association between childhood disability and malnutrition in rural Bangladesh. Method: We conducted a population-based case control study among children aged <18 years in a rural sub-district (i.e., Shahjadpur) in Bangladesh. Children with permanent disability (i.e., Cases) and their age/sex-matched peers (i.e., Controls) were identified from the local community utilizing the key informant method. Socioeconomic, anthropometric, and educational information was collected using a pre-tested questionnaire. Only Cases underwent detailed medical assessment for clinical and rehabilitation information. Descriptive and bivariate analyses were performed. Results: Between October 2017 and February 2018, 1274 Cases and 1303 Controls were assessed. Cases had 6.6 times and 11.8 times higher odds of being severely underweight and severely stunted respectively than Controls. Although epileptic children had the highest overall prevalence of malnutrition, the age/sex-adjusted odds of malnutrition were significantly higher among children with physical impairments. Underweight and/or stunting among children with disability was significantly associated with parental educational qualification, socioeconomic status and mainstream school attendance. Conclusion: The significantly high proportion of severe malnutrition among children with disability calls for urgent action and implementation of inclusive nutrition intervention programs in rural Bangladesh.
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Affiliation(s)
- Israt Jahan
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (T.K.); (M.H.A.I.); (M.C.D.); (K.M.A.); (M.M.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1213, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland 4701, Australia
| | - Tasneem Karim
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (T.K.); (M.H.A.I.); (M.C.D.); (K.M.A.); (M.M.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1213, Bangladesh
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2145, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney 2050, Australia
| | - Mahmudul Hassan Al Imam
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (T.K.); (M.H.A.I.); (M.C.D.); (K.M.A.); (M.M.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1213, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland 4701, Australia
| | - Manik Chandra Das
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (T.K.); (M.H.A.I.); (M.C.D.); (K.M.A.); (M.M.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1213, Bangladesh
| | - Khaled Mohammad Ali
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (T.K.); (M.H.A.I.); (M.C.D.); (K.M.A.); (M.M.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1213, Bangladesh
| | - Mohammad Muhit
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (T.K.); (M.H.A.I.); (M.C.D.); (K.M.A.); (M.M.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1213, Bangladesh
| | - Gulam Khandaker
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (T.K.); (M.H.A.I.); (M.C.D.); (K.M.A.); (M.M.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1213, Bangladesh
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2145, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland 4700, Australia
- Correspondence: ; Tel.: +612-9845-3382; Fax: +612-9845-1418
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16
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Jahan I, Muhit M, Hardianto D, Karim T, Al Imam MH, Das MC, Smithers-Sheedy H, Badawi N, Khandaker G. Nutritional status of children with cerebral palsy in remote Sumba Island of Indonesia: a community-based key informants study. Disabil Rehabil 2019; 43:1819-1828. [PMID: 31656105 DOI: 10.1080/09638288.2019.1676833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM To assess the burden and underlying factors of malnutrition among children with cerebral palsy (CP) in the remote Sumba Island, Indonesia. METHODS This is a community-based key informant (KI) method survey of children with CP in the southwest regency of Sumba Island, Indonesia (child population∼152 471). Children with suspected CP identified by trained community volunteers (KIs) underwent a detailed neurodevelopmental assessment by a multidisciplinary medical assessment team to confirm diagnosis of CP. Anthropometric measurements were taken, z scores were calculated, and nutritional status was determined following the World Health Organization guideline. Descriptive analyses were performed, multivariable linear regression model was fitted to identify potential predictors of malnutrition. RESULTS One hundred and thirty children with CP aged <18 years were included in the study. The majority were severely underweight (78.8%) and severely stunted (85.9%). Severe malnutrition was overrepresented among young children, children who had spastic tri/quadriplegia, Gross Motor Function Classification System levels III-V, had at least one associated impairment, speech impairment and/or swallowing difficulties. Age and presence of visual impairment were found to be significantly associated with weight-for-age z score (i.e., underweight) whereas, epilepsy was significantly associated with the height-for-age z score (i.e., stunting) when adjusted for other covariates. CONCLUSIONS The substantial-high burden of malnutrition among children with CP in remote Sumba Island highlights their vulnerability to poor health-related outcomes. There is an urgent need for nutritional rehabilitation services to avert such consequences among children with CP in low and middle-income countries like Indonesia.Implications for rehabilitationMalnutrition among children with cerebral palsy (CP) is alarmingly high in the remote Sumba island of Indonesia.Children with severe gross motor function limitations or spastic tri/quadriplegia had the most severe malnutrition.There is an urgent need for rehabilitation services including nutrition and feeding interventions for children with CP in low and middle-income countries like Indonesia.
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Affiliation(s)
- Israt Jahan
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | | | - Tasneem Karim
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Manik Chandra Das
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Hayley Smithers-Sheedy
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Cerebral Palsy Alliance Research Institute, The 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, The University of Sydney, Sydney, Australia
| | - Gulam Khandaker
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
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17
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Rationale for a Rapid Methodology to Assess the Prevalence of Hearing Loss in Population-Based Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183405. [PMID: 31540309 PMCID: PMC6765773 DOI: 10.3390/ijerph16183405] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 01/09/2023]
Abstract
Data on the prevalence and causes of hearing loss is lacking from many low and middle-income countries, in part, because all-age population-based surveys of hearing loss can be expensive and time consuming. Restricting samples to older adults would reduce the sample size required, as hearing loss is more prevalent in this group. Population-based surveys of hearing loss require clinicians to be involved in the data collection team and reducing the duration of the survey may help to minimise the impact on service delivery. The objective of this paper was to identify the optimal age-group for conduct of population-based surveys of hearing loss, balancing sample size efficiencies, and expected response rates with ability to make inferences to the all-age population. Methods: Between 2013–2014, two all aged population-based surveys of hearing loss were conducted in one district each of India and Cameroon. Secondary data analysis was conducted to determine the proportion of hearing loss (moderate or greater) in people aged 30+, 40+ and 50+. Poisson regression models were developed to predict the expected prevalence of hearing loss in the whole population, based on the prevalence in people aged 30+, 40+, and 50+, which was compared to the observed prevalence. The distribution of causes in these age groups was also compared to the all-age population. Sample sizes and response rates were estimated to assess which age cut-off is most rapid. Results: Of 160 people in India and 131 in Cameroon with moderate or greater hearing loss, over 70% were older than 50 in both settings. For people aged 30+ (90.6% India; 76.3% Cameroon), 40+ (81% India; 75% Cameroon) and 50+ (73% India; 73% Cameroon) the proportions were higher. Prediction based on Poisson distributed observations the predicted prevalence based on those aged 30+, 40+, and 50+ fell within the confidence intervals of the observed prevalence. The distribution of probable causes of hearing loss in the older age groups was statistically similar to the total population. Sample size calculations and an analysis of response rates suggested that a focus on those aged 50+ would minimise costs the most by reducing the survey duration. Conclusion: Restricting the age group included in surveys of hearing loss, in particular to people aged 50+, would still allow inferences to be made to the total population, and would mean that the required sample size would be smaller, thus reducing the duration of the survey and costs.
