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Modula MJ, Chipu MG. Exploring information needs among family caregivers of children with intellectual disability in a rural area of South Africa: a qualitative study. BMC Public Health 2024; 24:1139. [PMID: 38658872 PMCID: PMC11040777 DOI: 10.1186/s12889-024-18606-7] [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: 07/10/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Globally, families experience challenges caring for and raising children with intellectual disability (ID). Family caregivers in rural states are mostly known for lacking support resources, including information on understanding the care of ID. Lack of adequate information on understanding of ID compromises the provision of life-long care and support of the children with ID's physical, emotional, psychological and social developmental well-being. The study aimed to explore the information needs of family caregivers regarding the care of children with ID in rural areas of Limpopo Province, South Africa. METHODS This qualitative explorative research conducted 16 in-depth individual interviews and one focus group discussion with ten family members. The participants shared their experiences of raising children with ID in rural communities. Inductive thematic analysis using Atlas Ti software categorised emerging themes and subthemes of this study from merged data sets on information needs regarding the care of children with ID among family caregivers. RESULTS The findings highlighted the need for information regarding ID care among family caregivers raising children with ID in the home environment. The information challenges experienced by family caregivers include caring for the challenging behaviour of children with ID and available support resources and services for the children and their families. These challenges impact the care and support required to meet the developmental needs of children with ID. Furthermore, inadequate information on ID among family caregivers in rural communities with a lack of resources restricts the children from accessing required support services. CONCLUSIONS Given the information challenges these families face on ID, the stakeholders must develop continuous training programmes that will equip, empower, and further monitor ID care and management among family caregivers to enhance care and the raising of children with dignity.
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Affiliation(s)
- Mantji Juliah Modula
- School of Nursing, Faculty of Health Sciences, University of Free State, Nelson Mandela Drive, 9301, Bloemfontein, Free State Province, South Africa.
| | - Mpho Grace Chipu
- School of Nursing, Faculty of Health Sciences, University of Free State, Nelson Mandela Drive, 9301, Bloemfontein, Free State Province, South Africa
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Smythe T, Chen S, Rotenberg S, Unger M, Miner E, Seghers F, Servili C, Kuper H. Do children with disabilities have the same opportunities to play as children without disabilities? Evidence from the multiple indicator cluster surveys in 38 low and middle-income countries. EClinicalMedicine 2024; 67:102361. [PMID: 38169717 PMCID: PMC10758749 DOI: 10.1016/j.eclinm.2023.102361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024] Open
Abstract
Background Play is essential for the cognitive, social, and emotional development of all children. Disparities potentially exist in access to play for children with disabilities, and the extent of this inequity is unknown. Methods Data from 212,194 children aged 2-4 years in 38 Low and Middle-Income Countries were collected in the UNICEF supported Multiple Indicator Cluster Survey (2017-2020). Disability was assessed by the Washington Group-Child Functioning Module. Logistic regression models were applied to investigate the relationship between disability and play opportunities, controlling for age, sex, and wealth status. Meta-analysis was used to pool the estimates (overall, and disaggregated by sex), with heterogeneity assessed by Cochran's Q test. Findings Children with disabilities have approximately 9% fewer play opportunities than those without disabilities (adjusted RR [aRR] = 0.88, 95% CI = 0.82-0.93), and this varied across countries. Mongolia and Democratic Republic of São Tomé and Príncipe had the lowest likelihood of play opportunities for children with disabilities ((aRR = 0.26, 95% CI = 0.09-0.75; aRR = 0.46, 95% CI = 0.23-0.93, respectively). Moreover, children with disabilities are 17% less likely to be provided with opportunities to play with their mothers (aRR = 0.83, 95% CI: 0.73-0.93), which is further reduced for girls with disabilities (aRR = 0.74, 95% CI: 0.60-0.90) compared to their peers without disabilities. The associations varied by impairment type, and children with communication and learning impairments are less likely to have opportunities for play with aRR of 0.69 (95% CI: 0.60-0.79) and 0.78 (95% CI: 0.71-0.86), compared to those without disabilities, respectively. Interpretation Children with disabilities are being left behind in their access to play and this is likely to have negative impacts on their overall development and well-being. Funding HK and TS are funded by HK's NIHR Global Research Professorship (NIHR301621). SR is funded by a Rhodes Scholarship. This study was funded by the Programme for Evidence to Inform Disability Action (PENDA) grant from the UK Foreign, Commonwealth and Development Office.
