Disability In Low-income Countries Research Articles

Creating Family-Centred Support for Preschoolers with Developmental Disabilities in Low-Income Countries: A Rapid Review to Guide Practitioners.

Preschoolers with disabilities and their caregivers have been neglected in health and social service provision in most low-income countries and arguably also in low-resourced areas of more affluent nations. Yet as this rapid review of the published literature identifies, there are low-cost, evidence-based strategies to address their needs that can be implemented in communities by local people. Five key features of the necessary supports are examined. First, the leadership functions required to create and implement the support services. Second, the family-centred, home-based support provided to caregivers and the personnel undertaking this form of support. Third, providing opportunities for peer support to flourish and encouraging the formation of advocacy groups across families. Fourth, mobilizing the support of significant groups within the community: notably, traditional healers and leaders, health services and poverty alleviation initiatives. Fifth, devising ways in which preschool educational opportunities can be offered to children as a prelude to their inclusion in primary schools. The review serves a further purpose. It provides an example of how public health researchers and academics could achieve more rapid implementation of evidence-based knowledge into existing and new support services through dissemination to community practitioners.

Glycemic control and its associated factors among adult diabetic patients in Southern Ethiopia: a cross-sectional study.

Diabetes mellitus is a group of common metabolic disorders that share the phenotype of hyperglycemia. Chronic hyperglycemia causes vascular complications, mortality, and life-threatening disabilities in low-income countries including Ethiopia. Glycemic control status in diabetic patients is crucial to maintain the blood glucose level at the optimal level and to reduce the risk of diabetes-related complications and mortality. However, there is limited data on poor glycemic control status and its associated factors among diabetic patients in southern Ethiopia, particularly in the study area. Thus, this study aimed to determine glycemic control status and its associated factors using glycated hemoglobin among adult diabetic patients at Nigist Elleni Mohammad Memorial Referral Hospital, Hossana, southern Ethiopia. A facility-based cross-sectional study was conducted from May 1 to June 30, 2020. A systematic random sampling technique was used to recruit 307 diabetic patients at follow-up. Interviewer administered questionnaire was used to collect data on sociodemographic, clinical, and behavioral characteristics. Five milliliters of venous blood samples were collected to determine lipid profiles and hemoglobin A1C. Lipid profiles and hemoglobin A1C were measured by Cobas c311 analyzer. The data were analyzed by SPSS version 20. Bivariable and multivariable logistic regression were used to determine associated factors with poor glycemic control status. P-value <0.05 was considered statistically significant. The overall prevalence of poor glycemic control among the study participants based on hemoglobin A1C ≥7% was 82.4%. Having a history of diabetic complications (AOR: 7.09, 95%CI: 1.72-29.16), duration of diabetes ≥7 years (AOR: 4.09, 95%CI: 1.38-12.08), insulin and oral hypoglycemic agents (AOR: 0.106 95%CI: 0.02-0.44), lack of self-glucose monitoring (AOR: 8.27, 95%CI: 1.61-42.46), lack of physical exercise (AOR: 5.5, 95%CI: 1.6-18.9) and dyslipidemia (AOR: 2.74, 95%CI: 1.12-6.66) were significantly associated with poor glycemic control. A high prevalence of poor glycemic control status (82.4%) was observed among diabetic patients in this study area, and disease-related factors like duration of diabetes, complication, treatment type and lack of self-glucose monitoring, physical exercise, and dyslipidemia were identified as factors significantly associated with poor glycemic control status. The finding of the current study should be taken into account to conduct a strategic and timely intervention on significantly associated factors to delay diabetic complications and to improve the health outcome of diabetic patients. Routine screening and monitoring of dyslipidemia and providing health education on behavioral factors were the necessary measures that should be conducted to reduce the burden of poor glycemic control status among diabetic patients.

Sadness and Loneliness in Adolescents with Physical, Sensory or Health Problems in Low/Middle-Income Countries.

