1
|
Swai EA, Moshi HI, Msuya SE, Lindkvist M, Sörlin A, Sahlen KG. Adaptive adjustment to the needs of families caring for children and adolescents with physical disabilities in north-eastern Tanzania: a grounded-theory study. Glob Health Action 2024; 17:2354009. [PMID: 38832537 PMCID: PMC11151795 DOI: 10.1080/16549716.2024.2354009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 05/08/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Family interactions, which are always multi-faceted, are complicated further by family members with disabilities. In resource-poor settings, policies and programmes that address the needs of and challenges faced by families are often inaccessible or unavailable. Approximately 13% of the families in Tanzania have at least one member with a disability, yet family-centred research on caring for disabled children and adolescents is scarce in this context. OBJECTIVE The aim is to explore the needs and challenges faced by families that care for children and adolescents with physical disabilities in the Kilimanjaro Region of north-eastern Tanzania. METHODS This qualitative study had a constructivist grounded-theory design. In-depth interviews, using a semi-structured interview guide based on the social-capital framework, were conducted with 12 female participants aged between 24 and 80. A conceptual model of family needs, inspired by Maslow's hierarchy of needs, informed the analysis. RESULTS Challenging needs were grouped into five categories, which were linked to Maslow's hierarchy of needs and related to the central concept of 'adaptive adjustment': (1) 'barely surviving'; (2) 'safety needs in jeopardy'; (3) 'sociocultural protection'; (4) 'self-esteem far beyond reach', and (5) 'dreaming of self-actualisation'. CONCLUSION Families caring for children and adolescents with physical disabilities in north-eastern Tanzania have needs that extend beyond the available and accessible resources. Families can adjust and adapt by avoiding certain situations, accepting the reality of their circumstances and exploring alternative ways of coping. A sustainable support system, including social networks, is essential for meeting basic needs and ensuring safety.
Collapse
Affiliation(s)
- Elia Asanterabi Swai
- Department of Physiotherapy, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Haleluya Imanueli Moshi
- Department of Physiotherapy, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Sia Emmanueli Msuya
- Community Health Department, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Community Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Ann Sörlin
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Klas Göran Sahlen
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| |
Collapse
|
2
|
Chandy BR, Davey C, Oswald WE, Kaliappan SP, Aruldas K, Banks LM, Jasper S, Nagarajan G, Galagan S, Kennedy DS, Walson JL, Koshy B, Ajjampur SSR, Kuper H. Prevalence of Functional Difficulty Among School-Aged Children and Effect on School Enrolment in Rural Southern India: A Cross-Sectional Analysis. J Epidemiol Glob Health 2024:10.1007/s44197-024-00293-7. [PMID: 39298111 DOI: 10.1007/s44197-024-00293-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 08/22/2024] [Indexed: 09/21/2024] Open
Abstract
Despite the large number of children in India, there is little information on the impact of children's disability on school enrolment, and how this differs by population. We estimated the prevalence of childhood disability in two sites in Tamil Nadu, southern India, and the effect of functional difficulty on school enrolment. We used a parent-reported survey containing the UNICEF-Washington Group questions to identify children aged 5 to 17 years with functional difficulty during a census conducted for an ongoing trial. We estimated pooled- and gender-specific prevalence of functional difficulty among 29,044 children. We fitted regression models to identify subgroups with higher rates of functional difficulty and the effect of functional difficulty on reported school enrolment. We estimated the modification of the effect of functional difficulty by age, gender, socioeconomic status, household education, and sub-site, on additive and multiplicative scales. We found of 29,044 children, 299 (1.0%) had any functional difficulty, equal among boys and girls. Being understood (0.5%) and walking (0.4%) were the most common difficulties. Functional difficulty was strongly associated with non-enrolment in school (Prevalence ratio [PR] 4.59, 95% CI: 3.87, 5.43) after adjusting for age, gender, and site. We show scale-dependent differences between age and socioeconomic groups in the effect of functional difficulty on enrolment. This study shows that at least one in a hundred children in this region have severe functional difficulties and nearly half of these children are not enrolled in school, highlighting the need for further efforts and evidence-based interventions to increase school enrolment among these groups.
Collapse
Affiliation(s)
- Bobeena Rachel Chandy
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, TN, India
| | | | - William E Oswald
- Global Health Division, International Development Group, RTI International, Research Triangle Park, NC, USA
| | | | - Kumudha Aruldas
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, TN, India
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Smitha Jasper
- Department of Ophthalmology, Christian Medical College, Vellore, TN, India
| | - Guru Nagarajan
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, TN, India
| | - Sean Galagan
- Departments of Global Health, Medicine, Pediatrics and Epidemiology, University of Washington, Seattle, USA
| | - David S Kennedy
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Judd L Walson
- Departments of Global Health, Medicine, Pediatrics and Epidemiology, University of Washington, Seattle, USA
| | - Beena Koshy
- Department of Developmental Paediatrics, Christian Medical College, Vellore, TN, India
| | - Sitara S R Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, TN, India
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
3
|
Witek-McManus S, Simwanza J, Msiska R, Mangawah H, Oswald W, Timothy J, Galagan S, Pearman E, Shaikh M, Legge H, Walson J, Juziwelo L, Davey C, Pullan R, Bailey RL, Kalua K, Kuper H. Disability in childhood and the equity of health services: a cross-sectional comparison of mass drug administration strategies for soil-transmitted helminths in southern Malawi. BMJ Open 2024; 14:e083321. [PMID: 39242171 PMCID: PMC11381638 DOI: 10.1136/bmjopen-2023-083321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND School-based approaches are an efficient mechanism for the delivery of basic health services, but may result in the exclusion of children with disabilities if they are less likely to participate in schooling. Community-based 'door to door' approaches may provide a more equitable strategy to ensure that children with disabilities are reached, but disability is rarely assessed rigorously in the evaluation of health interventions. OBJECTIVES To describe the prevalence and factors associated with disability among children aged 5-17 years and to assess the relative effectiveness of routine school-based deworming (SBD) compared with a novel intervention of community-based deworming (CBD) in treating children with disabilities for soil-transmitted helminths. SETTING DeWorm3 Malawi Site (DMS), Mangochi district, Malawi. PARTICIPANTS All 44 574 children aged 5-17 years residing within the DMS. PRIMARY AND SECONDARY OUTCOME MEASURES Disability was defined as a functional limitation in one or more domains of the Washington Group/UNICEF Child Functioning Module administered as part of a community-based census. Treatment of all children during SBD and CBD was independently observed and recorded. For both intervention types, we performed bivariate analyses (z-score) of the absolute proportion of children with and without disabilities treated (absolute differences (ADs) in receipt of treatment), and logistic regression to examine whether disability status was associated with the likelihood of treatment (relative differences in receipt of treatment). RESULTS The overall prevalence of disability was 3.3% (n=1467), and the most common domains of disability were hearing, remembering and communication. Boys were consistently more likely to have a disability compared with girls at all age groups, and disability was strongly associated with lower school attendance and worse levels of education. There was no significant difference in the proportion of children with disabilities treated during SBD when assessed by direct observation (-1% AD, p=0.41) or likelihood of treatment (adjusted risk ratio (aRR)=1.07, 95% CI 0.89 to 1.28). Treatment of all children during CBD was substantially higher than SBD, but again showed no significant difference in the proportions treated (-0.5% AD, p=0.59) or likelihood of treatment (aRR=1.04, 95% CI 0.99 to 1.10). CONCLUSION SBD does not appear to exclude children with disabilities, but the effect of consistently lower levels of educational participation of children with disabilities should be actively considered in the design and monitoring of school health interventions. TRIAL REGISTRATION NUMBER NCT03014167.