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18
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Duke R, Eyong K, Burton K, MacLeod D, Dutton GN, Gilbert C, Bowman R. The effect of visual support strategies on the quality of life of children with cerebral palsy and cerebral visual impairment/perceptual visual dysfunction in Nigeria: study protocol for a randomized controlled trial. Trials 2019; 20:417. [PMID: 31291989 PMCID: PMC6617659 DOI: 10.1186/s13063-019-3527-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/15/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Cerebral visual impairment (CVI), including perceptual visual dysfunction (PVD), is common in children with cerebral palsy (CP). Inventories of questions relating to practical aspects of visual perception in everyday life, in particular the closed-ended Insight Questions Inventory (IQI), can be used to assess CVI/PVD. Studies linking responses to the inventory with specific visual support strategies, aimed at modifying the child's environment and/or behaviour to minimize the impact of the CVI/PVD, have been piloted. The IQI and tailored strategies have not been used in an African population, nor have they been tested in a controlled trial. This trial will compare the effectiveness of the IQI and linked visual support strategies versus general supportive treatments on the quality of life of children with CVI/PVD and CP through a randomized controlled trial. METHODS/DESIGN This is a prospective, double-blind, parallel-arm, randomized controlled trial. The primary outcome is change in quality of life scores between the two arms of the trial at 6 weeks, assessed using the Paediatric Quality of Life Inventory (PedsQL) generic 4.0 and CP 3.0 module. All children will undergo baseline assessment including the Open Questions Inventory, IQI, PedsQL 3.0, PedsQL 4.0 generic, and the Strengths and Difficulties Questionnaire (SDQ). Eligible children with CP aged 4 years to < 16 years will be stratified and blocked by the age groups 4-9 and 10 to < 16 years and by Gross Motor Function Classification System (GMFCS) levels 1-3 and 4-5. Families in the intervention arm will receive tailored insight visual support strategies and telephone calls during the 6-week trial period. The control arm will receive standard treatment and the intervention after the 6-week trial period. Follow-up interviews will be performed in both arms at 6 weeks with a repeat administration of the PedsQL CP 4.0 and 3.0, the IQI and the SDQ. Secondary outcomes include a change in functional vision. DISCUSSION This randomized controlled trial will provide evidence of the effectiveness of this intervention for children with CP in a resource-poor setting. TRIAL REGISTRATION Pan African Clinical Trials Registration, PACTR201612001886396 . Registered on 3 December 2016.
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Affiliation(s)
- Roseline Duke
- London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, WC1E 7HT UK
- Calabar Childrens’ Eye Center, Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River State Nigeria
| | - Komomo Eyong
- Paediatric Neurology Unit, Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Cross River State Nigeria
| | | | - David MacLeod
- Calabar Childrens’ Eye Center, Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River State Nigeria
| | | | - Clare Gilbert
- London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, WC1E 7HT UK
| | - Richard Bowman
- London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, WC1E 7HT UK
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Mulwafu W, Tataryn M, Polack S, Viste A, Goplen FK, Kuper H. Children with hearing impairment in Malawi, a cohort study. Bull World Health Organ 2019; 97:654-662. [PMID: 31656330 PMCID: PMC6796677 DOI: 10.2471/blt.18.226241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the outcomes of children diagnosed with hearing impairment 3 years earlier in terms of referral uptake, treatment received and satisfaction with this treatment, and social participation. Methods We conducted a population-based longitudinal analysis of children with a hearing impairment in two rural districts of Malawi. Key informants within the community identified the cohort in 2013 (baseline). Informants clinically screened children at baseline, and by questionnaires at baseline and follow-up in 2016. We investigated associations between sociodemographic characteristics and outcomes by multivariate logistic regression. Results We diagnosed 752 children in 2013 as having a hearing impairment and traced 307 (40.8%) children of these for follow-up in 2016. Referral uptake was low (102/184; 55.4%), more likely among older children (odds ratio, OR: 3.5; 95% confidence interval, CI: 1.2–10.2) and less likely for those with an illiterate caregiver (OR: 0.5; 95% CI: 0.2–0.9). Few of the children who attended hospital received any treatment (33/102; 32.4%) and 63.6% (21/33) of caregivers reported satisfaction with treatment. Difficulty making friends and communicating needs was reported for 10.0% (30/299) and 35.6% (107/301) of the children, respectively. Lack of school enrolment was observed for 29.5% (72/244) of children, and was more likely for older children (OR: 28.6; 95% CI: 10.3–79.6), girls (OR: 2.4; 95% CI: 1.2–4.8) and those with an illiterate caregiver (OR: 2.1; 95% CI: 1.0–4.1). Conclusion More widespread and holistic services are required to improve the outcomes of children with a hearing impairment in Malawi.