Feelings of loneliness and sadness are increasing among the global youth, especially in disadvantaged settings. Young people with disabilities from low-income countries may be at greater risk of experiencing such emotions. This study aims to assess the dependence between difficulties/disability and sadness, loneliness and crying for no reason in young people from low- to middle-income countries and to test the risk of experiencing these emotions in young people with different disabilities versus the overall population. A cross-sectional study was conducted based on the Programme for International Student Assessment for Development survey, with 34,604 participants aged 15 years from seven countries: Cambodia, Ecuador, Guatemala, Honduras, Paraguay, Senegal, and Zambia. Dependent relationships were found between difficulties/disabilities and loneliness, sadness and crying. People with disabilities had a higher prevalence of these emotions. The probability of experiencing sadness, loneliness and crying was higher among people with difficulties/disabilities. Young people with disabilities in low-income countries are at a higher risk of experiencing feelings of loneliness, sadness and crying compared to the general population of the same age.

An Audit of Injuries Sustained in Two–Wheeler Accidents in the Metropolitan City of Karachi, Pakistan

Background: Road traffic accidents have major contribution in injury related mortality and disability in low income countries. Two-wheelers being a major mode of transportation due to absence of proper public transport system in Karachi hence most often reported accidents are related with two wheelers. In Karachi two wheelers are quite commonly being used as mode of transportation, number of two wheelers has increased to 10 folds since last 10 years because of lack of public transports and high fuel prices and easy availability on low monthly instalments. Objective: To analyze the injury pattern among two-wheeler riders in Karachi. Study Design: Retrospective study Place and Duration of Study: Three major medico-legal centres of Karachi (Civil, Jinnah, and Abbasi Shaheed Hospitals) from 1st January 2017 to 31st December 2021. Methodology: About 11444 two-wheeler incidents occurred on roads with the consent of Police Surgeon Office Karachi were enrolled. The patients' demographics, injuries sustained, date of the injuries, cause of the injuries, types of collision and outcomes were recorded. Results: Most of the riders engaged in accidents were between the ages of 18 and 30 years; 90.99% of the riders were men. The most frequent type of injuries found in two wheeler accidents were abrasions/grazes seen in (56.26%) cases followed by fractures (20.82%), head injuries (11.02%). Conclusion: Greater prevalence in the age group of 18-30 years, with male dominance analyzed. Fatal and non-fatal injuries were observed. Metro services mass transit programme to be encouraged so to decrease the traffic on road which will automatically reduce the number of accidents to wheeler as well as pillion riders strict efforts need to be made at both government and personal levels to reduce accidents in two-wheeler riders Keyword: Riders, Pillion, Road traffic accidents

“Don’t rush into thinking of walking again”: Patient views of treatment and disability following an open tibia fracture in Malawi

Background: Open tibia fractures are a common injury following road traffic accidents in Malawi and can lead to long term disability. Very little is known about patients’ experiences of the healthcare system and the disability in low-income countries following this injury. The aim of the study was to explore patient experiences of treatment and disability following an open tibia fracture in Malawi. Methods: A qualitative study was conducted using semi-structured interviews with ten patients with open tibia fractures at a central hospital in Blantyre, Malawi. A mixed deductive-inductive thematic analysis was used to identify broad themes of treatment and disability. Written informed consent was obtained from all participants. Results: Patient characteristics included an average age of 39.1 years old (22-63) and 80% were male. Broad themes found were delays in receiving treatment, change in individuals’ societal role and delayed recovery associated with pain and immobility. Conclusions: Open tibia fractures in Malawi have a devastating impact on patients and their families. Further studies are required to explore the reasons for the delays in open fracture emergency treatment.

"Don't rush into thinking of walking again": Patient views of treatment and disability following an open tibia fracture in Malawi.

Background: Open tibia fractures are a common injury following road traffic accidents in Malawi and can lead to long term disability. Very little is known about patients' experiences of the healthcare system and the disability in low-income countries following this injury. The aim of the study was to explore patient experiences of treatment and disability following an open tibia fracture in Malawi. Methods: A qualitative study was conducted using semi-structured interviews with ten patients with open tibia fractures at a central hospital in Blantyre, Malawi. A mixed deductive-inductive thematic analysis was used to identify broad themes of treatment and disability. Written informed consent was obtained from all participants. Results: Patient characteristics included an average age of 39.1 years old (22-63) and 80% were male. Broad themes found were delays in receiving treatment, change in individuals' societal role and delayed recovery associated with pain and immobility. Conclusions: Open tibia fractures in Malawi have a devastating impact on patients and their families. Further studies are required to explore the reasons for the delays in open fracture emergency treatment.