Collapse
Affiliation(s)
- Stefan Witek-McManus
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - James Simwanza
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | - Rejoice Msiska
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | | | - William Oswald
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph Timothy
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Sean Galagan
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Emily Pearman
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Mariyam Shaikh
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Hugo Legge
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Judd Walson
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Lazarus Juziwelo
- National Schistosomiasis and STH Control Programme, Community Health Sciences Unit, Ministry of Health & Population, Lilongwe, Malawi
| | - Calum Davey
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rachel Pullan
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Robin L Bailey
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Hannah Kuper
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
4
|
Olusanya BO, Wright SM, Smythe T, Khetani MA, Moreno-Angarita M, Gulati S, Brinkman SA, Almasri NA, Figueiredo M, Giudici LB, Olorunmoteni O, Lynch P, Berman B, Williams AN, Olusanya JO, Wertlieb D, Davis AC, Hadders-Algra M, Gladstone MJ. Early childhood development strategy for the world's children with disabilities. Front Public Health 2024; 12:1390107. [PMID: 38962774 PMCID: PMC11220280 DOI: 10.3389/fpubh.2024.1390107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/28/2024] [Indexed: 07/05/2024] Open
Abstract
Early childhood is foundational for optimal and inclusive lifelong learning, health and well-being. Young children with disabilities face substantial risks of sub-optimal early childhood development (ECD), requiring targeted support to ensure equitable access to lifelong learning opportunities, especially in low- and middle-income countries. Although the Sustainable Development Goals, 2015-2030 (SDGs) emphasise inclusive education for children under 5 years with disabilities, there is no global strategy for achieving this goal since the launch of the SDGs. This paper explores a global ECD framework for children with disabilities based on a review of national ECD programmes from different world regions and relevant global ECD reports published since 2015. Available evidence suggests that any ECD strategy for young children with disabilities should consists of a twin-track approach, strong legislative support, guidelines for early intervention, family involvement, designated coordinating agencies, performance indicators, workforce recruitment and training, as well as explicit funding mechanisms and monitoring systems. This approach reinforces parental rights and liberty to choose appropriate support pathway for their children. We conclude that without a global disability-focussed ECD strategy that incorporates these key features under a dedicated global leadership, the SDGs vision and commitment for the world's children with disabilities are unlikely to be realised.
Collapse
Affiliation(s)
| | - Scott M. Wright
- Johns Hopkins Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Tracey Smythe
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Mary A. Khetani
- Department of Occupational Therapy, College of Applied Health Sciences of Illinois Chicago, Chicago, IL, United States
| | | | | | - Sally A. Brinkman
- Fraser Mustard Centre, Telethon Kids Institute, School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Nihad A. Almasri
- School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Marta Figueiredo
- European Network of Occupational Therapy in Higher Education, Escola Superior de Saúde do Alcoitão, Alcabideche, Portugal
| | - Lidia B. Giudici
- Latín American Association for Neonatal and Pediatric Follow-Up (ALSEPNEO), Buenos Aires, Argentina
| | | | - Paul Lynch
- School of Education, University of Glasgow, Glasgow, United Kingdom
| | - Brad Berman
- Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Andrew N. Williams
- Virtual Academic Unit, Children’s Directorate, Northampton General Hospital, Northampton, United Kingdom
| | | | - Donald Wertlieb
- Eliot-Pearson Department of Child Development, Tufts University, Medford, MA, United States
| | | | - Mijna Hadders-Algra
- University Medical Centre Groningen, Department of Pediatrics, Division of Developmental Neurology, and Faculty of Theology and Religious Studies, University of Groningen, Groningen, Netherlands
| | - Melissa J. Gladstone
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
5
|
Adugna MB, Ghahari S, Lysaght R. Disability stigma and the pursuit of inclusion among children with physical disabilities in northwest Ethiopia. Disabil Rehabil 2024:1-11. [PMID: 38832395 DOI: 10.1080/09638288.2024.2356016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/12/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE Globally, many children with physical disabilities (CwPDs) are excluded from their education and social life, mainly due to stigma and its effects. However, information on disability stigma is scarce in low-and middle-income countries like Ethiopia. The purpose of this study, therefore, was to explore the lived experience of stigma from the perspective of CwPDs and their caregivers in northwest Ethiopia. METHODS The study incorporated a constructivist grounded theory approach. Data were gathered through observations, in-depth interviews, and key informant interviews. Inductive and iterative grounded theory techniques were used to code and categorize data through constant comparison. FINDINGS The study showed that CwPDs are bullied and talked about, subject to pity, socially excluded, and held in contempt at home, in their neighborhood, and at school. They live in fear and uncertainty and struggle with stigma. These factors affect their emotions, social relationships, and educational activities. CONCLUSIONS This study makes theoretical and practical contributions to understanding and addressing disability stigma and can help to introduce inclusive education policy, school practice, and disability advocacy. The study results highlight the need for disability awareness-raising programs, interventions for empowerment, and informing disability policy and practice.
Collapse
Affiliation(s)
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Rosemary Lysaght
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| |
Collapse
|
6
|
Chandy BR, Davey C, Oswald WE, Kaliappan SP, Aruldas K, Banks LM, Jasper S, Nagarajan G, Galagan S, Kennedy DS, Walson JL, Koshy B, Ajjampur SS, Kuper H. Prevalence of functional difficulty among school-aged children and effect on school enrolment in rural southern India: A cross-sectional analysis. RESEARCH SQUARE 2024:rs.3.rs-4154190. [PMID: 38746354 PMCID: PMC11092848 DOI: 10.21203/rs.3.rs-4154190/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Despite the large number of children in India, there is little information on the impact of children's disability on school enrolment, and how this differs by population. We estimated the prevalence of childhood disability in two sites in Tamil Nadu, southern India, and the effect of functional difficulty on school enrolment. We used a parent-reported survey containing the UNICEF-Washington Group questions to identify children aged 5 to 17 years with functional difficulty during a census conducted for an ongoing trial. We estimated pooled- and gender-specific prevalence of functional difficulty among 29,044 children. We fitted regression models to identify subgroups with higher rates of functional difficulty and the effect of functional difficulty on reported school enrolment. We estimated the modification of the effect of functional difficulty by age, gender, socioeconomic status, household education, and sub-site, on additive and multiplicative scales. We found of 29,044 children, 299 (1.0%) had any functional difficulty, equal among boys and girls. Being understood (0.5%) and walking (0.4%) were the most common difficulties. Functional difficulty was strongly associated with non-enrolment in school (Prevalence ratio [PR] 4.59, 95% CI: 3.87, 5.43) after adjusting for age, gender, and site. We show scale-dependent differences between age and socioeconomic groups in the effect of functional difficulty on enrolment. This study shows that at least one in a hundred children in this region have severe functional difficulties and nearly half of these children are not enrolled in school, highlighting the need for further efforts and evidence-based interventions to increase school enrolment among these groups.
