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Alam MB, Khanam SJ, Rana MS, Khandaker G, Kabir MA, Khan MN. Effects of disability on adverse health outcomes and anthropometric deficits among under-five children in South Asian countries: evidence from multiple indicator cluster surveys. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 25:100401. [PMID: 38616818 PMCID: PMC11015120 DOI: 10.1016/j.lansea.2024.100401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
Background Children with disabilities face an increased risk of adverse health outcomes and poor anthropometric deficits, although the focus on them is limited in the South Asian context thus far and need newer and more evidence. This study investigates the effects of disability on adverse health outcomes and anthropometric deficits among 2-4 years aged children in South Asian countries. Methods We analyzed data from 93,180 children aged 2-4 years across Bangladesh, Nepal, Pakistan, and Afghanistan using Multiple Indicator Cluster Surveys (2017-2023). Disability status was the primary exposure, and outcomes included adverse health outcome (acute respiratory infection, diarrhea, fever), anthropometric deficit (stunting, wasting, underweight), and healthcare service sources during adverse health events (care received from skilled healthcare personnel, care received from non-professional personnel, and care received from health facility workers other than skilled healthcare personnel). Using multilevel and multinomial logistic regression models, we examined associations between exposure and outcome variables, adjusting for covariates. Findings We found average disability prevalence in South Asia was 8.7% (8.3-9.0; n = 8072), varying from 3.4% (3.0-3.8; n = 446) in Bangladesh to 12.3% (11.4-13.3; n = 1259) in Afghanistan. Common health issues included fever (n = 24,982, 26.8%, 26.2-27.4) and diarrhea (n = 14,081, 15.1%, 14.7-15.6), while prevalent poor anthropometric deficits were stunting (n = 39,766, 42.7%, 42.0-43.3) and underweight (n = 22,390, 24.0%, 23.5-24.5). Children with disability had 1.30 (95% CI: 1.21-1.40) to 1.60 (95% CI: 1.47-1.75) times and 1.17 (95% CI: 1.05-1.29) to 1.39 (95% CI: 1.30-1.48) times higher likelihoods of adverse health outcomes and anthropometric deficits, respectively, with variations observed among countries and different disability types. Individuals with disability were 1.16 (95% CI: 1.00-1.35) to 1.26 (95% CI: 1.01-1.58) times more likely to receive healthcare services from skilled healthcare personnel compared to health facility workers other than skilled healthcare personnel. Interpretation This study findings emphasizes the need for community-level awareness programs to improve anthropometric well-being and healthcare of the children with disability. Funding This research did not receive any specific funds.
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Affiliation(s)
- Md Badsha Alam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Shimlin Jahan Khanam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Md Shohel Rana
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Gulam Khandaker
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Md Awal Kabir
- Department of Social Work, Pabna University of Science and Technology, Pabna, Bangladesh
| | - Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
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Störbeck C. Early Childhood Development Is Not Enough: In Defense of Children with Developmental Delays and Disabilities and Their Right to Family-Centered Early Childhood Intervention (In the Global South). CHILDREN (BASEL, SWITZERLAND) 2024; 11:606. [PMID: 38790601 PMCID: PMC11119497 DOI: 10.3390/children11050606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/10/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024]
Abstract
The international recognition of the critical importance of the early childhood phase has been firmly established through decades of rigorous research, evidence-based practices, and undeniable evidence of the returns on investment made during this formative period. Consequently, early childhood development has emerged as a top priority on both national and international agendas. This momentum reached a pinnacle in 2015 with the unanimous adoption of the 17 Sustainable Development Goals (SDGs) by the United Nations, which placed a particular emphasis on children under the age of five within the education-focused SDG 4, notably target 4.2, centered on ensuring that all girls and boys are ready for primary education through the provision of accessible "quality early childhood development, care and pre-primary education". However, the Global South reflects the glaring omission of addressing the needs of children at risk of poor development due to disabilities. This paper underscores the imperative for specialized early childhood intervention tailored to young children with disabilities and their families, commencing as early as possible following birth. It advocates for Early Childhood Intervention (ECI) as a service distinct from general Early Childhood Development (ECD), emphasizing the crucial role of families as active partners from the outset. Furthermore, the paper strengthens the case for Family-Centered Early Childhood Intervention (Fc-ECI) through the integration of evidence-based practices and an in-depth description of one such program in South Africa with specific reference to deaf and hard-of-hearing infants and their families. This model will be guided by core concepts outlined in WHO and UNICEF Early Childhood Intervention frameworks. Through this exploration, the paper aims to shed light on the urgent need for inclusive approaches to early childhood development, particularly for children with disabilities, and to advocate for the adoption of Family-Centered Early Childhood Intervention as a cornerstone of global efforts to ensure the holistic well-being and development of all children.
