Five challenges for disability-related research in sub-Saharan Africa

Disability policy and practice in Malawian employment and education

Malawi is a landlocked country in Southern Africa with a population of 17.5 million. It has taken great strides in addressing disability inequality in recent years. Despite this, Malawian trade unions, educators and disability activists report wide-reaching disability discrimination at an infrastructural and individual level. Situated at the intersections between disability studies and medical sociology, alongside work of postcolonial and Global South scholars, this article highlights how neo-colonial and Anglocentric dominant framings of disability do not necessarily fit the Malawian workforce, as they ignore cultural and structural differences in the causes and maintenance of ill health and disability. Building on interviews with workers with disabilities, trade unionists, educators, government representatives and disability activists in Malawi's two biggest cities, the article emphasises the need to address specific local contexts; while policy asserts a model of social oppression, in practice, disability inclusion requires recognition of the social determinants of disability and inequality, and the economic, political and cultural context within which disability resides. Sharing co-designed approaches to engaging with disability definitions, stigma, language, infrastructure and resources, this article highlights the necessity of grounding disability and medical sociological theory in localised framings and lived experiences.

Promoting regional coherence and cohesion amidst multiple assistive technology initiatives in Africa

Background

Appropriate provision of assistive technology services (ATS) and products are a global health issue and essential for achieving the Sustainable Development Goals (SDGs). The Sixth African Network for Evidence-to-Action on Disability (AfriNEAD) conference included a workshop on collaboration, cohesion and coherence in ATS delivery in Africa.

Objective

This article aimed to summarise the workshop proceedings and to provide some recommendations on how coherence and cohesion can be facilitated in assistive technology services in Africa.

Method

A round table and small group discussions on assistive technology were facilitated in the virtual space of the AfriNEAD conference. Organisations and role players in ATS and products in Africa participated as keynote speakers, round table members and in small group discussions.

Results

There was consensus amongst participants that cohesive collaboration must be facilitated. They further agreed that users must be central to future action. There are local, national and regional initiatives, but none of these have grown into an African assistive technology platform. World Health Organization (WHO) Africa can bring partners together and facilitate creation, officialisation and operationalising of a continental assistive technology platform, through building on the existing initiatives. The AfriNEAD disability research country working groups can act as in-country coordinating bodies for ATS and afford a possibility of a structured approach to assistive technology research.

Conclusion

It is time to break away from Western institutionalised biomedical ways of providing ATS in Africa. Africans must develop coherent, cohesive ATS driven by empowered users who build on Africa's strengths and addresses the continents' unique needs.

Access to healthcare for people with disabilities in South Africa: Bad at any time, worse during COVID-19?

People with disabilities, especially those living in low- and middle-income countries, experience significant challenges in accessing healthcare services and support. At times of disasters and emergencies, people with disabilities are further marginalised and excluded. During the coronavirus disease 2019 (COVID-19) pandemic, many people with disabilities are unable to access healthcare facilities, receive therapeutic interventions or rehabilitation, or gain access to medication. Of those who are able to access facilities, many experience challenges, and at times direct discrimination, accessing life-saving treatment such as intensive care unit admission and ventilator support. In addition, research has shown that people with disabilities are at higher risk of contracting the virus because of factors that include the need for interpersonal caregivers and living in residential facilities. We explore some of the challenges that people with disabilities residing in South Africa currently experience in relation to accessing healthcare facilities.

African families' and caregivers' experiences of raising a child with intellectual disability: A narrative synthesis of qualitative studies

Background

The prevalence of intellectual disability was high in Africa, particularly amongst low socio-economic communities. Despite this, there was limited literature on primary caregivers and parents of people with intellectual disabilities regarding their experience raising an individual with the condition, especially within the African context.

Objectives

The aim of the current systematic review was to investigate experiences of caregivers and parents of children with intellectual disability in Africa.

Method

We used strict eligibility criteria to identify suitable studies. We identified Medical Subject Headings (MeSH) terms and other keyword terms and, after conducting searches in electronic databases, identified articles that met the inclusion criteria for articles published between 1975 and the end of 2019.

Results

164 articles were assessed for eligibility. Nine studies met the review's criteria. Six major themes emerged: understanding of intellectual disability (ID), worries about the future, burden of care, lack of services, coping strategies and stigma and discrimination.

Conclusion

Caregivers of children with intellectual disability in Africa faced substantial challenges. Current findings suggested that there was the need for both formal and alternative healthcare workers to work together towards an understanding and management of intellectual disability in Africa.