Collapse
|
7
|
Mestre TD, Lopes MJ, Mestre DM, Ferreira RF, Costa AP, Caldeira EV. Impact of family-centered care in families with children with intellectual disability: A systematic review. Heliyon 2024; 10:e28241. [PMID: 38560242 PMCID: PMC10981057 DOI: 10.1016/j.heliyon.2024.e28241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
Background Family-Centered Care (FCC) is an approach to healthcare planning, delivery and evaluation, based on beneficial partnerships between health professionals, patients and families. FCC may be particularly relevant for families with children with intellectual disability (ID), given their needs of continuum care. Objective To identify which components of the FCC are practiced and which health outcomes are considered effective in families with children with ID. Method A systematic review guided by the PRISMA STATEMENT 2020 approach and the STROBE reporting guidelines was performed on specific databases through the EBSCOhost Web platform: MEDLINE with Full Text, CINAHL PLUS with Full Text, Academic Search Complete and Psychology and Behavioral Sciences Collection. Peer-reviewed articles published in English or Portuguese languages from 2018 to September 2023 were retrieved. Methodological quality was established using the Quality Assessment Tool for Observational, Cohort and Cross-Sectional Studies - NHLBI, NIH. Results Ten studies met the eligibility criteria and were synthetized. The results revealed nine components, reflecting the way FCC was developed: shared decision-making; family education; respect for culture; family engagement; recognition of the family's needs, characteristics and interests; specialized care support; social and emotional support; family functionality; and family seen as a unit. The health outcomes demonstrate effective gains in improving children's health through family satisfaction with health services. Also achieved psychological and social benefits, with improved family well-being and quality of life, favoring family empowerment. Conclusions The evidence suggests that FCC components involves an effective partnership between the family and health professionals as the main key in developing care plans, as well as the experience that the family unit brings to the delivery of care. FCC approach include all family members as decision-makers, providing emotional, physical and instrumental levels of support. Health outcomes emerged in three strands; for children with ID, families and health services.
Collapse
Affiliation(s)
- Teresa Dionísio Mestre
- Comprehensive Health Research Centre [CHRC], Portugal
- Polytechnic Institute of Beja – Health Department, Portugal
| | - Manuel José Lopes
- Comprehensive Health Research Centre [CHRC], Portugal
- University of Évora – Health Department, Portugal
| | | | - Rogério Ferrinho Ferreira
- Comprehensive Health Research Centre [CHRC], Portugal
- Polytechnic Institute of Beja – Health Department, Portugal
| | - Ana Pedro Costa
- Comprehensive Health Research Centre [CHRC], Portugal
- Local Health Unit of Lower Alentejo [ULSBA], Beja, Portugal
| | | |
Collapse
|
8
|
Metwally AM, Aboulghate A, Elshaarawy GA, Abdallah AM, Abdel Raouf ER, El-Din EMS, Khadr Z, El-Saied MM, Elabd MA, Nassar MS, Abouelnaga MW, Ashaat EA, El-Sonbaty MM, Badawy HY, Dewdar EM, Salama SI, Abdelrahman M, Abdelmohsen AM, Eldeeb SE, Naga MM, Elshamy NH, Shaaban FA, ElRifay AS. Prevalence and risk factors of disabilities among Egyptian preschool children: a community-based population study. BMC Psychiatry 2023; 23:689. [PMID: 37735643 PMCID: PMC10514965 DOI: 10.1186/s12888-023-05171-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Child disability has significant implications on their well-being and healthcare systems. AIM This survey aimed to assess the magnitude of seven types of disability among Egyptian children aged 1 < 6 years and their socio-demographic, epidemiological, and perinatal predictors. METHODS A national population-based cross-sectional household survey targeting 21,316 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for identifying seven disability categories. RESULTS The percentage of children with at least one disability was 8.1% as follows: speech/communication (4.4%), Mobility/physical (2.5%), Seizures (2.2%), Comprehension (1.7%), Intellectual impairment (1.4%), Visual (0.3%) and Hearing (0.2%). Age was not found to affect the odds of disability except for visual disability (significantly increased with age (AOR = 1.4, 95% CI:1.1-1.7). Male sex also increased the odds of all disabilities except visual, hearing, and seizures. Convulsions after birth significantly increased the odds of disability as follows: hearing (AOR = 8.1, 95% CI: 2.2-30.5), intellectual impairment (AOR = 4.2, 95% CI: 2.5-6.9), and mobility/physical (AOR = 3.4, 95% CI: 2.3-5.0). Preterm delivery and being kept in an incubator for more than two days after birth increased the odds for visual disability (AOR = 3.7, 95% CI: 1.1-12.1 & AOR = 3.7, 95% CI: 1.7-7.9 respectively). Cyanosis increased the odds of seizures (AOR = 4.7, 95% CI: 2.2-10.3). Low birth weight also increased the odds for all disability domains except for visual and hearing. Maternal health problems during pregnancy increased the odds for all types of disability except hearing and seizures. Higher paternal education decreased the odds for all disabilities by at least 30% except for vision and hearing. CONCLUSION The study found a high prevalence of disability among Egyptian children aged 1-6 years. It identified a number of modifiable risk factors for disability. The practice of early screening for disability is encouraged to provide early interventions when needed.
