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Rahman MM, Alam MI, Mansur M. Functional difficulty among young children in Bangladesh: An analysis of nationally representative data. PLoS One 2024; 19:e0300403. [PMID: 38512905 PMCID: PMC10956765 DOI: 10.1371/journal.pone.0300403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
Functional difficulty in children is a crucial public health problem still undervalued in developing countries. This study explored the socio-demographic factors and anthropometry associated with children's functional difficulty in Bangladesh. Data for 2-4-year-old children, obtained from Multiple Indicator Cluster Survey 2019, were used in this study. The mixed-effects logistic regression model was used to analyse the data. Children whose mothers had functional difficulty were found to be 2.75 times more likely to have functional difficulty than children whose mothers had no functional difficulty (95% CI 1.63-4.63). Male children were more likely to experience functional difficulty than female children (OR = 1.48). Furthermore, stunting was found to be significantly associated with functional difficulty (OR = 1.50). The study also revealed that division and mother's education, specifically, children with mothers having higher secondary + education, had significant association with the outcome variable. The findings provided a vital overview of child disability in a developing country.
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Affiliation(s)
- Maisha Maliha Rahman
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - M Iftakhar Alam
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Mohaimen Mansur
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
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Olusanya BO, Kancherla V, Shaheen A, Ogbo FA, Davis AC. Global and regional prevalence of disabilities among children and adolescents: Analysis of findings from global health databases. Front Public Health 2022; 10:977453. [PMID: 36249226 PMCID: PMC9554924 DOI: 10.3389/fpubh.2022.977453] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/26/2022] [Indexed: 01/25/2023] Open
Abstract
Objective The United Nations' Sustainable Development Goals (SDGs) require population-based data on children with disabilities to inform global policies and intervention programs. We set out to compare the prevalence estimates of disabilities among children and adolescents younger than 20 years as reported by the world's leading organizations for global health statistics. Methods We purposively searched the disability reports and databases of the United Nations Children's Fund (UNICEF), the World Health Organization (WHO), the World Bank and the Global Burden of Diseases (GBD) Study. We analyzed the latest disability data reported by these organizations since 2015. We examined the methodologies adopted in generating the reported prevalence estimates and evaluated the degree of agreement among the data sources using Welch's test of statistical difference, and the two one-sided t-test (TOST) for statistical equivalence. Results Only UNICEF and GBD provided the most comprehensive prevalence estimates of disabilities in children and adolescents. Globally, UNICEF estimated that 28.9 million (4.3%) children aged 0-4 years, 207.4 million (12.5%) children aged 5-17 years and 236.4 million (10.1%) children aged 0-17 years have moderate-to-severe disabilities based on household surveys of child functional status. Using the UNICEF estimated prevalence of 10.1%, approximately 266 million children aged 0-19 years are expected to have moderate-to-severe disabilities. In contrast, GBD 2019 estimated that 49.8 million (7.5%) children aged under 5 years, 241.5 million (12.6%) children aged 5-19 years and 291.3 million (11.3%) children younger than 20 years have mild-to-severe disabilities. In both databases, Sub-Saharan Africa and South Asia accounted for more than half of children with disabilities. A comparison of the UNICEF and GBD estimates showed that the overall mean prevalence estimates for children under 5 years were statistically different and not statistically equivalent based on ±3 percentage-point margin. However, the prevalence estimates for children 5-19 years and < 20 years were not statistically different and were statistically equivalent. Conclusion Prevalence estimates of disabilities among children and adolescents generated using either functional approach or statistical modeling appear to be comparable and complementary. Improved alignment of the age-groups, thresholds of disability and the estimation process across databases, particularly among children under 5 years should be considered. Children and adolescents with disabilities will be well-served by a variety of complementary data sources to optimize their health and well-being as envisioned in the SDGs.