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Affiliation(s)
- Wakisa Mulwafu
- Department of Surgery, College of Medicine, Private Bag 360, Blantyre, Malawi
| | - Myroslava Tataryn
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, England
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, England
| | - Asgaut Viste
- Department of Clinical Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, England
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20
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Bonouvrié LA, Becher JG, Vles JSH, Vermeulen RJ, Buizer AI. The Effect of Intrathecal Baclofen in Dyskinetic Cerebral Palsy: The IDYS Trial. Ann Neurol 2019; 86:79-90. [PMID: 31050023 PMCID: PMC6617761 DOI: 10.1002/ana.25498] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 01/04/2023]
Abstract
Objective Intrathecal baclofen treatment is used for the treatment of dystonia in patients with severe dyskinetic cerebral palsy; however, the current level of evidence for the effect is low. The primary aim of this study was to provide evidence for the effect of intrathecal baclofen treatment on individual goals in patients with severe dyskinetic cerebral palsy. Methods This multicenter, randomized, double‐blind, placebo‐controlled trial was performed at 2 university medical centers in the Netherlands. Patients with severe dyskinetic cerebral palsy (Gross Motor Functioning Classification System level IV–V) aged 4 to 24 years who were eligible for intrathecal baclofen were included. Patients were assigned by block randomization (2:2) for treatment with intrathecal baclofen or placebo for 3 months via an implanted microinfusion pump. The primary outcome was goal attainment scaling of individual treatment goals (GAS T score). A linear regression model was used for statistical analysis with study site as a covariate. Safety analyses were done for number and type of (serious) adverse events. Results Thirty‐six patients were recruited from January 1, 2013, to March 31, 2018. Data for final analysis were available for 17 patients in the intrathecal baclofen group and 16 in the placebo group. Mean (standard deviation) GAS T score at 3 months was 38.9 (13.2) for intrathecal baclofen and 21.0 (4.6) for placebo (regression coefficient = 17.8, 95% confidence interval = 10.4‐25.0, p < 0.001). Number and types of (serious) adverse events were similar between groups. Interpretation Intrathecal baclofen treatment is superior to placebo in achieving treatment goals in patients with severe dyskinetic cerebral palsy. ANN NEUROL 2019
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Affiliation(s)
- Laura A Bonouvrié
- Amsterdam University Medical Center, Free University Amsterdam, Department of Rehabilitation Medicine, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Jules G Becher
- Amsterdam University Medical Center, Free University Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Johan S H Vles
- Maastricht University Medical Center, Department of Child Neurology, Maastricht, the Netherlands
| | - R Jeroen Vermeulen
- Maastricht University Medical Center, Department of Child Neurology, Maastricht, the Netherlands.,Amsterdam University Medical Center, Free University Amsterdam, Department of Child Neurology, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Annemieke I Buizer
- Amsterdam University Medical Center, Free University Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Andrews C, Kakooza-Mwesige A, Eliasson AC, Forssberg H. Important report on cerebral palsy in Bangladesh: but different findings compared with other countries need further exploration. Dev Med Child Neurol 2019; 61:511-512. [PMID: 30828785 DOI: 10.1111/dmcn.14202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Carin Andrews
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | | | - Ann-Christin Eliasson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Hans Forssberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Stockholm, Sweden
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Khandaker G, Muhit M, Karim T, Smithers-Sheedy H, Novak I, Jones C, Badawi N. Epidemiology of cerebral palsy in Bangladesh: a population-based surveillance study. Dev Med Child Neurol 2019; 61:601-609. [PMID: 30394528 DOI: 10.1111/dmcn.14013] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2018] [Indexed: 12/11/2022]
Abstract
AIM To examine the prevalence, clinical characteristics, and risk factors of cerebral palsy (CP) in children in Bangladesh. METHOD The Bangladesh CP Register is an ongoing population-based surveillance database of children with CP from a geographically defined area in Bangladesh. Cases were defined based on Surveillance of CP in Europe and Australian CP Register criteria after clinical assessments and identification by the key informant's method. RESULTS In total, 726 children with CP were identified between January 2015 and December 2016. Mean age was 7 years 7 months (standard deviation [SD] 4y 6mo; range: 4.8mo-18y; median 7y 1.2mo; 61.8% male, 38.2% female). Mean age at CP diagnosis was 5 years 2 months (SD 3.8). Observed prevalence was 3.4 per 1000 children (95% confidence interval [CI]: 3.2-3.7), resulting in an estimated 233 514 children (95% CI: 219 778-254 118) with CP in Bangladesh. The majority (79.6%) had spastic CP. Altogether, 79.6% of the children with CP had at least one associated impairment (speech 67.6%, intellectual 39.0%, epilepsy 23.7%, visual 10.2%, and hearing 10.2%). In total, 78.2% never received rehabilitation. INTERPRETATION In Bangladesh, the burden of CP is high, and diagnosis is substantially delayed, limiting opportunities for early intervention. There is a lack of available services and the majority of the children had preventable risk factors. WHAT THIS PAPER ADDS Prevalence of cerebral palsy (CP) is 3.4 per 1000 children in rural Bangladesh. There are an estimated 233 514 children with CP in Bangladesh. The majority have potentially preventable risk factors. Diagnosis of CP is delayed, limiting opportunities for early intervention. There is a lack of available services for children with CP in rural Bangladesh.