Collapse
Affiliation(s)
- Ammal M. Metwally
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Ahmed Aboulghate
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Ghada A. Elshaarawy
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Ali M. Abdallah
- Quantitative Methods Department, Aswan University, Aswan, Egypt
| | - Ehab R. Abdel Raouf
- Child With Special Needs Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Ebtissam M. Salah El-Din
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Zeinab Khadr
- Department of Statistics, Faculty of Economics and Political Science, Cairo University, Cairo, Egypt
- The Social Research Center, American University in Cairo, Cairo, Egypt
| | - Mostafa M. El-Saied
- Child With Special Needs Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Mona A. Elabd
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Maysa S. Nassar
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Marwa W. Abouelnaga
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Engy A. Ashaat
- Clinical Genetics Department, Human Genetics and Genome Research Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Mohamed M. El-Sonbaty
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Hala Y. Badawy
- Prevention of Disability General Directorate, Ministry of Health and Population, Cairo, Egypt
| | - Eman M. Dewdar
- Prevention of Disability General Directorate, Ministry of Health and Population, Cairo, Egypt
| | - Somia I. Salama
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Mohamed Abdelrahman
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Aida M. Abdelmohsen
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Sherif E. Eldeeb
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Maie M. Naga
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Nada H. Elshamy
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Fatma A. Shaaban
- Child With Special Needs Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Amira S. ElRifay
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| |
Collapse
|
9
|
Smith F, Perera S, Marella M. The Journey to Early Identification and Intervention for Children with Disabilities in Fiji. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6732. [PMID: 37754592 PMCID: PMC10531044 DOI: 10.3390/ijerph20186732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023]
Abstract
Early identification of developmental delay or disability and access to early intervention improves outcomes for children with disabilities and their families. However, in many low- and middle-income countries, services and systems to enable timely, co-ordinated care and support are lacking. The aim of this research was to explore the experiences of families of children with developmental disabilities in Fiji in accessing services for intervention and support across sectors. This qualitative study involved conducting interviews with caregivers of children with disabilities (n = 12), and relevant key stakeholders from health, education, disability, and social support sectors (n = 17). We used journey maps to identify key stages of the families' journeys, identify key barriers and enablers at each stage, and provide multi-sectoral recommendations for each stage. Enablers include proactive help seeking behaviours, the use of informal support networks and an increasingly supportive policy environment. Barriers to identification include a lack of awareness of developmental disabilities and the benefits of early intervention among service providers and the community. A lack of service availability and capacity, workforce issues, family financial constraints and a lack of collaboration between sectors were barriers to intervention once needs were identified, resulting in significant unmet needs and impacting inclusion and participation for children with disabilities. Overcoming these challenges requires a multi-sectoral approach.
Collapse
Affiliation(s)
- Fleur Smith
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne 3010, Australia;
| | - Sureni Perera
- Head Office, Frank Hilton Organization, Lot 139 Brown Street, Suva, Fiji;
| | - Manjula Marella
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne 3010, Australia;
| |
Collapse
|
10
|
Almasri NA, Smythe T, Hadders-Algra M, Olusanya BO. Prioritising rehabilitation in early childhood for inclusive education: a call to action. Disabil Rehabil 2023; 45:3155-3159. [PMID: 36066022 DOI: 10.1080/09638288.2022.2118870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/30/2022] [Accepted: 08/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This commentary examines the provisions for early childhood development (ECD) in the global action plan for rehabilitation published by the World Health Organisation (WHO) within the context of the United Nations' Sustainable Development Goal (SDG) for inclusive education. METHODS The meeting reports of the WHO Rehabilitation 2030 for 2017 and 2019 and the related documents were reviewed along with ECD policy documents from WHO, UNICEF, UNESCO, and the World Bank. RESULTS The importance of a life-course approach to rehabilitation for the health and wellbeing of persons with disabilities was highlighted in the Rehabilitation 2030. However, the critical and foundational role of rehabilitation in ECD for children with disabilities to facilitate inclusive education, especially in low- and middle-income countries as envisioned by the SDG 4.2, was not clearly addressed. Children under 5 years with developmental delays and disabilities who are not developmentally on track in health and psychosocial wellbeing require timely rehabilitation to ensure that they benefit from inclusive education. CONCLUSIONS The culture and practice of rehabilitation should be nurtured from infancy as an indispensable component of ECD to adequately prepare children with developmental disabilities for inclusive education and ensure effective rehabilitation services over the life course. IMPLICATIONS FOR REHABILITATIONRehabilitation is an integral and critical component of early childhood development to optimise school readiness for children with developmental disabilities.Routine newborn screening, developmental assessment, and surveillance of children from birth are foundational to any effective rehabilitation in early childhood.Global investment to promote and support rehabilitation services from early childhood within the health systems and across all levels of service delivery including community settings is warranted to achieve the sustainable development goals for children with disabilities.
Collapse
Affiliation(s)
- Nihad A Almasri
- Department of Physiotherapy, The University of Jordan, Amman, Jordan
| | - Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Mijna Hadders-Algra
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | | |
Collapse
|
11
|
Basu A, Friel K, Olusanya B, Hadders-Algra M. Visibilizando la discapacidad: Mirando el otro lado. Dev Med Child Neurol 2023; 65:e34-e36. [PMID: 36752275 DOI: 10.1111/dmcn.15514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Anna Basu
- Population Health Sciences Institute, Newcastle University, and Department of Paediatric Neurology, Great North Childrens Hospital, Newcastle upon Tyne, UK
| | - Kathleen Friel
- Burke Neurological Institute, White Plains, NY, United States.,Weill Cornell Medicine, New York, NY, USA
| | | | - Mijna Hadders-Algra
- Department of Paediatrics - Section Developmental Neurology and Faculty of Theology and Religious Studies, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
12
|
Basu A, Friel K, Olusanya B, Hadders-Algra M. Regard sur le handicap: Voir l'autre côté. Dev Med Child Neurol 2023; 65:e40-e42. [PMID: 36732320 DOI: 10.1111/dmcn.15521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Anna Basu
- Population Health Sciences Institute, Newcastle University, and Department of Paediatric Neurology, Great North Childrens Hospital, Newcastle upon Tyne, UK
| | - Kathleen Friel
- Burke Neurological Institute, White Plains, NY, and Weill Cornell Medicine, New York, NY, USA
| | | | - Mijna Hadders-Algra
- Department of Paediatrics - Section Developmental Neurology and Faculty of Theology and Religious Studies, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
13
|
Basu A, Friel K, Olusanya B, Hadders-Algra M. Viewing disability: Seeing the other side. Dev Med Child Neurol 2023; 65:443-445. [PMID: 36468188 DOI: 10.1111/dmcn.15452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 12/09/2022]
Affiliation(s)
- Anna Basu
- Population Health Sciences Institute, Newcastle University, and Department of Paediatric Neurology, Great North Childrens Hospital, Newcastle upon Tyne, UK
| | - Kathleen Friel
- Burke Neurological Institute, White Plains, NY, USA.,Weill Cornell Medicine, New York, NY, USA
| | | | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics - Section Developmental Neurology and Faculty of Theology and Religious Studies, Groningen, the Netherlands
| |
Collapse
|
14
|
Basu A, Friel K, Olusanya B, Hadders-Algra M. Visualizando a deficiência: Vendo o outro lado. Dev Med Child Neurol 2023; 65:e37-e39. [PMID: 36752073 DOI: 10.1111/dmcn.15515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Ana Basu