'Satan is holding your tongue back': Stuttering as moral failure

Background

The last decade has seen researchers and speech–language pathologists employ and advocate for a disability studies approach in the study of the lived experiences of people who stutter and in the design of interventions and treatment approaches for such individuals. Joshua St. Pierre, one of the few theorists to explore stuttering as a disability, mentions as a key issue the liminal nature of people who stutter when describing their disabling experiences.

Objectives

This article aimed to build on the work of St. Pierre, exploring the liminal nature of people who stutter.

Method

Drawing on my personal experiences of stuttering as a coloured South African man, I illuminated the liminal nature of stuttering.

Results

This analytic autoethnography demonstrates how the interpretation of stuttering as the outcome of moral failure leads to the discrimination and oppression of people who stutter by able-bodied individuals as well as individuals who stutter.

Conclusion

As long as stuttering is interpreted as the outcome of moral failure, the stigma and oppression, as well as the disablism experience by people who stutter, will continue to be concealed and left unaddressed.

More Than Just Assistive Devices: How a South African Social Enterprise Supports an Environment of Inclusion

Appropriate assistive technology has the potential to considerably enhance quality of life, access to health and education, and social and economic participation for people with disabilities. Most disabled people in the world live in low- and middle-income countries where access to assistive devices and other support is severely lacking. There is little evidence that describes contextually relevant approaches to meeting these needs, particularly in African countries. We provide a detailed description of a South African organisation which has manufactured mobility and seating devices for children with disabilities since 1992. The Shonaquip Social Enterprise (SSE) also trains and builds capacity among a wide range of stakeholders (caregivers, health workers, educators, government, and communities) to acknowledge and advocate for the wellbeing of disabled children and adults, and works closely with government to strengthen existing service provisions. Using examples from the SSE, we highlight a number of useful principles to consider when trying to provide for the needs of people with disabilities, particularly in low-resource settings. While access to assistive devices is important, devices have limited capacity to improve participation if the broader environment is overly restrictive and stigmatising. Improved access to devices ought to be situated within a range of broader efforts to increase the inclusion and participation of people with disabilities.

Caregivers' and parents' explanatory models of intellectual disability in Khayelitsha, Cape Town, South Africa

BACKGROUND

Post-apartheid, understanding and management of intellectual disability remain poor in South Africa, complicated by various contextual and cultural explanations used to describe and conceptualize this condition.

METHOD

We conducted 20 semi-structured interviews with primary caregivers and parents of children with intellectual disability residing in Khayelitsha, a low-income setting in Cape Town, South Africa. We used Kleinman's Explanatory Models (EMs) of illness to explore terms used to describe and conceptualize this condition.

RESULTS

Carers' explanatory models included biomedical causes, injuries during pregnancy or birth, as well as spiritual causes. It was reported that there were significant difficulties in accessing services and support, and difficulties with coping in the context of extreme poverty and deprivation.

CONCLUSIONS

Current findings highlight a need for collaboration between the biomedical and alternative healthcare systems in educating carers and parents regarding intellectual disability.

A comparative analysis of disability measures in Cameroonian surveys

Background

Although identifying vulnerable groups is an important step in shaping appropriate and efficient policies for targeting populations of disabled people, it remains a challenge. This study aims to evaluate for the first time the comparability of the different disability measurements used in Cameroon. This is done by comparing them with the international standards proposed by the Washington Group (WG). It also evaluates the consistency of the association between the disability as measured by these surveys and the sociodemographic characteristics.

Method

We used data from the third Cameroonian Population and Housing Census (3RGPH) of 2005, the third Cameroonian Household survey (ECAM3) of 2007, the Demographic Health and Multiple Indicator Cluster Survey (DHS-MICS) of 2011 and a survey conducted on adults in Yaoundé (HandiVIH) in 2015 with the WG tool. The proportion and their confidence intervals, chi-square tests and multivariate logistic regressions are used for analyses.

Results

In the city of Yaoundé and for the 15–49 age group, disability prevalence was estimated at 3.6% (CI = [2.5, 5.1]), 2.7% CI = [2.1, 3.5]), 2.6% (CI = [2.4, 2.7]) and 1.0% (CI = [1.0, 1.10]), according to DHS-MICS, ECAM3, HandiVIH and 3RGPH, respectively. The prevalence of severe motor and mental disabilities in DHS-MICS (0.4% CI = [0.2, 0.8], 1.1% CI = [0.7, 1.8] and 0.5% CI = [0.2, 1.1], respectively) are not significantly different from the findings of HandiVIH (0.3% CI = [0.2, 0.3], 0.8% CI = [0.7, 0.9] and 0.5% CI = [0.5, 0.6], respectively). Only motor disability prevalence in ECAM3 (0.8%, CI = [0.5, 1.2]) is not different from that of HandiVIH. When the WG screening tool is used in HandiVIH, disability is positively associated with age, negatively associated with educational level, being in a union and socioeconomic status (SES) and it is not associated with sex. Severe disability, for its part, is not associated with SES and is positively associated with being a male. A different association trend is observed with 3RGPH, ECAM3 and DHS-MICS.