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Affiliation(s)
- Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel st, WC1E 7HT, London, UK
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, 8000, South Africa
| | - Shanquan Chen
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel st, WC1E 7HT, London, UK
| | - Sara Rotenberg
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, OX2 6GG, UK
| | - Marianne Unger
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, 8000, South Africa
| | - Emily Miner
- Clinton Health Access Initiative, Boston, MA, 02127, USA
| | | | - Chiara Servili
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel st, WC1E 7HT, London, UK
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Chaudhry N, Sattar R, Kiran T, Wan MW, Husain M, Hidayatullah S, Ali B, Shafique N, Suhag Z, Saeed Q, Maqbool S, Husain N. Supporting Depressed Mothers of Young Children with Intellectual Disability: Feasibility of an Integrated Parenting Intervention in a Low-Income Setting. CHILDREN (BASEL, SWITZERLAND) 2023; 10:913. [PMID: 37371145 DOI: 10.3390/children10060913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 06/29/2023]
Abstract
As a lifelong condition, intellectual disability (ID) remains a public health priority. Parents caring for children with ID experience serious challenges to their wellbeing, including depression, anxiety, stress and health-related quality of life. Integrated parenting interventions, which have been well evidenced for depressed mothers, may also effectively support depressed parents with a child with ID in low-resource settings such as Pakistan, and in turn optimise child outcomes. We conducted a mixed-method rater-blind feasibility randomised controlled trial, which assessed the feasibility and acceptability of the Learning Through Play in My Own Way Plus (LTP-IMOW Plus) intervention. Mothers who screened positive for depression (n = 26) with a young child (age 3-6 years) with ID were recruited from two low-resource community settings. Participants in the intervention arm (n = 13) received 12 group sessions of LTP-IMOW Plus and others (n = 13) received routine care. The intervention was feasible and acceptable with 100% retention and 100% session attendance. The intervention improved depression, anxiety, parenting stress and child socialisation score outcomes relative to the routine care arm. The framework utilised to analyse the qualitative interviews with seven participants at pre-intervention identified a range of struggles experienced by the mothers, and at post-intervention, found improved knowledge of child development and practices, improved mother-child relationships, recommendations for the intervention and perceived practical barriers and facilitators. The findings highlight the prospects for a clinical and cost-effective trial of an integrated parenting intervention to manage long-term parental mental health needs and improve child outcomes.
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Affiliation(s)
- Nasim Chaudhry
- Pakistan Institute of Living and Learning, Karachi 75600, Pakistan
| | - Rabia Sattar
- Pakistan Institute of Living and Learning, Karachi 75600, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi 75600, Pakistan
| | - Ming Wai Wan
- Division of Psychology and Mental Health, University of Manchester, Manchester M13 9PL, UK
| | - Mina Husain
- Department of Psychiatry, University of Toronto, Toronto, ON M5S IR8, Canada
| | | | - Bushra Ali
- Pakistan Institute of Living and Learning, Karachi 75600, Pakistan
| | - Nadia Shafique
- Department of Psychology, Foundation University Islamabad, Rawalpindi 44000, Pakistan
| | - Zamir Suhag
- TVI-Trust for Vaccines and Immunization, Head Office, Suite No 301, Al-Sehat Centre, Rafiqui Shaheed Road, Karachi 74000, Pakistan
| | - Qamar Saeed
- School of Public Health, Dow University of Health Sciences DUHS, Karachi 74200, Pakistan
| | - Shazia Maqbool
- Department of Developmental-Behavioral Pediatrics, The Children's Hospital, (UC HS-CH), University of Child Health Sciences, Lahore 54600, Pakistan
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester M13 9PL, UK
- Mersey Care NHS Foundation Trust, Prescot L34 1PJ, UK
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Trafford Z. 'People don't understand what we go through!': Caregiver views on South Africa's care dependency grant. Afr J Disabil 2023; 12:1114. [PMID: 36876023 PMCID: PMC9982474 DOI: 10.4102/ajod.v12i0.1114] [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: 08/22/2022] [Accepted: 11/08/2022] [Indexed: 02/24/2023] Open
Abstract
Background Caregivers are under enormous pressure in trying to provide for the needs of their children with disabilities in South Africa. The care dependency grant (CDG), an unconditional cash transfer, is the primary state-subsidised intervention for the social protection of low-income caregivers of children with disabilities. Objectives The primary objective of this substudy, within a larger multistakeholder qualitative project, was to investigate caregiver perspectives on CDG assessment and application, their beliefs about the purpose of the CDG and how they actually used these funds. Methods Data for this qualitative research included in-depth individual interviews and one focus group discussion. Six low-income caregivers who were current or previous CDG beneficiaries participated. Deductive thematic analysis was conducted using codes related to the objectives. Results Access to the CDG was usually too late and over-complicated. Caregivers were grateful for the CDG but it was insufficient to cover the costs of care, in the context of high unemployment and weaknesses in complementary social services. Pressure on these caregivers was intensified by criticism in their social environments and a lack of respite care. Conclusion Caregivers need service providers to be better trained and for systems of referral to available social services to be strengthened. The whole of society ought also to be targeted for increased social inclusion facilitated by improvements in understandings of the lived experience and cost of disability. Contribution The rapid time from data collection to write-up of this study will aid in building the evidence base on the CDG, an urgent priority for South Africa's journey towards comprehensive social protection.