- Population Health Sciences Institute, Newcastle University and Department of Paediatric Neurology, Great North Childrens Hospital, Newcastle upon Tyne, UK
| | - Kathleen Friel
- Burke Neurological Institute, White Plains, NY, United States.,Weill Cornell Medicine, New York, NY, USA
| | | | - Mijna Hadders-Algra
- Department of Paediatrics - Section Developmental Neurology and Faculty of Theology and Religious Studies, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
15
|
Baird S, Abu Hamad B, Baniodeh K, Carew M, Goel N, Ismail A, Oakley E, Seager J, Woldehanna T, Jones N. Creating a better post-pandemic future for adolescents with disabilities. BMJ 2023; 380:e072343. [PMID: 36940979 PMCID: PMC10028661 DOI: 10.1136/bmj-2022-072343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Adolescents with disabilities must have their needs prioritised in recovery and future pandemic responses to improve health, educational, and social outcomes, argue Sarah Baird and colleagues
Collapse
Affiliation(s)
- Sarah Baird
- Department of Global Health, George Washington University, Washington DC, USA
| | | | - Kifah Baniodeh
- Gender and Adolescence: Global Evidence, Ramallah, State of Palestine
| | | | - Nimisha Goel
- Norway India Partnership Initiative, New Delhi,India
| | | | - Erin Oakley
- Department of Global Health, George Washington University, Washington DC, USA
| | - Jennifer Seager
- Department of Global Health, George Washington University, Washington DC, USA
| | - Tassew Woldehanna
- Department of Economics, Addis Ababa University, Addis Ababa, Ethiopia
| | | |
Collapse
|
16
|
Olusanya BO, Davis AC, Hadders-Algra M, Wright SM. Global investments to optimise the health and wellbeing of children with disabilities: a call to action. Lancet 2023; 401:175-177. [PMID: 36410361 DOI: 10.1016/s0140-6736(22)02368-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022]
Affiliation(s)
| | - Adrian C Davis
- Department of Population Health Science, London School of Economics, London, UK; Vision and Eye Research Institute, School of Medicine Anglia Ruskin University, Cambridge, UK
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Division of Developmental Neurology and University of Groningen, Faculty of Theology and Religious Studies, Groningen, Netherlands
| | - Scott M Wright
- Division of General Internal Medicine, Department of Medicine, School of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| |
Collapse
|
17
|
Disabilities in Early Childhood: A Global Health Perspective. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010155. [PMID: 36670705 PMCID: PMC9857482 DOI: 10.3390/children10010155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
Prior to the launch of the United Nations' Sustainable Development Goals (SDGs) in 2015, childhood disability was rarely considered an important subject in global health. The SDGs till 2030 now require that children under 5 years who are at risk of not benefitting from inclusive quality education are identified, monitored, and promptly supported. A new tool for identifying children who are not developmentally on track has been developed by UNICEF but has limited sensitivity for detecting children with disabilities due to reliance on parental assessment of child behavior in certain everyday situations. In this paper, we identified conditions that are commonly associated with developmental disabilities based on the International Classification of Diseases (ICD) codes and clarified the concept of "developmentally on track" as it relates to children with developmental disabilities and developmental delays. We summarized the latest evidence on the global burden of developmental disabilities in children under 5 years based on the diagnostic and functional approaches for measuring disabilities at the population level. We highlighted the global health context for addressing the needs of children with developmental disabilities and provided an overview of the opportunities and the role of pediatric caregivers in supporting children with developmental disabilities.
Collapse
|
18
|
Swai EA, Msuya SE, Moshi H, Lindkvist M, Sörlin A, Sahlén KG. Children and adolescents with physical disabilities: describing characteristics and disability-related needs in the Kilimanjaro region, north-eastern Tanzania - a cross-sectional survey. BMJ Open 2023; 13:e064849. [PMID: 36592996 PMCID: PMC9809220 DOI: 10.1136/bmjopen-2022-064849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To describe the characteristics and disability-related needs of children and adolescents with physical disabilities in the Kilimanjaro region, North-Eastern Tanzania. DESIGN A cross-sectional community survey was conducted from November 2020 to June 2021. Trained research assistants interviewed primary children's carers using a questionnaire based on the International Classification of Functioning, Disability and Health-Children and Youth Framework. Data were analysed using IBM SPSS Statistics V.27. The Pearson χ2 test was used to examine differences between age, gender and self-reported needs. The independent t-test assessed difference in needs according to age and gender. SETTING Kilimanjaro region, Tanzania. PARTICIPANTS Children and adolescents, aged 2-18 years, with physical disabilities (n=212). RESULTS Almost 40% had severe speech (n=84) and joint mobility (n=79) impairments, and more than half (n=124) had severe or complete difficulties walking. In aspects of self-care (caring for body parts, toileting, dressing, eating and drinking), most had severe and complete difficulties. Almost 70% (n=135) of households were located near health facilities without rehabilitation services. About one-quarter (n=51) had never received rehabilitation services. More than 90% (n=196) needed assistive devices, and therapeutic exercises (n=193). Over three-quarters needed nutritional supplements (n=162). CONCLUSION Children and adolescents with physical disabilities in North-Eastern Tanzania have impaired speech and joint mobility, and difficulties in communication, self-care and walking. Rehabilitation services essential for addressing these impairments and activity limitations are either scarce or inaccessible. Action is needed to facilitate urban and rural access to rehabilitation services in order to improve the well-being of children and adolescents with physical disabilities.
Collapse
Affiliation(s)
- Elia Asanterabi Swai
- Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
- Physiotherapy, Faculty of Rehabilitation Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sia E Msuya
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Haleluya Moshi
- Physiotherapy, Faculty of Rehabilitation Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Marie Lindkvist
- Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Ann Sörlin
- Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | | |
Collapse
|
19
|
Revisiting the Role of Pediatricians for Optimal Early Childhood Development in LMICs. J Dev Behav Pediatr 2023; 44:e69. [PMID: 36563347 DOI: 10.1097/dbp.0000000000001144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
20
|
Smythe T, Freeze L, Cuthel A, Flowers M, Seghers F, Zia N, Bachani AM. Provision of rehabilitation for congenital conditions. Bull World Health Organ 2022; 100:717-725. [PMID: 36324557 PMCID: PMC9589394 DOI: 10.2471/blt.22.288147] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Considerable progress has been made in saving the lives of children younger than 5 years. Nevertheless, these advances have failed to help all children thrive, particularly children with disabilities. We describe the increasing prevalence of disability among children and adolescents. We evaluate the current situation regarding children with disabilities and rehabilitation in the context of health systems, particularly those in low- and middle-income countries. Within the newborn health agenda, congenital anomalies often require early intervention and rehabilitation. We provide Argentina as an example of a country where rehabilitation for congenital anomalies is integrated into the health system. We argue that congenital anomalies that require rehabilitation have the potential to strengthen rehabilitation systems and policies by: strengthening coordination between primary care and rehabilitation; identifying and understanding pathways that allow families to engage with services; providing human resources for rehabilitation; and building systems and resources that support assistive technology and rehabilitation. We propose ways for countries to prioritize and integrate early identification, referral and care for children with congenital anomalies to strengthen health systems for all. We identify opportunities to expand policy and planning and to design service delivery and workforce strategies through World Health Organization guidelines and frameworks for rehabilitation. We argue that the global health community must act to ensure that rehabilitation services to support functioning from birth are well established, accepted and integrated within health systems, and that disability is prioritized within child health. These steps would strengthen health systems, ensure functioning from birth and make rehabilitation accessible to all.