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Affiliation(s)
- Bolajoko O. Olusanya
- Centre for Healthy Start Initiative, Lagos, Nigeria,*Correspondence: Bolajoko O. Olusanya
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Amira Shaheen
- Division of Public Health, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Felix A. Ogbo
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia
| | - Adrian C. Davis
- Department of Population Health Science, London School of Economics, London, United Kingdom,Vision and Eye Research Institute, School of Medicine Anglia Ruskin University, Cambridge, United Kingdom
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Zia N, Bachani AM, Kajungu D, Galiwango E, Loeb M, Diener-West M, Wegener S, Pariyo G, Hyder AA. Understanding child disability: Factors associated with child disability at the Iganga-Mayuge Health and Demographic Surveillance Site in Uganda. PLoS One 2022; 17:e0267182. [PMID: 35427403 PMCID: PMC9012358 DOI: 10.1371/journal.pone.0267182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/04/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction There is scarcity of data on children with disabilities living in low-and-middle-income countries, including Uganda. This study describes disability prevalence and explores factors associated with different disability categories. It highlights the value of using a standardized, easy-to-use tool to determine disability in children and contextualizing disability in children in light of their developmental needs. Methods A cross-sectional study was conducted between September 2018–January 2019 at the Iganga-Mayuge Health and Demographic Surveillance Site in Uganda. Respondents were caregivers of children between 5–17 years and were administered an in-depth Child Functioning Module (CFM). The outcome variable, disability, was defined as an ordered categorical variable with three categories–mild, moderate, and severe. Generalized ordered logit model was applied to explore factors associated with disability categories. Results Out of 1,842 caregivers approached for the study, 1,439 (response: 78.1%) agreed to participate in the study. Out of these 1,439, some level of disability was reported by 67.89% (n = 977) of caregivers. Of these 977 children with disability, 48.01% (n = 692) had mild disability and 15.84% (n = 228) had moderate disability, while 3.96% (n = 57) had severe disability. The mean (SD) score for mild disability was 2.22±1.17, with a median of 2. The mean and median for moderate disability was 5.26±3.28 and 4 (IQR:3–6), and for severe disability was 14.23±9.51 and 12 (IQR:6–22). The most common disabilities reported were depression (54.83%) and anxiety (50.87%). Statistically significant association was found for completion of immunization status and school enrollment when controlled for a child’s age, sex, having a primary caregiver, age of mother at child’s birth, family system, family size and household wealth quintile. Conclusion This study suggests association between incomplete immunization status and school enrollment for children with disability. These are areas for further exploration to ensure inclusive health and inclusive education of children with disabilities in Uganda.
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Affiliation(s)
- Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Abdulgafoor M. Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dan Kajungu
- Iganga-Mayuge Health and Demographic Surveillance Site, Makerere University School of Public Health, Kampala, Uganda
| | - Edward Galiwango
- Iganga-Mayuge Health and Demographic Surveillance Site, Makerere University School of Public Health, Kampala, Uganda
| | - Mitchell Loeb
- Washington Group on Disability Statistics, Hyattsville, Maryland, United States of America
| | - Marie Diener-West
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Stephen Wegener
- Department of Physical Medicine and Rehabilitation, Division of Rehabilitation Psychology and Neuropsychology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - George Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Adnan A. Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
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Exploring the Use of Washington Group Questions to Identify People with Clinical Impairments Who Need Services including Assistive Products: Results from Five Population-Based Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074304. [PMID: 35409984 PMCID: PMC8998283 DOI: 10.3390/ijerph19074304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 02/05/2023]
Abstract
This study analyses the use of the self-reported Washington Group (WG) question sets as a first stage screening to identify people with clinical impairments, service and assistive product (AP) referral needs using different cut-off levels in four functional domains (vision, hearing, mobility and cognition). Secondary data analysis was undertaken using population-based survey data from five countries, including one national survey (The Gambia) and four regional/district surveys (Cameroon, Chile, India and Turkey). In total 19,951 participants were sampled (range 538–9188 in individual studies). The WG question sets on functioning were completed for all participants alongside clinical impairment assessments/questionnaires. Using the WG “some/worse difficulty” cut-off identified people with mild/worse impairments with variable sensitivity (44–79%) and specificity (73–92%) in three of the domains. At least 64% and 60% of people with mild/worse impairments who required referral for surgical/medical and rehabilitation/AP services, respectively, self-reported “some/worse difficulty”, and much fewer reported “a lot/worse difficulty.” For moderate/worse impairment, both screening cut-offs improved identification of service/AP need, but a smaller proportion of people with need were identified. In conclusion, WG questions could be used as a first-stage screening option to identify people with impairment and referral needs, but only with moderate sensitivity and specificity.