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Affiliation(s)
- Gulam Khandaker
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Tasneem Karim
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Hayley Smithers-Sheedy
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Cerebral Palsy Alliance Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Cheryl Jones
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, New South Wales, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Cerebral Palsy Alliance Research Institute, University of Sydney, Sydney, New South Wales, Australia
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Developing Behaviour Change Interventions for Improving Access to Health and Hygiene for People with Disabilities: Two Case Studies from Nepal and Malawi. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122746. [PMID: 30563096 PMCID: PMC6313611 DOI: 10.3390/ijerph15122746] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/22/2018] [Accepted: 11/24/2018] [Indexed: 11/17/2022]
Abstract
Limited evidence exists about how to design interventions to improve access to health care for people with disabilities in low and middle-income countries (LMICs). This paper documents the development of two behaviour change interventions. Case study one outlines the design of an intervention to improve uptake of referral for ear and hearing services for children in Malawi. Case study two describes the design of an intervention to improve menstrual hygiene management for people with intellectual impairments in Nepal. Both followed existing approaches—Medical Research Council Guidance for developing and evaluating complex interventions and Behaviour Centred Design. The purpose is to demonstrate how these frameworks can be applied, to document the interventions developed, and encourage further initiatives to advance health services targeting people with disabilities. Important components of the intervention design process were: (1) systematic reviews and formative research ensure that interventions designed are relevant to current discourse, practice and context; (2) people with disabilities and their family/carers must be at the heart of the process; (3) applying the theory of change approach and testing it helps understand links between inputs and required behaviour change, as well as ensuring that the interventions are relevant to local contexts; (4) involving creative experts may lead to the development of more engaging and appealing interventions. Further evidence is needed on the effectiveness of these types of interventions for people with disabilities to ensure that no one is left behind.
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Jahan I, Muhit M, Karim T, Smithers-Sheedy H, Novak I, Jones C, Badawi N, Khandaker G. What makes children with cerebral palsy vulnerable to malnutrition? Findings from the Bangladesh cerebral palsy register (BCPR). Disabil Rehabil 2018; 41:2247-2254. [PMID: 29658318 DOI: 10.1080/09638288.2018.1461260] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: To assess the nutritional status and underlying risk factors for malnutrition among children with cerebral palsy in rural Bangladesh. Materials and methods: We used data from the Bangladesh Cerebral Palsy Register; a prospective population based surveillance of children with cerebral palsy aged 0-18 years in a rural subdistrict of Bangladesh (i.e., Shahjadpur). Socio-demographic, clinical and anthropometric measurements were collected using Bangladesh Cerebral Palsy Register record form. Z scores were calculated using World Health Organization Anthro and World Health Organization AnthroPlus software. Results: A total of 726 children with cerebral palsy were registered into the Bangladesh Cerebral Palsy Register (mean age 7.6 years, standard deviation 4.5, 38.1% female) between January 2015 and December 2016. More than two-third of children were underweight (70.0%) and stunted (73.1%). Mean z score for weight for age, height for age and weight for height were -2.8 (standard deviation 1.8), -3.1 (standard deviation 2.2) and -1.2 (standard deviation 2.3) respectively. Moderate to severe undernutrition (i.e., both underweight and stunting) were significantly associated with age, monthly family income, gross motor functional classification system and neurological type of cerebral palsy. Conclusions: The burden of undernutrition is high among children with cerebral palsy in rural Bangladesh which is augmented by both poverty and clinical severity. Enhancing clinical nutritional services for children with cerebral palsy should be a public health priority in Bangladesh. Implications for Rehabilitation Population-based surveillance data on nutritional status of children with cerebral palsy in Bangladesh indicates substantially high burden of malnutrition among children with CP in rural Bangladesh. Children with severe form of cerebral palsy, for example, higher Gross Motor Function Classification System (GMFCS) level, tri/quadriplegic cerebral palsy presents the highest proportion of severe malnutrition; hence, these vulnerable groups should be focused in designing nutrition intervention and rehabilitation programs. Disability inclusive and focused nutrition intervention programme need to be kept as priority in national nutrition policies and nutrition action plans specially in low- and middle-income countries. Community-based management of malnutrition has the potential to overcome this poor nutritional scenario of children with disability (i.e., cerebral palsy). The global leaders such as World Health Organization, national and international organizations should take this in account and conduct further research to develop nutritional guidelines for this vulnerable group of population.
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Affiliation(s)
- Israt Jahan
- a CSF Global , Dhaka , Bangladesh.,b Asian Institute of Disability and Development (AIDD) , University of South Asia , Dhaka , Bangladesh
| | - Mohammad Muhit
- a CSF Global , Dhaka , Bangladesh.,b Asian Institute of Disability and Development (AIDD) , University of South Asia , Dhaka , Bangladesh
| | - Tasneem Karim
- a CSF Global , Dhaka , Bangladesh.,b Asian Institute of Disability and Development (AIDD) , University of South Asia , Dhaka , Bangladesh
| | - Hayley Smithers-Sheedy
- c Cerebral Palsy Alliance Research Institute , University of Sydney , Sydney , Australia.,d Discipline of Child and Adolescent Health , Sydney Medical School, University of Sydney , Sydney , Australia
| | - Iona Novak
- c Cerebral Palsy Alliance Research Institute , University of Sydney , Sydney , Australia
| | - Cheryl Jones
- e Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI) , University of Sydney , Sydney , Australia.,f Department of Paediatrics , The University of Melbourne , Parkville , Australia
| | - Nadia Badawi
- c Cerebral Palsy Alliance Research Institute , University of Sydney , Sydney , Australia.,d Discipline of Child and Adolescent Health , Sydney Medical School, University of Sydney , Sydney , Australia
| | - Gulam Khandaker
- a CSF Global , Dhaka , Bangladesh.,b Asian Institute of Disability and Development (AIDD) , University of South Asia , Dhaka , Bangladesh.,d Discipline of Child and Adolescent Health , Sydney Medical School, University of Sydney , Sydney , Australia
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Tsai CF, Guo HR, Tseng YC, Lai DC. Sex and Geographic Differences in the Prevalence of Reported Childhood Motor Disability and Their Trends in Taiwan. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6754230. [PMID: 29850547 PMCID: PMC5907418 DOI: 10.1155/2018/6754230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/28/2018] [Indexed: 11/24/2022]
Abstract
Motor disability (MD) is not uncommon in children, but data at the national level are scarce. As the Taiwan government certifies and registers disabled residents for providing services on a routine basis, the registry provides a unique opportunity for studying MD. Using data from the registry, we calculated the prevalence of MD by age, sex, and geographic area and assessed the changes from 2004 to 2010. We excluded cases under 3 years old because the government discourages the certification at this age. We found that cases between 3 and 17 years old decreased from 8187 to 6022 per year from 2004 to 2010 and the prevalence generally decreased every year in all age groups. There were more boy cases than girl cases every year, and the prevalence rate ratios ranged from 1.26 to 1.39 (p < 0.05 in all years), with a decreasing trend over time (p < 0.01). Rural areas had higher prevalence in all the years, and the prevalence rate ratio decreased from 1.31 to 1.23 (p < 0.05 in all years), with a decreasing trend over time (p < 0.05). Further studies identifying the risk factors contributing to the decreases might help in the prevention of MD in the future.