Collapse
Affiliation(s)
- Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, England
| | - Lindsey Freeze
- MiracleFeet, Chapel Hill, United States of America (USA)
| | - Anna Cuthel
- MiracleFeet, Chapel Hill, United States of America (USA)
| | | | | | - Nukhba Zia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Abdulgafoor M Bachani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| |
Collapse
|
21
|
Olusanya BO, Gladstone M, Wright SM, Hadders-Algra M, Boo NY, Nair MKC, Almasri N, Kancherla V, Samms-Vaughan ME, Kakooza-Mwesige A, Smythe T, del Castillo-Hegyi C, Halpern R, de Camargo OK, Arabloo J, Eftekhari A, Shaheen A, Gulati S, Williams AN, Olusanya JO, Wertlieb D, Newton CRJ, Davis AC. Cerebral palsy and developmental intellectual disability in children younger than 5 years: Findings from the GBD-WHO Rehabilitation Database 2019. Front Public Health 2022; 10:894546. [PMID: 36091559 PMCID: PMC9452822 DOI: 10.3389/fpubh.2022.894546] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/12/2022] [Indexed: 01/22/2023] Open
Abstract
Objective Children with developmental disabilities are associated with a high risk of poor school enrollment and educational attainment without timely and appropriate support. Epidemiological data on cerebral palsy and associated comorbidities required for policy intervention in global health are lacking. This paper set out to report the best available evidence on the global and regional prevalence of cerebral palsy (CP) and developmental intellectual disability and the associated "years lived with disability" (YLDs) among children under 5 years of age in 2019. Methods We analyzed the collaborative 2019 Rehabilitation Database of the Global Burden of Disease (GBD) Study and World Health Organization for neurological and mental disorders available for 204 countries and territories. Point prevalence and YLDs with 95% uncertainty intervals (UI) are presented. Results Globally, 8.1 million (7.1-9.2) or 1.2% of children under 5 years are estimated to have CP with 16.1 million (11.5-21.0) or 2.4% having intellectual disability. Over 98% resided in low-income and middle-income countries (LMICs). CP and intellectual disability accounted for 6.5% and 4.5% of the aggregate YLDs from all causes of adverse health outcomes respectively. African Region recorded the highest prevalence of CP (1.6%) while South-East Asia Region had the highest prevalence of intellectual disability. The top 10 countries accounted for 57.2% of the global prevalence of CP and 62.0% of the global prevalence of intellectual disability. Conclusion Based on this Database, CP and intellectual disability are highly prevalent and associated with substantial YLDs among children under 5 years worldwide. Universal early detection and support services are warranted, particularly in LMICs to optimize school readiness for these children toward inclusive education as envisioned by the United Nations' Sustainable Development Goals.
Collapse
Affiliation(s)
- Bolajoko O. Olusanya
- Centre for Healthy Start Initiative, Lagos, Nigeria,*Correspondence: Bolajoko O. Olusanya
| | - Melissa Gladstone
- Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Scott M. Wright
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mijna Hadders-Algra
- Division of Developmental Neurology, Department of Paediatrics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Nem-Yun Boo
- Department of Population Medicine, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - M. K. C. Nair
- Child Development Centre, Thiruvananthapuram Medical College, Thiruvananthapuram, Kerala, India
| | - Nihad Almasri
- Department of Physiotherapy, The University of Jordan, Amman, Jordan
| | - Vijaya Kancherla
- Department of Epidemiology Epidemiologist, Center for Spina Bifida Prevention Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - Angelina Kakooza-Mwesige
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Ricardo Halpern
- Child Development Outpatient Clinic, Hospital da Criança Santo Antônio, Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | - Olaf K. de Camargo
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Jalal Arabloo
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Eftekhari
- Department of Toxicology and Pharmacology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amira Shaheen
- Division of Public Health, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Sheffali Gulati
- Center of Excellence & Advanced Research on Childhood Neurodevelopmental Disorders, Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Andrew N. Williams
- Virtual Academic Unit, Children's Directorate, Northampton General Hospital, Northampton, United Kingdom
| | | | - Donald Wertlieb
- Eliot-Pearson Department of Child Development, Tufts University, Medford, MA, United States
| | - Charles R. J. Newton
- Kenya Medical Research Institute–Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, KiIifi, Kenya
| | - Adrian C. Davis
- Department of Population Health Sciences, London School of Economics, London, United Kingdom,Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| |
Collapse
|
22
|
Children and adolescents are not small adults: towards a better understanding of multimorbidity in younger populations. J Clin Epidemiol 2022; 149:165-171. [PMID: 35820585 DOI: 10.1016/j.jclinepi.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/25/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022]
Abstract
Multimorbidity is of increasing importance for the health of both children and adults but research has hitherto focused on adult multimorbidity. Hence, public awareness, practice and policy lack vital information about multimorbidity in childhood and adolescence. We convened an international and interdisciplinary group of experts from six nations to identify key priorities supported by published evidence to strengthen research for children and adolescent with multimorbidity. Future research is encouraged 1) To develop a conceptual framework to capture unique aspects of child and adolescent multimorbidity - including definitions, characteristic patterns of conditions for different age groups, its dynamic nature through childhood and adolescence and understanding of severity and trajectories for different clusters of multiple chronic conditions, 2) To define new indices to classify the presence of multimorbidity in children and adolescents, 3) To improve the availability and linkage of data across countries, 4) To synthesize evidence on the global phenomenon of multimorbidity in childhood and adolescence as well as health inequalities, 5) To involve children and adolescents in research relevant to their health.