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Affiliation(s)
- Claudine Störbeck
- The Wits Centre for Deaf Studies, School of Education, Faculty of Humanities, University of the Witwatersrand, Johannesburg 2000, South Africa
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Kamila G, Gulati S. Navigating the Frontiers in Childhood Neurodevelopmental Disorders: Unravelling Challenges in South-East Asia. WHO South East Asia J Public Health 2023; 12:81-84. [PMID: 38848526 DOI: 10.4103/who-seajph.whoseajph_6_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 06/09/2024]
Affiliation(s)
- Gautam Kamila
- Department of Pediatrics, Child Neurology Division, Centre of Excellence and Advanced Research for Childhood Neurodevelopmental Disorders, All India Institute of Medical Sciences, New Delhi, India
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Olusanya BO, Nair MKC, Wright SM, Hadders-Algra M. Global progress towards early childhood development for children with disabilities, 2013-2023. BMJ Paediatr Open 2023; 7:e002046. [PMID: 37460256 PMCID: PMC10357775 DOI: 10.1136/bmjpo-2023-002046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Affiliation(s)
| | - M K C Nair
- NIMS-Spectrum-Child Development Research Centre, Thiruvananthapuram, Kerala, India
| | - Scott M Wright
- Division of General Internal Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Division of Developmental Neurology and University of Groningen, Faculty of Religion, Culture and Society, Groningen, The Netherlands
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Olusanya BO, Nair MKC, Lynch P, Hadders-Algra M. Editorial: Optimizing school readiness for children with developmental disabilities. Front Pediatr 2023; 11:1196934. [PMID: 37124185 PMCID: PMC10133715 DOI: 10.3389/fped.2023.1196934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Affiliation(s)
| | - M. K. C. Nair
- NIMS-Spectrum-Child Development Research Centre, Thiruvananthapuram, India
| | - Paul Lynch
- School of Education, University of Glasgow, Glasgow, United Kingdom
| | - 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
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Lynch P, Nabwera HM, Babikako HM, Rasheed M, Donald KA, Mbale EW, Stockdale E, Chand P, Van den Heuvel M, Kakooza Mwesige A, Gladstone M. Experiences of identifying pre-school children with disabilities in resource limited settings - an account from Malawi, Pakistan and Uganda. DISABILITY & SOCIETY 2023; 39:2053-2073. [PMID: 39045395 PMCID: PMC11265222 DOI: 10.1080/09687599.2023.2181769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 01/30/2023] [Indexed: 07/25/2024]
Abstract
Although access to effective medical care for acutely sick children has improved globally, the number of children surviving but who may not be thriving due to disability, is increasing. This study aimed to understand the views of health professionals, educators and caregivers of pre-school children with disabilities in Malawi, Pakistan and Uganda regarding early identification, referral and support. Using applied thematic analysis, we identified themes relating to; limited 'demand' by caregivers for services; different local beliefs and community perceptions regarding the causes of childhood disability. Themes relating to 'supply' of services included inability to respond to community needs, and inadequate training among professionals for identification and referral. Stepwise, approaches provided to the families, community health worker and higher-level services could include training for community and primary care health workers on basic identification techniques and enhanced awareness for families and communities on the importance of early identification of children with disabilities.
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Affiliation(s)
- Paul Lynch
- School of Education & School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Helen M. Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Alder Hey Children’s Hospital, Liverpool, UK
| | - Harriet M. Babikako
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Muneera Rasheed
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Kirsten A. Donald
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Emmie W. Mbale
- Department of Pediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Prem Chand
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Angelina Kakooza Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Melissa Gladstone
- Alder Hey Children’s Hospital, Liverpool, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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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.
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Samia P, Oyieke K, Kigen B, Wamithi S. Education for children and adolescents living with disabilities in sub-Saharan Africa-The gaps and opportunities. Front Public Health 2022; 10:979351. [PMID: 36159264 PMCID: PMC9490008 DOI: 10.3389/fpubh.2022.979351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/18/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
- Pauline Samia
- Department of Paediatrics and Child Health, Medical College, Aga Khan University, Nairobi, Kenya,Brain and Mind Institute, Aga Khan University, Nairobi, Kenya,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium,*Correspondence: Pauline Samia
| | - Katherine Oyieke
- Department of Paediatrics and Child Health, Medical College, Aga Khan University, Nairobi, Kenya
| | - Barnabas Kigen
- Department of Paediatrics and Child Health, Medical College, Aga Khan University, Nairobi, Kenya,Department of Child Health and Paediatrics Medical College, Moi University, Eldoret, Kenya
| | - Susan Wamithi
- Department of Paediatrics and Child Health, Medical College, Aga Khan University, Nairobi, Kenya
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Pillay S, Duncan M, de Vries PJ. "We are doing the best we can to bridge the gap" - service provider perspectives of educational services for autism spectrum disorder in South Africa. Front Psychiatry 2022; 13:907093. [PMID: 35928780 PMCID: PMC9343733 DOI: 10.3389/fpsyt.2022.907093] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/24/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The South African education system is increasingly unable to meet the growing needs of children with autism spectrum disorder (ASD). Recent studies in the Western Cape, one of the better resourced provinces in South Africa, showed that the pathway to care for children with ASD was an inconsistent and lengthy process, and that many children with ASD waited for extended periods to get access to an appropriate school placement. It is therefore clear that scalable and sustainable solutions are required to improve access to appropriate education for children with ASD. METHODS Here we performed a qualitative study using thematic analysis of ten multi-sectorial ASD service provider interviews in the Western Cape Province to examine provider perspectives and proposed solutions to meet the educational needs of children with ASD. RESULTS Provider perspectives were grouped in three categories: "bridging the gap across the spectrum and lifespan", "gaps to bridge", and "building bridges". The first category captured provider perspectives of the service-related needs inherent to a diagnosis of ASD. The second category summarized service provider views of the challenges associated with providing services to children with ASD and the third category captured provider perspectives on potential actions to improve ASD education services delivery in the province. The overarching theme that emerged was "We're doing the best we can to bridge the gap". CONCLUSION Participants provided ten key recommendations for service strengthening that may lead to contextually relevant innovations to meet the educational needs of children with ASD in the province. Findings from this study has direct relevance to other South African provinces and may have relevance to improve pathways and reduce service delivery gaps also in other low-and-middle-income countries.
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Affiliation(s)
- Sarosha Pillay
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa.,Centre for Autism Research in Africa, Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Madeleine Duncan
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Petrus J de Vries
- Centre for Autism Research in Africa, Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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