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Affiliation(s)
- Cheng-Fang Tsai
- Department of Physical Medicine and Rehabilitation, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 539 Zhongxiao Road, Chiayi 600, Taiwan
- Graduate Institute of Clinical Medical Science, Chang Gung University, 259 Wenhua 1st Road, Taoyuan 333, Taiwan
| | - How-Ran Guo
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan 704, Taiwan
- Department of Environmental and Occupational Health, National Cheng Kung University, 138 Sheng-Li Road, Tainan 704, Taiwan
- Occupational Safety, Health and Medicine Research Center, National Cheng Kung University, 138 Sheng-Li Road, Tainan 704, Taiwan
| | - Yen-Cheng Tseng
- Language Education Center and Department of Tourism, Food and Beverage Management, Chang Jung Christian University, 1 Chang-Da Road, Tainan 711, Taiwan
| | - Der-Chung Lai
- Department of Physical Medicine and Rehabilitation, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 539 Zhongxiao Road, Chiayi 600, Taiwan
- Department of Senior Citizen Service Management, Chia Nan University of Pharmacy & Science, 60 Erren Road, Section 1, Tainan 717, Taiwan
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Muhit M, Karim T, Islam J, Hardianto D, Muhiddin HS, Purwanta SA, Suhardjo S, Widyandana D, Khandaker G. The epidemiology of childhood blindness and severe visual impairment in Indonesia. Br J Ophthalmol 2018; 102:1543-1549. [DOI: 10.1136/bjophthalmol-2017-311416] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 11/03/2022]
Abstract
BackgroundThe magnitude of blindness among children in Indonesia is unknown. In this study, we aimed to define the magnitude and aetiology of childhood blindness in two parts of Indonesia.MethodChildren aged 0–15 years, identified through key informant method and from special schools and community-based rehabilitation programme in Sumba and Yogyakarta, were assessed following WHO protocol and definitions for ophthalmological assessment and classification of visual impairment and blindness among children.ResultsOut of 195 children assessed, 113 had blindness/severe visual impairment (BL/SVI), 48 had visual impairment (VI) and 34 had no VI. 43.4% children with BL/SVI were female.The main anatomical site of BL/SVI was lens (n=35, 31.0%), followed by retina (n=13, 11.5%) and cornea (n=9, 8.0%). Among the known aetiologies, childhood factors predominated (n=14, 12.4%), followed by hereditary diseases (n=12, 10.6%) where parental consanguinity was found among 33.3% (n=4) of them. Overall, 77.8% (n=88) had avoidable causes of BL/SVI: 69.0% (n=78) treatable and 8.8% (n=10) preventable causes.The estimated prevalence of BL/SVI was 0.25 (95% CI 0.19 to 0.32) and 0.23 (95% CI 0.18 to 0.29) per 1000 children in Sumba and Yogyakarta, respectively. The estimated prevalence of cataract was 0.07 per 1000 children (95% CI 0.04 to 0.12) in Sumba and 0.05 per 1000 children (95% CI 0.03 to 0.09) in Yogyakarta. Based on our conservative estimates, there are 17 241 children with BL/SVI in Indonesia; 4270 are blind due to cataract.ConclusionThe magnitude of childhood BL/SVI in Sumba and Yogyakarta is high. Our study suggests that a large proportion of childhood BL/SVI in Indonesia is avoidable.
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Bright T, Mulwafu W, Thindwa R, Zuurmond M, Polack S. Reasons for low uptake of referrals to ear and hearing services for children in Malawi. PLoS One 2017; 12:e0188703. [PMID: 29261683 PMCID: PMC5736203 DOI: 10.1371/journal.pone.0188703] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Early detection and appropriate intervention for children with hearing impairment is important for maximizing functioning and quality of life. The lack of ear and hearing services in low income countries is a significant challenge, however, evidence suggests that even where such services are available, and children are referred to them, uptake is low. The aim of this study was to assess uptake of and barriers to referrals to ear and hearing services for children in Thyolo District, Malawi. METHODS This was a mixed methods study. A survey was conducted with 170 caregivers of children who were referred for ear and hearing services during community-based screening camps to assess whether they had attended their referral and reasons for non-attendance. Semi-structured interviews were conducted with 23 caregivers of children who did not take up their referral to explore in-depth the reasons for non-uptake. In addition, 15 stakeholders were interviewed. Thematic analysis of the interview data was conducted and emerging trends were analysed. RESULTS Referral uptake was very low with only 5 out of 150 (3%) children attending. Seven main interacting themes for non-uptake of referral were identified in the semi-structured interviews: location of the hospital, lack of transport, other indirect costs of seeking care, fear and uncertainty about the referral hospital, procedural problems within the camps, awareness and understanding of hearing loss, and lack of visibility and availability of services. CONCLUSION This study has highlighted a range of interacting challenges faced by families in accessing ear and hearing services in this setting. Understanding these context specific barriers to non-uptake of ear and hearing services is important for designing appropriate interventions to increase uptake.