Collapse
|
23
|
Olusanya BO, Boo NY, de Camargo OK, Hadders-Algra M, Wertlieb D, Davis AC. Child health, inclusive education and development. Bull World Health Organ 2022; 100:459-461. [PMID: 35813511 PMCID: PMC9243688 DOI: 10.2471/blt.22.288103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Bolajoko O Olusanya
- Center for Healthy Start Initiative, 286A Corporation Drive, Dolphin Estate, Ikoyi, Lagos, Nigeria
| | - Nem Yun Boo
- Department of Population Medicine, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | | | - Mijna Hadders-Algra
- Division of Developmental Neurology, University Medical Center Groningen, Groningen, Netherlands
| | - Donald Wertlieb
- Eliot-Pearson Department of Child Study & Human Development, Tufts University, Medford, United States of America
| | - Adrian C Davis
- Department of Population Health, London School of Economics, London, England
| | | |
Collapse
|
24
|
Requejo J, Strong K, Agweyu A, Billah SM, Boschi-Pinto C, Horiuchi S, Jamaluddine Z, Lazzerini M, Maiga A, McKerrow N, Munos M, Park L, Schellenberg J, Weigel R. Measuring and monitoring child health and wellbeing: recommendations for tracking progress with a core set of indicators in the Sustainable Development Goals era. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:345-352. [PMID: 35429452 PMCID: PMC9764429 DOI: 10.1016/s2352-4642(22)00039-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
Although great improvements in child survival were achieved in the past two decades, progress has been uneven within and across countries, and the COVID-19 pandemic threatens to reverse previous advances. Demographic and epidemiological transitions around the world have resulted in shifts in the causes and distribution of child death and diseases, and many children are living with short-term and long-term chronic illnesses and disabilities. These changes, plus global threats such as pandemics, transnational and national security issues, and climate change, mean that regular monitoring of child health and wellbeing is essential if we are to achieve the Sustainable Development Goals. This Health Policy describes the three-phased process undertaken by the Child Health Accountability Tracking technical advisory group (CHAT) to develop a core set of indicators on child health and wellbeing for global monitoring purposes, and presents CHAT's research recommendations to address data gaps. CHAT reached consensus on 20 core indicators specific to the health sector, which include 11 impact-level indicators and nine outcome-level indicators that cover the topics of: acute conditions and prevention; health promotion and child development; and chronic conditions, disabilities, injuries, and violence against children. An additional six indicators (three impact and three outcome) that capture information on child health issues such as malaria and HIV are recommended; however, these indicators are only relevant to high-burden regions. CHAT's four research priorities will require investments in health information systems and measurement activities. These investments will help to increase data on children aged 5-9 years; develop standard metadata and data collection processes to enable cross-country comparisons and progress assessments over time; reach a global consensus on essential interventions and associated indicators for monitoring emerging priority areas such as child development, chronic conditions, disabilities, and injuries; and implement strategies to increase the uptake of data on child health to improve evidence-based planning, programming, and advocacy efforts.
Collapse
Affiliation(s)
- Jennifer Requejo
- Division of Data, Analytics, Planning and Monitoring, United Nations Children's Fund, New York, NY, USA.
| | - Kathleen Strong
- Maternal, Newborn, Child and Adolescent Health and Aging Department, World Health Organization, Geneva, Switzerland
| | - Ambrose Agweyu
- Epidemiology and Demography Department, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Sk Masum Billah
- Maternal and Child Health Division, International Centre of Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Cynthia Boschi-Pinto
- Departamento de Epidemiologia e Bioestatistica, Instituto de Saude Coletiva, University Federal Fluminense, Rio de Janeiro, Brazil
| | - Sayaka Horiuchi
- Center for Birth Cohort Studies, University of Yamanashi, Chuo-shi, Japan
| | | | - Marzia Lazzerini
- World Health Organization Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Trieste, Italy
| | - Abdoulaye Maiga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neil McKerrow
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Melinda Munos
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lois Park
- University of Southern California, Los Angeles, CA, USA
| | | | - Ralf Weigel
- School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| |
Collapse
|
25
|
Black RE, Liu L, Hartwig FP, Villavicencio F, Rodriguez-Martinez A, Vidaletti LP, Perin J, Black MM, Blencowe H, You D, Hug L, Masquelier B, Cousens S, Gove A, Vaivada T, Yeung D, Behrman J, Martorell R, Osmond C, Stein AD, Adair LS, Fall CHD, Horta B, Menezes AMB, Ramirez-Zea M, Richter LM, Patton GC, Bendavid E, Ezzati M, Bhutta ZA, Lawn JE, Victora CG. Health and development from preconception to 20 years of age and human capital. Lancet 2022; 399:1730-1740. [PMID: 35489357 PMCID: PMC9061873 DOI: 10.1016/s0140-6736(21)02533-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/02/2021] [Accepted: 11/11/2021] [Indexed: 12/13/2022]
Abstract
Optimal health and development from preconception to adulthood are crucial for human flourishing and the formation of human capital. The Nurturing Care Framework, as adapted to age 20 years, conceptualises the major influences during periods of development from preconception, through pregnancy, childhood, and adolescence that affect human capital. In addition to mortality in children younger than 5 years, stillbirths and deaths in 5-19-year-olds are important to consider. The global rate of mortality in individuals younger than 20 years has declined substantially since 2000, yet in 2019 an estimated 8·6 million deaths occurred between 28 weeks of gestation and 20 years of age, with more than half of deaths, including stillbirths, occurring before 28 days of age. The 1000 days from conception to 2 years of age are especially influential for human capital. The prevalence of low birthweight is high in sub-Saharan Africa and even higher in south Asia. Growth faltering, especially from birth to 2 years, occurs in most world regions, whereas overweight increases in many regions from the preprimary school period through adolescence. Analyses of cohort data show that growth trajectories in early years of life are strong determinants of nutritional outcomes in adulthood. The accrual of knowledge and skills is affected by health, nutrition, and home resources in early childhood and by educational opportunities in older children and adolescents. Linear growth in the first 2 years of life better predicts intelligence quotients in adults than increases in height in older children and adolescents. Learning-adjusted years of schooling range from about 4 years in sub-Saharan Africa to about 11 years in high-income countries. Human capital depends on children and adolescents surviving, thriving, and learning until adulthood.
Collapse
Affiliation(s)
- Robert E Black
- Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Li Liu
- Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Fernando P Hartwig
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas Brazil
| | - Francisco Villavicencio
- Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Centre for Demographic Studies, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Rodriguez-Martinez
- Medical Research Council Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Luis P Vidaletti
- International Center for Equity in Health, Federal University of Pelotas, Pelotas Brazil
| | - Jamie Perin
- Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; RTI International, Research Triangle Park, NC, USA
| | - Hannah Blencowe
- Maternal Adolescent Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Danzhen You
- Data and Analytics Section, UNICEF, New York, NY, USA
| | - Lucia Hug
- Data and Analytics Section, UNICEF, New York, NY, USA
| | - Bruno Masquelier
- Centre de Recherche en Démographie, Université Catholique de Louvain, Louvain, Belgium
| | - Simon Cousens
- Maternal Adolescent Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Amber Gove
- RTI International, Research Triangle Park, NC, USA
| | - Tyler Vaivada
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Diana Yeung
- Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jere Behrman
- Department of Economics, Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Linda S Adair
- Nutrition Department, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Bernardo Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas Brazil
| | - Ana M B Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas Brazil
| | - Manuel Ramirez-Zea
- Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Linda M Richter
- Department of Science and Innovation, National Research Foundation Centre of Excellence in Human Development, University of the Witwatersrand, Parktown, South Africa
| | - George C Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Eran Bendavid
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Majid Ezzati
- Medical Research Council Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Zulfiqar A Bhutta
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada; Centre for Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Joy E Lawn
- Maternal Adolescent Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas Brazil
| |
Collapse
|
26
|
Seidel B, De Azevedo Mazza V, Louyse Schuertz A, Trevisan Nobrega Martins Ruthes VB, Macedo LC. Percepção do profissional da Estratégia Saúde da Família no cuidado à criança com deficiência. AVANCES EN ENFERMERÍA 2022. [DOI: 10.15446/av.enferm.v40n2.91505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Objetivo: compreender a percepção dos profissionais da Estratégia Saúde da Família sobre o cuidado às crianças com deficiências.