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Dunne TF, Chandna J, Majo F, Tavengwa N, Mutasa B, Chasekwa B, Ntozini R, Prendergast AJ, Humphrey JH, Gladstone MJ. Performance of the UNICEF/UN Washington Group tool for identifying functional difficulty in rural Zimbabwean children. PLoS One 2022; 17:e0274664. [PMID: 36112574 PMCID: PMC9480986 DOI: 10.1371/journal.pone.0274664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Over one billion people live with disability worldwide, of whom 80% are in developing countries. Robust childhood disability data are limited, particularly as tools for identifying disability function poorly at young ages. METHODS A subgroup of children enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial (a cluster-randomised, community-based, 2x2 factorial trial in two rural districts in Zimbabwe) had neurodevelopmental assessments at 2 years of age. We evaluated functional difficulty prevalence in HIV-exposed and HIV-unexposed children using the Washington Group Child Functioning Module (WGCFM), comparing absolute difference using chi-squared or Fisher's exact tests. Concurrent validity with the Malawi Developmental Assessment Tool (MDAT) was assessed using logistic regression with cohort MDAT score quartiles, linear regression for unit-increase in raw scores and a Generalised Estimating Equation approach (to adjust for clusters) to compare MDAT scores of those with and without functional difficulty. A 3-step, cluster-adjusted multivariable regression model was then carried out to examine risk factors for functional difficulty. FINDINGS Functional Difficulty prevalence was 4.2% (95%CI: 3.2%, 5.2%) in HIV-unexposed children (n = 1606) versus 6.1% (95%CI: 3.5%, 8.9%) in HIV-exposed children (n = 314) (absolute difference 1.9%, 95%CI: -0.93%, 4.69%; p = 0.14). Functional difficulty score correlated negatively with MDAT: for each unit increase in WGCFM score, children completed 2.6 (95%CI: 2.2, 3.1) fewer MDAT items (p = 0.001). Children from families with food insecurity and poorer housing were more at risk of functional difficulty. INTERPRETATION Functional difficulty was identified in approximately 1-in-20 children in rural Zimbabwe, which is comparable to prevalence in previous studies. WGCFM showed concurrent validity with the MDAT, supporting its use in early childhood.
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Affiliation(s)
- Thomas Frederick Dunne
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Jaya Chandna
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume Tavengwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Batsirai Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Andrew J. Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, United Kingdom
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Melissa J. Gladstone
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
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Norman QA, Dey NEY, Owusu Ansah K, Arthur-Holmes F, Duah HO, Agbadi P. Relationship between mothers'/caregivers' reported learning difficulty and internalizing symptoms (anxiety and depression) of children aged 5-17 years in Ghana. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 119:104108. [PMID: 34653831 DOI: 10.1016/j.ridd.2021.104108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 09/07/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Children with learning difficulties are vulnerable to internalizing symptoms, particularly anxiety and depression. However, only few studies have examined this relationship in low-and-middle-income countries using a nationally representative data. AIMS This study aimed to examine the relationship between learning difficulty and internalizing symptoms of children aged 5-17 years in Ghana while controlling for covariates. METHODS AND PROCEDURES We analyzed children's data using mothers'/caregivers' reports from the 2017/2018 Ghana Multiple Indicator Cluster Survey Six (MICS 6). Data of 8,958 children aged 5-17 years were used for the analysis. OUTCOMES AND RESULTS About 20% of the children had some learning difficulties whereas 5% could not learn at all. Learning difficulty was associated with symptoms of anxiety and depression of children. Specifically, children who had some learning difficulties had higher odds of feeling anxious [APOR = 1.28, 95% CI:1.11, 1.49, p = 0.001] while those with some difficulties [APOR=1.24, 95% CI:1.07, 1.44, p = 0.004] and a lot of difficulties or could not learn at all [APOR=1.74, 95% CI:1.28, 2.37, p < 0.01] had higher odds of feeling depressed. CONCLUSION AND IMPLICATIONS The findings call on stakeholders in education and health to prioritize the mental health of all school-going children, particularly those with learning difficulties in Ghana.
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Affiliation(s)
| | | | | | - Francis Arthur-Holmes
- Department of Sociology and Social Policy, Lingnan University, Tuen Mun, 8 Castle Peak Road, Hong Kong Special Administrative Region
| | | | - Pascal Agbadi
- Department of Sociology and Social Policy, Lingnan University, Tuen Mun, 8 Castle Peak Road, Hong Kong Special Administrative Region
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Robinson A, Nguyen L, Smith F. Use of the Washington Group Questions in Non-Government Programming. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11143. [PMID: 34769661 PMCID: PMC8582947 DOI: 10.3390/ijerph182111143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 12/01/2022]
Abstract
The Washington Group questions (WGQ) on functioning have been widely promoted as the go-to tool for disability data collection. Designed for use by government, the WGQ have been adopted by non-government organizations (NGOs) for use in programming. However, little is known about how the WGQs are being used by NGOs or how use may be contributing to disability inclusion. METHOD This paper describes exploratory research on the use of the WGQ in NGO programming. An online survey provided an overview of adoption followed by semi-structured interviews from a purposive sample to explore data collection, analysis, and use. RESULTS Thematic analysis showed limited inclusion outcomes directly attributable to use of the WGQ, adoption driven by individual champions rather than systematically across organizations, and challenges in data collection resulting in a wide range of prevalence rates. What information the WGQ can realistically contribute to programs was also overestimated. However, the process of using the WGQ was raising awareness on disability inclusion within program teams and communities. CONCLUSION Acknowledging differences in emerging use by NGOs beyond the WGQ's intended purpose, alongside promoting a flexible and staged approach to adoption and use in programming, may improve utility and disability inclusion outcomes over time.