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Affiliation(s)
- Tess Bright
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Wakisa Mulwafu
- Ear Nose and Throat Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Richard Thindwa
- Ear Nose and Throat Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Maria Zuurmond
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Polack
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Abstract
The World Health Organization estimates that 19 million children are visually impaired, among whom, 1.4 million are blind. Childhood blindness is an excellent indicator of the state of child health and primary care services in a country. Childhood blindness is important not just due to the number of children blind but also because the number of years that the surviving child has to live with blindness (blind years lived). Childhood blindness is next only to adult cataract in terms of the number of blind person years lived. Under-five mortality rates have been used as a proxy measure to compute the prevalence of childhood blindness in low and middle income countries due to limitations of other methods of data collection. In India, it is estimated that there are 0.8 blind for 1000 children. Whole globe lesions, corneal scarring, retinal pathology and afflictions of the lens are important anatomical sites in children. Causes operating in childhood and hereditary causes are important in etiology of childhood blindness. In 38.2%-68.4% cases across the region, a specific cause of blindness could not be identified in South Asia. The proportion of blindness that can be prevented or treated (avoidable) in children is less than 50%. Therefore a comprehensive eye care system needs to be in place to cater to the needs of children with avoidable and those with incurable blindness. Early detection and prompt management are critical for success of programs targeting avoidable blindness in children.
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Affiliation(s)
- Venkata S Murthy Gudlavalleti
- Indian Institute of Public Health, Hyderabad, India. .,International Centre for Eye Health, Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E7HT, UK. .,, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, 500033, India.
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29
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Tataryn M, Polack S, Chokotho L, Mulwafu W, Kayange P, Banks LM, Noe C, Lavy C, Kuper H. Childhood disability in Malawi: a population based assessment using the key informant method. BMC Pediatr 2017; 17:198. [PMID: 29179740 PMCID: PMC5704595 DOI: 10.1186/s12887-017-0948-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Epidemiological data on childhood disability are lacking in Low and Middle Income countries (LMICs) such as Malawi, hampering effective service planning and advocacy. The Key Informant Method (KIM) is an innovative, cost-effective method for generating population data on the prevalence and causes of impairment in children. The aim of this study was to use the Key Informant Method to estimate the prevalence of moderate/severe, hearing, vision and physical impairments, intellectual impairments and epilepsy in children in two districts in Malawi and to estimate the associated need for rehabilitation and other services. Methods Five hundred key informants (KIs) were trained to identify children in their communities who may have the impairment types included in this study. Identified children were invited to attend a screening camp where they underwent assessment by medical professionals for moderate/severe hearing, vision and physical impairments, intellectual impairments and epilepsy. Results Approximately 15,000 children were identified by KIs as potentially having an impairment of whom 7220 (48%) attended a screening camp. The estimated prevalence of impairments/epilepsy was 17.3/1000 children (95% CI: 16.9–17.7). Physical impairment (39%) was the commonest impairment type followed by hearing impairment (27%), intellectual impairment (26%), epilepsy (22%) and vision impairment (4%). Approximately 2100 children per million population could benefit from physiotherapy and occupational therapy and 300 per million are in need of a wheelchair. An estimated 1800 children per million population have hearing impairment caused by conditions that could be prevented or treated through basic primary ear care. Corneal opacity was the leading cause of vision impairment. Only 50% of children with suspected epilepsy were receiving medication. The majority (73%) of children were attending school, but attendance varied by impairment type and was lowest among children with multiple impairments (38%). Conclusion Using the KIM this study identified more than 2500 children with impairments in two districts of Malawi. As well as providing data on child disability, rehabilitation and referral service needs which can be used to plan and advocate for appropriate services and interventions, this method study also has an important capacity building and disability awareness raising component.
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Affiliation(s)
- Myroslava Tataryn
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK.
| | | | - Wakisa Mulwafu
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Petros Kayange
- Department of Surgery, Opthalmology Unit, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
| | | | - Chris Lavy
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Science, Oxford University, Oxford, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
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The Prevalence of Hearing Impairment by Age and Gender in a Population-based Study. IRANIAN JOURNAL OF PUBLIC HEALTH 2017; 46:1237-1246. [PMID: 29026790 PMCID: PMC5632326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study aimed to determine the prevalence of hearing impairment (HI) by age and gender in a population aged 5 yr and older residing in Tehran, Iran. METHODS In this cross-sectional study, 140 clusters each including 10 households from Tehran, Iran were sampled between 2012 and 2013 using cluster random sampling. Trained audiologists examined the participants during face-to-face interviews. The hearing of the participants was evaluated before the removal of wax or other foreign bodies. In this study, HI was categorized as mild (grade 1, 26-40 db), moderate (grade 2, 41-60 db), severe (grade 3, 61-80 db), and deaf (grade 5, 81 db or more). All participants signed informed consent forms. The SATA software was used for data analysis. RESULTS Of 6521 individuals, 4370 (67%) were interviewed. The prevalence of HI (auditory threshold of 0.5, 1, 2, 4 KHz and more than 25 db in the better ear) was 14.27 (11.53-17.91) of whom 9.52 (7.07-11.98) had grade 1, 4.04 (3.02-5.06) had grade 2, 0.67 (0.33-1.02) had grade 3 HI and 0.48 (0.16-0.8) were deaf. About 5.19% of the participants had disabling hearing impairment. All HI grades increased significantly with age but no significant difference was observed between men and women. CONCLUSION The considerable prevalence of HI in Iran in comparison with other developing countries, with regards to the trend of aging in the population, seems concerning. The results of the study could be used as a treatment and research guideline for future works in the area of policymaking and plan to decrease these disorders.