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Affiliation(s)
- Zara Trafford
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
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Mohamed AR, Sterkenburg P, van Rensburg E, Schuengel C. Adapting Attachment and Biobehavioral Catch-up for infants and young children with intellectual disabilities and developmental delays in South Africa: Reflections and recommendations from local stakeholders. Infant Ment Health J 2023; 44:54-75. [PMID: 36538474 PMCID: PMC10107761 DOI: 10.1002/imhj.22027] [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: 05/22/2022] [Accepted: 10/02/2022] [Indexed: 12/24/2022]
Abstract
Attachment and Biobehavioral Catch-up (ABC) is an intervention targeted at enhancing the socioemotional and regulatory functioning of at-risk infants. However, to use the ABC for infants/toddlers with intellectual disabilities/developmental delays (ID/DD) and in novel cultural contexts, such as South Africa, adaptations may be required. This study aimed, therefore, to explore the opinions of clinical experts and perceptions of caregivers regarding the use of ABC for children with ID/DD in South Africa. It also sought to incorporate the experiences of families of children with ID/DD who received, and intervenors who delivered, ABC in its first implementation in South Africa. Semi-structured interviews were conducted with 18 participants. Thematic analysis explicated 12 main themes: Intervention Strengths, Points of Concern, and Recommendations (Experts); Focus on Caregiver-child Relationship, and Intervention Targets and Duration (Caregivers); Benefits of ABC, and Cultural Considerations (ABC Recipients); Focused and Targeted, Value of Feedback, Supportive Supervision, Working Alliance, and Challenges Experienced (ABC Intervenors). Practice and training recommendations include psychoeducation for parents and training for intervenors that is ID/DD-specific, expanding supervision capacity, building intervenors' cultural/linguistic sensitivity and competence, accessing referral networks, including local Community Health Workers as intervenors, and greater flexibility in how the sessions are organized.
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Affiliation(s)
- Ahmed Riaz Mohamed
- Department of Clinical Child and Family Studies, and Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands.,Department of Psychology, North-West University, Potchefstroom, South Africa.,Department of Psychology, University of Pretoria, Pretoria, South Africa
| | - Paula Sterkenburg
- Department of Clinical Child and Family Studies, and Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands.,Department of Assessment and Treatment, Bartiméus, Doorn, Netherlands
| | - Esmé van Rensburg
- Department of Psychology, North-West University, Potchefstroom, South Africa
| | - Carlo Schuengel
- Department of Clinical Child and Family Studies, and Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
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Modula MJ, Sumbane GO. Families' Experiences on Safety Needs of Children with Intellectual Disability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15246. [PMID: 36429964 PMCID: PMC9690227 DOI: 10.3390/ijerph192215246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/23/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Children with intellectual disability (ID) are known to have a deficit in self-care, social interaction, and learning abilities. Families raising these children experience a range of difficulties that require supportive systems to meet the physical, psychological, and social safety rights of children with ID. The study explored the safety of children with ID through the experiences of their families in the rural Capricorn District of Limpopo Province, South Africa. METHODS In-depth individual interviews and focus group discussion were conducted with 26 families directly involved in raising the children with ID. An inductive thematic analysis of data on the experiences of raising children with ID was undertaken with the aid of ATLAS.ti 8 computer programme. RESULTS The study revealed that children with ID lack safety at home, schools, and day care centre environments due to a lack of active involvement by nuclear family members, neighbours, and communities, including interaction with their peers and professional service providers in facilities. Safety of children with ID is compromised through exploitation and injuries, leading to marginalisation as they feared further humiliation. CONCLUSION The study highlighted that active involvement of family members, communities, and governmental and non-governmental organisations is crucial in ensuring safe environments for children with ID.
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Affiliation(s)
- Mantji Juliah Modula
- School of Nursing, Faculty of Health Sciences, University of Free State, Bloemfontein 9300, South Africa
| | - Gsakani Olivia Sumbane
- School of Medicine, Faculty of Health Sciences, University of Limpopo, Polokwane 0727, South Africa
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