Materiais e método: estudo exploratório descritivo com abordagem qualitativa. A coleta de dados ocorreu no primeiro semestre de 2019. Realizaram-se entrevistas não estruturadas, com questões orientadoras referentes à percepção dos profissionais quanto ao cuidado realizado às crianças com deficiências com 33 profissionais de seis equipes de saúde, de um município da região Sul do Brasil. Utilizou-se a análise categorial temática com o auxílio do software WebQDA®.
Resultados: as categorias temáticas finais identificadas neste estudo são sobre o cuidado às crianças com deficiências na Estratégia Saúde da Família, as quais foram divididas em potencialidades e fragilidades. Com relação às potencialidades, identificaram-se a rede de atenção, dando suporte aos encaminhamentos necessários, os atendimentos realizados com priorização e equidade e a consideração da importância das famílias nos cuidados; nas fragilidades, ressaltaram-se as limitações dos serviços, que dificultam ou até impossibilitam os atendimentos, como falta de profissionais, insumos e ambiência adequada, falta de protocolos direcionando os atendimentos, falta de capacitação e desconhecimento dos direitos desse público, o que prejudica o cuidado prestado a essas crianças.
Conclusões: compreender a percepção dos profissionais que estão na assistência dessas crianças possibilita identificar as lacunas dos serviços e proporciona a valorização do pessoal de saúde; em consequência disso, favorece o direcionamento adequado de recursos, beneficiando o cuidado para as famílias de crianças com deficiência.
Collapse
|
27
|
Olusanya BO, Boo NY, Nair M, Samms-Vaughan ME, Hadders-Algra M, Wright SM, Breinbauer C, Almasri N, Moreno-Angarita M, Arabloo J, Arora NK, Block SS, Berman BD, Burchell G, de Camargo OK, Carr G, del Castillo-Hegyi C, Cheung VG, Halpern R, Hoekstra R, Lynch P, Mulaudzi MC, Kakooza-Mwesige A, Ogbo FA, Olusanya JO, Rojas-Osorio V, Shaheen A, Williams AN, Servili C, Gladstone M, Kuper H, Wertlieb D, Davis AC, Newton CR. Accelerating progress on early childhood development for children under 5 years with disabilities by 2030. Lancet Glob Health 2022; 10:e438-e444. [PMID: 35038406 PMCID: PMC7613579 DOI: 10.1016/s2214-109x(21)00488-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/10/2021] [Accepted: 10/13/2021] [Indexed: 12/30/2022]
Abstract
The likelihood of a newborn child dying before their fifth birthday (under-5 mortality rate) is universally acknowledged as a reflection of the social, economic, health, and environmental conditions in which children (and the rest of society) live, but little is known about the likelihood of a newborn child having a lifelong disability before their fifth birthday if he or she survives. Available data show that globally the likelihood of a child having a disability before their fifth birthday was ten times higher than the likelihood of dying (377·2 vs 38·2 per 1000 livebirths) in 2019. However, disability funding declined by 11·4% between 2007 and 2016, and only 2% of the estimated US$79·1 billion invested in early childhood development during this period was spent on disabilities. This funding pattern has not improved since 2016. This paper highlights the urgent need to prioritise early childhood development for the beneficiaries of global child survival initiatives who have lifelong disabilities, especially in low-income and middle-income countries, as envisioned by the Sustainable Development Goals agenda. This endeavour would entail disability-focused programming and monitoring approaches, economic analysis of interventions services, and substantial funding to redress the present inequalities among this cohort of children by 2030.
Collapse
|
28
|
Zhao Y, Hagel C, Tweheyo R, Sirili N, Gathara D, English M. Task-sharing to support paediatric and child health service delivery in low- and middle-income countries: current practice and a scoping review of emerging opportunities. HUMAN RESOURCES FOR HEALTH 2021; 19:95. [PMID: 34348709 PMCID: PMC8336272 DOI: 10.1186/s12960-021-00637-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/23/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND Demographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for complex and chronic conditions in the 0-19 years (paediatric) age range. Providing such services will be undermined by general and skilled paediatric workforce shortages especially in low- and middle-income countries (LMICs). In this paper, we aim to understand existing, sanctioned forms of task-sharing to support the delivery of care for more complex and chronic paediatric and child health conditions in LMICs and emerging opportunities for task-sharing. We specifically focus on conditions other than acute infectious diseases and malnutrition that are historically shifted. METHODS We (1) reviewed the Global Burden of Diseases study to understand which conditions may need to be prioritized; (2) investigated training opportunities and national policies related to task-sharing (current practice) in five purposefully selected African countries (Kenya, Uganda, Tanzania, Malawi and South Africa); and (3) summarized reported experience of task-sharing and paediatric and child health service delivery through a scoping review of research literature in LMICs published between 1990 and 2019 using MEDLINE, Embase, Global Health, PsycINFO, CINAHL and the Cochrane Library. RESULTS We found that while some training opportunities nominally support emerging roles for non-physician clinicians and nurses, formal scopes of practices often remain rather restricted and neither training nor policy seems well aligned with probable needs from high-burden complex and chronic conditions. From 83 studies in 24 LMICs, and aside from the historically shifted conditions, we found some evidence examining task-sharing for a small set of specific conditions (circumcision, some complex surgery, rheumatic heart diseases, epilepsy, mental health). CONCLUSION As child health strategies are further redesigned to address the previously unmet needs careful strategic thinking on the development of an appropriate paediatric workforce is needed. To achieve coverage at scale countries may need to transform their paediatric workforce including possible new roles for non-physician cadres to support safe, accessible and high-quality care.
Collapse
Affiliation(s)
- Yingxi Zhao
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK.
| | - Christiane Hagel
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
| | - Raymond Tweheyo
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Department of Public Health, Lira University, Lira, Uganda
| | - Nathanael Sirili
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - David Gathara
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Mike English
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| |
Collapse
|