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Solebo AL, Teoh L, Rahi J. Epidemiology of blindness in children. Arch Dis Child 2017; 102:853-857. [PMID: 28465303 DOI: 10.1136/archdischild-2016-310532] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 01/25/2023]
Abstract
An estimated 1.4 million of the world's children are blind. A blind child is more likely to live in socioeconomic deprivation, to be more frequently hospitalised during childhood and to die in childhood than a child not living with blindness. This update of a previous review on childhood visual impairment focuses on emerging therapies for children with severe visual disability (severe visual impairment and blindness or SVI/BL).For children in higher income countries, cerebral visual impairment and optic nerve anomalies remain the most common causes of SVI/BL, while retinopathy of prematurity (ROP) and cataract are now the most common avoidable causes. The constellation of causes of childhood blindness in lower income settings is shifting from infective and nutritional corneal opacities and congenital anomalies to more resemble the patterns seen in higher income settings. Improvements in maternal and neonatal health and investment in and maintenance of national ophthalmic care infrastructure are the key to reducing the burden of avoidable blindness. New therapeutic targets are emerging for childhood visual disorders, although the safety and efficacy of novel therapies for diseases such as ROP or retinal dystrophies are not yet clear. Population-based epidemiological research, particularly on cerebral visual impairment and optic nerve hypoplasia, is needed in order to improve understanding of risk factors and to inform and support the development of novel therapies for disorders currently considered 'untreatable'.
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Affiliation(s)
- Ameenat Lola Solebo
- Lifecourse Epidemiology and Biostatistics Section, Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK.,Great Ormond Street Hospital/Institute of Child Heath, NIHR Biomedical Research Centre, London, UK.,Visual function and integrative epidemiology, Moorfields Eye Hospital and Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK.,Ulverscroft Vision Research Group, London, UK
| | - Lucinda Teoh
- Lifecourse Epidemiology and Biostatistics Section, Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK
| | - Jugnoo Rahi
- Lifecourse Epidemiology and Biostatistics Section, Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK.,Ulverscroft Vision Research Group, London, UK.,Great Ormond Street Hospital/Institute of Child Heath, NIHR Biomedical Research Centre, London, UK.,Visual function and integrative epidemiology, Moorfields Eye Hospital and Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK
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du Toit R, Courtright P, Lewallen S. The Use of Key Informant Method for Identifying Children with Blindness and Severe Visual Impairment in Developing Countries. Ophthalmic Epidemiol 2017; 24:153-167. [PMID: 28287870 DOI: 10.1080/09286586.2016.1259637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE An estimated 19 million children are visually impaired; of these, 1.4 million are irreversibly blind. A key challenge is to identify them early in life to benefit maximally from visual rehabilitation, and/or treatment. This aggregative review and structured literature analysis summarizes evidence of what it is about the key informant (KI) approach that works to identify children with blindness or severe visual impairment (B/SVI) in the community (for whom, to what extent, in what circumstances, in what respect, how and why). METHODS Peer-reviewed (PubMed, hand search) and grey literature (Google, World Health Organization website, academic theses, direct requests) were included, and methods and criteria used for identification, productivity (number of children referred per KI), accuracy of referrals (positive predictive value, PPV), age of children with B/SVI, KI definition, sex, information about cost and comparisons aggregated. RESULTS We included 31 documents describing 22 unique KI programs. Mostly KIs identified children with B/SVI in 1-3 weeks, i.e. "campaign mode." In 60%, KIs were community volunteers, others formal health sector workers (FHSW). Around 0.02-1.56 children per KI (median = 0.25) were successfully recruited. PPV ranged from 12 to 66%. In two studies comparing FHSWs and community KIs, the latter were 8 and 10 times more productive. CONCLUSION KIs working in campaign mode may provide an effective approach to identifying children with B/SVI in communities. Including identification of ocular problems and/or other impairments has been recommended. Research on factors that influence effectiveness and on whether KIs continue to contribute could inform programs.
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Affiliation(s)
| | - Paul Courtright
- b Kilimanjaro Centre for Community Ophthalmology , UCT Division of Ophthalmology, Groote Schuur Hospital , Cape Town , South Africa
| | - Susan Lewallen
- b Kilimanjaro Centre for Community Ophthalmology , UCT Division of Ophthalmology, Groote Schuur Hospital , Cape Town , South Africa
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Aghaji AE, Bowman R, Ofoegbu VC, Smith A. Dual sensory impairment in special schools in South-Eastern Nigeria. Arch Dis Child 2017; 102:174-177. [PMID: 28100557 DOI: 10.1136/archdischild-2016-311285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 12/04/2016] [Accepted: 12/10/2016] [Indexed: 11/03/2022]
Abstract
In a cross-sectional study to determine the magnitude of dual sensory impairment (DSI-combined hearing and vision loss) in children in single-disability special education schools, children in schools for the blind and schools for the deaf in four states in South-East Nigeria were examined by an ophthalmologist and otorhinolaryngologist to determine the level of their disability and to identify other disabilities if any. Participants were all students with childhood blindness or childhood deafness. The magnitude and causes of DSI and the burden of undetected DSI were the main outcome measures. A total of 273 students were examined. About 7% of these students had DSI out of which over 60% (12/19) was previously undetected. There was more DSI in the blind schools than in the deaf schools (p=0.003). There is a large burden of undetected DSI in children in special schools in Nigeria. There is a need to create awareness of this problem and advocate appropriate screening, rehabilitative and educational strategies for children who have it.
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Affiliation(s)
- Ada E Aghaji
- Department of Ophthalmology, University of Nigeria, Enugu, Nigeria
| | - Richard Bowman
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Vincent C Ofoegbu
- Department of Otorhinolaryngology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Andrew Smith
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Quevedo ALAD, Leotti VB, Goulart BNGD. Análise da prevalência de perda auditiva autodeclarada e fatores associados: informante primário versus proxy. CAD SAUDE PUBLICA 2017; 33:e0076216. [DOI: 10.1590/0102-311x00076216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/28/2016] [Indexed: 11/21/2022] Open
Abstract
O objetivo foi avaliar diferenças entre as prevalências de perda auditiva autodeclarada e fatores associados, obtidas nas respostas de informantes primário e proxy no Estudo de Distúrbios da Comunicação Humana de Base Populacional (DCH-POP). Trata-se de um estudo de métodos em epidemiologia, utilizando dados de um inquérito domiciliar do tipo transversal, com uma amostra de 1.253 indivíduos do Sul do Brasil. Para verificar diferenças de prevalências entre informantes primários e informante proxy foram utilizados os testes qui-quadrado ou exato de Fisher para variáveis categóricas, e Mann-Whitney para as contínuas. Ainda, o modelo log-binomial foi ajustado para a variável dependente perda auditiva considerando-se três conjuntos de dados: toda a amostra, apenas informantes primários e apenas informantes proxy, estimando-se as associações por meio da razão de prevalências. Nos modelos finais, apenas as variáveis independentes idade e tontura estiveram associadas com o desfecho de perda auditiva independentemente do conjunto de dados utilizado. Em geral, informantes proxy subestimaram as prevalências dos desfechos estudados em relação aos informantes primários.