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Affiliation(s)
- Alex Robinson
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC 3010, Australia; (L.N.); (F.S.)
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Sprunt B, Marella M. Combining Child Functioning Data with Learning and Support Needs Data to Create Disability-Identification Algorithms in Fiji's Education Management Information System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179413. [PMID: 34501998 PMCID: PMC8431482 DOI: 10.3390/ijerph18179413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022]
Abstract
Disability disaggregation of Fiji’s Education Management Information System (FEMIS) is required to determine eligibility for inclusive education grants. Data from the UNICEF/Washington Group Child Functioning Module (CFM) alone is not accurate enough to identify disabilities for this purpose. This study explores whether combining activity and participation data from the CFM with data on environmental factors specific to learning and support needs (LSN) more accurately identifies children with disabilities. A survey on questions related to children’s LSN (personal assistance, adaptations to learning, or assessment and assistive technology) was administered to teachers within a broader diagnostic accuracy study. Descriptive statistics and correlations were used to analyze relationships between functioning and LSN. While CFM data are useful in distinguishing between disability domains, LSN data are useful in strengthening the accuracy of disability severity data and, crucially, in identifying which children have disability amongst those reported as having some difficulty on the CFM. Combining activity and participation data from the CFM with environmental factors data through algorithms may increase the accuracy of domain-specific disability identification. Amongst children reported as having some difficulty on the CFM, those with disabilities are effectively identified through the addition of LSN data.
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Inge D, Pedro Celestino ÁV, Ximena del Carmen PB, Celia Katherine RA, Peter P, Jo L. Lessons from Disability Counting in Ecuador, with a Contribution from Primary Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5103. [PMID: 34065836 PMCID: PMC8151690 DOI: 10.3390/ijerph18105103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022]
Abstract
Disability data are essential for policy. Yet, the predominant use of disability prevalence for service planning reflects dichotomous counting, increasingly less compatible with current disability thinking. Difficulties relate to variations in rates, the lack of matching with needs, and the use of prevalence to compare disability situations. From the perspective of Primary Health Care (PHC), we explore methods for disability counting regarding the usefulness of prevalences in identifying persons with disabilities and meeting their needs with local service implementation. First, we analyze the methods and results of six national cross-sectional studies in Ecuador. Then, we present a case about an exploratory needs-driven method for disability counting in a local PHC setting. The analysis of variations in rates focuses the attention on reasons for and risks of a priori exclusion of persons with disabilities from services. Longitudinal disability counting as a collateral result of meeting needs in the PHC setting yields local disability data worthy of further exploration. Thinking about disability counting from a PHC scope in a developing country prompted reflection on the comparison of prevalences to evaluate disability situations. Findings invite further exploration of the needs-driven counting method, its contributions to planning local services, and complementarity with cross-sectional disability counting.
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Affiliation(s)
- Debrouwere Inge
- Fundación Tapori Paladines de la Felicidad, Quito 170308, Ecuador; (Á.V.P.C.); (P.B.X.d.C.); (R.A.C.K.)
| | - Álvarez Vera Pedro Celestino
- Fundación Tapori Paladines de la Felicidad, Quito 170308, Ecuador; (Á.V.P.C.); (P.B.X.d.C.); (R.A.C.K.)
- Department of Psychology, Universidad Politécnica Salesiana—Sede Quito, Quito 170308, Ecuador
| | | | - Rosero Arboleda Celia Katherine
- Fundación Tapori Paladines de la Felicidad, Quito 170308, Ecuador; (Á.V.P.C.); (P.B.X.d.C.); (R.A.C.K.)