Conclusion

None of the instruments used in the nationally representative Cameroonian surveys produced both disability prevalence and association trends that are exactly similar to those obtained when using the WG disability screening tool, thus highlighting the necessity to include the WG questions in nationally representative surveys.

"What Can We Learn From First-Person Narratives?" The Case of Nonfatal Suicidal Behavior

Responding to the limitations of dominant biomedical quantitative approaches to suicide research, scholars have called for qualitative research documenting first-person narratives of suicide to gain access to the "true experts." This raises questions about what we can learn about suicide from first-person narratives. In this article, we critically examine the practice of analyzing first-person narratives of nonfatal suicidal behavior to make truth claims about the causes of suicide. We make explicit the assumptions that underlie the interpretation of first-person narratives and draw on research within cognitive neuropsychology and social psychology to explore how memory processes, perception, and attribution errors might influence the way individuals narrate their experience. We employ literature from narrative theory and life-writing to argue that narratives about nonfatal suicidal behavior are at best partial accounts which are constructed within very particular circumstances, making it impossible to interpret them as revealing the true causes of suicide.

Troubling stereotypes: South African elite disability athletes and the paradox of (self-)representation

Despite the increasing prominence of competitive disability sport, the literature on the experiences of disabled athletes, particularly in low- and middle- income countries, is sparse. We aimed to describe the participation experiences of a group of athletes in competitive disability sport in South Africa, as well as exploring the ways they talk about issues of identity and self-representation in the context of elite disability sport. Data were collected via in-depth, semistructured interviews with a purposefully sampled group of 22 athletes competing at a national level. Interviews were analyzed using thematic analysis. Participants reported that disability sport is personally transformative and that sport allows them to experience their bodies as capable and to feel a sense of pride. Participant narratives reinforced supercrip discourses and both reproduced stereotypes and challenged them. Participants experienced pride and social inclusion by reproducing aspects of supercrip discourse. The findings imply that participating in competitive disability sport can reinforce stereotypes about disability by strengthening supercrip discourses while simultaneously providing a context for internal personal transformation and private political struggles.

Simple ideas that work: Celebrating development in persons with profound intellectual and multiple disabilities

BACKGROUND

The purpose of this article is to share some lessons learnt by an interdisciplinary therapy team working with persons with profound intellectual and multiple disabilities (PIMD), implemented in diverse, low-income contexts over a period of 8 years.

OBJECTIVES

The objective of all the activities described here was to provide increased stimulation and development opportunities for persons with PIMD within different settings (day care centre, residential centre or family home).

METHOD

We used an iterative action-learning approach where we applied existing evidence in the given context, reflected on and adapted strategies in collaboration with stakeholders on a cyclical basis. We focussed on achieving our objectives through ongoing hands-on training of the carers involved with the clients as we felt that by providing them with the knowledge and skills needed, plus ongoing support, these programmes would be more sustainable.

FINDINGS

It took some time to put systems in place in care settings, but once they became part of the daily routine, they provided increased opportunities for learning for clients with PIMD. In addition, there were often marked changes in individual clients' communicative and physical functioning, which in turn encouraged carers to find new and different ways to interact with, and stimulate, the persons with PIMD in their care.

CONCLUSION

Our hope is that parents and carers or professionals working in the field of PIMD in low-income contexts elsewhere may find one, some or all of these simple ideas useful in providing opportunities for learning, development and enjoyment for persons with PIMD.

The cultural turn in critical suicidology: What can we claim and what do we know?

The cultural turn in critical suicidology notes the limitations of dominant acontextual, biomedical, quantitative approaches to suicide prevention. Qualitative methods are idealized within this cultural turn as the only way to advance suicidology. Qualitative methods, however, also have limitations. Drawing on our research with traditional healers in South Africa, the authors explore tensions associated with making truth claims based on qualitative research. Turning the critical gaze on their work, they consider the question of what we can claim to know about suicide prevention when investigating culture using qualitative methods. The authors suggest a circumspect approach to making truth claims about what the cultural turn can achieve.