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Malnutrition and Childhood Disability in Turkana, Kenya: Results from a Case-Control Study. PLoS One 2015; 10:e0144926. [PMID: 26689213 PMCID: PMC4686999 DOI: 10.1371/journal.pone.0144926] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 11/26/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Children with disabilities may be particularly vulnerable to malnutrition, as a result of exclusions and feeding difficulties. However, there is limited evidence currently available on this subject. METHODS A population-based case-control study was conducted in Turkana County, Kenya, between July and August 2013. Key informants in the community identified children aged 6 months to 10 years who they believed may have a disability. These children were screened by a questionnaire (UNICEF-Washington Group) and assessed by a paediatrician to confirm whether they had a disability and the type. Two controls without disabilities were selected per case: A sibling control (sibling nearest in age) and a neighbourhood control (nearest neighbour within one year of age). The caregiver completed a questionnaire on behalf of the child (e.g. information on feeding, poverty, illness, education), and anthropometric measures were taken. We undertook multivariable logistic and linear regression analyses to estimate the relationship between disability and malnutrition. RESULTS The study included 311 cases with disabilities, 196 sibling controls and 300 neighbour controls. Children with disabilities were more likely to report a range of feeding difficulties. They were 1.6-2.9 times more likely to have malnutrition in comparison to neighbour controls or family controls, including general malnutrition (low weight for age), stunting (low height for age), low body mass index (BMI) or low mid upper arm circumference (MUAC) for age. Children with disabilities were almost twice as likely to have wasting (low weight for height) in comparison to neighbour controls (OR = 1.9, 95% CI 1.1-3.2), but this difference was not apparent compared with siblings (OR = 1.5, 95% CI 0.8-2.7). Children with disabilities also faced other exclusions. For instance those aged 5+ were much more likely not to attend school than neighbour controls (OR = 8.5, 95% CI 4.3-16.9). CONCLUSIONS Children with disabilities were particularly vulnerable to malnutrition, even within this area of food insecurity and widespread malnutrition. Efforts need to be made to include children with disabilities within food supplementation programmes, and school based programmes alone may be inadequate to meet this need. Exclusion of children with disabilities from education is also a priority area to be addressed.
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Khandaker G, Smithers-Sheedy H, Islam J, Alam M, Jung J, Novak I, Booy R, Jones C, Badawi N, Muhit M. Bangladesh Cerebral Palsy Register (BCPR): a pilot study to develop a national cerebral palsy (CP) register with surveillance of children for CP. BMC Neurol 2015; 15:173. [PMID: 26407723 PMCID: PMC4582618 DOI: 10.1186/s12883-015-0427-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/11/2015] [Indexed: 11/29/2022] Open
Abstract
Background The causes and pathogenesis of cerebral palsy (CP) are all poorly understood, particularly in low- and middle-income countries (LMIC). There are gaps in knowledge about CP in Bangladesh, especially in the spheres of epidemiological research, intervention and service utilization. In high-income countries CP registers have made substantial contributions to our understanding of CP. In this paper, we describe a pilot study protocol to develop, implement, and evaluate a CP population register in Bangladesh (i.e., Bangladesh Cerebral Palsy Register - BCPR) to facilitate studies on prevalence, severity, aetiology, associated impairments and risk factors for CP. Methods/Design The BCPR will utilise a modified version of the Australian Cerebral Palsy Register (ACPR) on a secured web-based platform hosted by the Cerebral Palsy Alliance Research Institute, Australia. A standard BCPR record form (i.e., data collection form) has been developed in consultation with local and international experts. Using this form, the BPCR will capture information about maternal health, birth history and the nature of disability in all children with CP aged <18 years. The pilot will be conducted in the Shahjadpur sub-district of Sirajgonj district in the northern part of Bangladesh. There are 296 villages in Shahjadpur, a total population of 561,076 (child population ~ 226,114), an estimated 70,998 households and 12,117 live births per annum. Children with CP will be identified by using the community based Key Informants Method (KIM). Data from the completed BPCR record together with details of assessment by a research physician will be entered into an online data repository. Discussion Once implemented, BCPR will be, to the best of our knowledge, the first formalised CP register from a LMIC. Establishment of the BCPR will enable estimates of prevalence; facilitate clinical surveillance and promote research to improve the care of individuals with CP in Bangladesh.
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Affiliation(s)
- Gulam Khandaker
- The Children's Hospital at Westmead (Clinical School), The University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia.
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Westmead, Australia.
| | - Johurul Islam
- Child Sight Foundation (CSF), House 9, Flat A1& B3, Road 2/1, Banani, Dhaka, 1213, Bangladesh.
| | - Monzurul Alam
- Child Sight Foundation (CSF), House 9, Flat A1& B3, Road 2/1, Banani, Dhaka, 1213, Bangladesh.
| | - Jenny Jung
- School of Public Health, Sydney Medical School, The University of Sydney, Westmead, Australia.
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Westmead, Australia.
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance (NCIRS) and The University of Sydney, Westmead, Australia.
| | - Cheryl Jones
- The Children's Hospital at Westmead and the Marie Bashir Institute, University of Sydney, Westmead, Australia.
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute and the Children's Hospital at Westmead, Westmead, Australia.
| | - Mohammad Muhit
- Child Sight Foundation (CSF) and University of South Asia, House 9, Flat A1& B3, Road 2/1, Banani, Dhaka, 1213, Bangladesh.
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