- Teaching Department, Hospital Voz Andes Quito, Quito 170308, Ecuador
| | - Prinzie Peter
- Dominiek Savio Institute, Dienstencentrum GID(t)S, 8830 Hooglede-Gits, Belgium;
- Department of Psychology, Education and Child Studies, Faculty of Social and Behavioural Sciences, Erasmus University Rotterdam, 3000 DR Rotterdam, The Netherlands
| | - Lebeer Jo
- Disability Studies, Faculty of Medicine and Health Sciences, Family Medicine & Population Health, University of Antwerp, 2610 Wilrijk, Belgium;
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A Rehabilitation Framework for Children Living With HIV in South Africa: Reaching Consensus for a Resource-Poor Community. J Assoc Nurses AIDS Care 2020; 31:228-240. [PMID: 31764208 DOI: 10.1097/jnc.0000000000000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although rehabilitation frameworks for adults living with HIV are developing steadily, interventions to ensure the integration of rehabilitation into the routine care of children living with HIV-related disabilities lags. We sought to explore perceptions of, and gain expert consensus on, a rehabilitation framework for children living with HIV. Experts in HIV pediatric care in South Africa engaged in a Delphi survey, based on findings from a context-specific rehabilitation framework for adults. Consensus was determined by an a priori threshold of 80% agreement and an interquartile range of 1 or lower on criteria to be included as essential or useful in the framework. Experts agreed that enhancing access to patient-centered care through decentralization and training of health care and community care workers in the use of disability screening tools at each point of care needed to be included in the framework. Strengthening multiprofessional team collaboration was also seen as fundamental.
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Ng K, Asunta P, Leppä N, Rintala P. Intra-Rater Test-Retest Reliability of a Modified Child Functioning Module, Self-Report Version. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17196958. [PMID: 32977572 PMCID: PMC7579571 DOI: 10.3390/ijerph17196958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/02/2022]
Abstract
Determining disability prevalence is a growing area for population statistics, especially among young adolescents. The Washington Group on Disability Statistics is one source of reporting disabilities through functional difficulties. Yet, young adolescents self-reporting through this measure is in its infancy. The purpose of this study was to carry out an intra-rater test-retest reliability study on a modified set of items for self-reporting functional difficulties. Young adolescents (N = 74; boys = 64%; age M = 13.7, SD = 1.8) with special educational needs in Finland completed a self-reported version of the Child Functioning Module in a supervised classroom. The second administration took place two weeks later. Intraclass correlation coefficient (ICC) and Kappa (k) statistics were used to test the reliability of the items, and interpretation took place through Landis and Koch, and Cohen, respectively. The majority of items had substantial or moderate agreement, although there was only fair agreement for self-care (ICC = 0.59), concentration (ICC = 0.50), and routine changes (ICC = 0.54). Kappa statistics of behavior control were interpreted to be large (k = 0.65), and seeing (k = 0.49), walking (k = 0.49), and speaking (k = 0.49) difficulties were moderate. The majority of the items in the self-reported version of the Child Functioning Module can be used in a scale format, although some caution may be required on items of self-care and concentration when used as a dichotomous variable.
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Affiliation(s)
- Kwok Ng
- School of Educational Sciences and Psychology, University of Eastern Finland, 80101 Joensuu, Finland
- Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Limerick V94 T9PX, Ireland
- Correspondence:
| | - Piritta Asunta
- LIKES Physical Activity for Health Research Centre, 40700 Jyväskylä, Finland;
| | - Niko Leppä
- Spesia Vocational College, Keskussairaalantie 21, 40620 Jyväskylä, Finland;
| | - Pauli Rintala
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylä, Finland;
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Child functioning and disability in children living with human immunodeficiency virus in a semi-rural healthcare setting in South Africa. Afr J Prim Health Care Fam Med 2020. [PMCID: PMC7433250 DOI: 10.4102/phcfm.v12il.2259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Children living with HIV (CLHIV) often experience HIV-related impairment and disability. Aim The study sought to understand the level of child functioning and access to rehabilitative care in the context of South African healthcare in order to inform an integrated rehabilitative framework. Setting District level semi-rural healthcare facility in KwaZulu-Natal. Methods The Washington Group/United Nations International Children’s Emergency Fund Module on Child Functioning, was administered to carers of CLHIV aged between 5 and 10 years, and accessing care at the study setting. Results Forty-four caregivers of children receiving treatment from June 2018 to March 2019, at the facility, participated. Four (9.1%) children had difficulty with seeing, 13 (29.5%) children had difficulty with hearing and 10 (22.7%) children had difficulty with walking. In the cognitive and behavioural domains, 17 (38.6%) children reported difficulties in communication and concentration, with 16 (36.4%) children experiencing difficulties in learning and remembering. Difficulties reported in accepting change and controlling behaviour were both experienced by 23 (52.3%) children. Although many children experiencing impairments were referred for rehabilitation, many caregivers did not follow-up after the initial assessment, because of financial constraints, lack of time and transport restrictions. Conclusion Functional difficulties were frequently experienced by children living with HIV. Disability screening would be beneficial at various points of care to promote early identification and timely referral to healthcare professionals. Decentralising rehabilitative care to homes and communities could offer a solution to some of the reported barriers to accessing care.
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