Assessing neurodevelopmental outcome in children with hydrocephalus in Malawi. A pilot study

IntroductionCongenital and infantile hydrocephalus are assumed to be major contributors to pediatric morbidity, mortality and functional disability in low-income countries. Despite this, epidemiologic data and the overview of neurodevelopmental outcomes in these regions is very limited. We aimed to pilot the use of a wide range of more locally suitable tools to assess neurodevelopment to understand whether they were feasible for use and could provide estimates of developmental delay and poor functioning in a population of children with hydrocephalus in Malawi. MethodsWe conducted a prospective observational cohort study, at the tertiary neurosurgery clinic in Blantyre, Malawi in 2018, recruiting consecutive children with congenital and infantile hydrocephalus who were previously treated with ventriculoperitoneal shunts and endoscopic third ventriculostomy (ETV) in the neurosurgery unit of the hospital. We assessed demographic details, and gained information on children’s functioning using the Liverpool Outcome Score (LOS), and the Eating and Drinking Ability Classification System as well as full anthropometric assessment and child development with the Malawi Developmental Assessment Tool (MDAT). ResultsAll tools were feasible for use, easy to train on, could be used for assessing children with hydrocephalus and were suitable to adapt for our environment. We evaluated 41 children, aged 2–60 months with a mean age of 22.6 months (interquartile range [IQR] = 8.3 months −36.5 months). Functional assessment using the Liverpool Outcome Score showed the majority of children 92.7% (CI 80.1–98.5, n = 38) had severe sequelae from the hydrocephalus and were dependent on their parents or caregivers. Only 27 children (65.9%, CI 49.4, 80.0) had full or expected control of their bowel and bladder and 6 children (14.6%, CI 5.6, 29.2), had a recent history of seizures. About two thirds (63.4% CI 45.0–77.9, n = 26/41) of children were able to eat and to drink safely and efficiently. Over two thirds of the children (70.7%, CI 56.8, 84.6, n = 29) were stunted and almost half of the cohort underweight (43.9%,(CI 28.5, 60.3, n = 18). Almost half 48.8% (CI 32.9, 64.9, n = 20/41) had developmental delay on MDAT with 41.5% (CI 26.4, 56.6, n = 17/41) graded as severely delayed (-<2sd on developmental age z score). We found significant associations between dependence identified by the LOS and developmental delay according to the MDAT (p = 0.014, Pearson’s chi-squared test). ConclusionThis pilot study demonstrates that the assessment tools we used identified a high proportion of children with hydrocephalus as having functional difficulties, stunted growth and developmental delay, in Malawi. Use of these tools can now be scaled up and will be helpful to support research in understanding what factors contribute to poor functioning, growth and development in these cohorts and help us to investigate what strategies may prevent and support children with hydrocephalus in African settings.

Facilitating the Participation of Children with Disabilities in Early Childhood Development Centres in Malawi: Developing a Sustainable Staff Training Programme

This article explores the development of a sustainable training programme supporting the inclusion of children with disabilities in early childhood, education and care (ECEC) centres in Malawi. This programme is based on a review of literature of curriculum, pedagogy and teaching approaches in ECEC in sub-Saharan Africa, alongside a review of national policy documents. The training was designed to enable staff to value the inclusion of children with disabilities in ECEC centres, as well as suggesting practical ways to do so. We set out our response to the gap in training of ECEC staff through the development of a supplementary integrated training programme, which, whilst respectful of the curriculum, policy and practice of Malawi, challenged staff to consider ways of including children with disabilities (CWD) and their families. We suggest this is a pragmatic and sustainable model that could be applied to training in other ECEC settings across the region in sub-Saharan Africa. It concludes with guiding principles for training those working in ECEC with young children with disabilities in low-income countries.

The policy transfer of community-based rehabilitation in Gulu, Uganda

This paper explores the influence of the community-based rehabilitation approach among international development actors in Gulu, Uganda through the lens of policy transfer. Developed by international organizations, this approach has been promoted as a meaningful way to address the needs of persons with disabilities in low-income countries. This qualitative case study consists of a questionnaire completed by representatives from 25 different organizations, in addition to semi-structured follow-up interviews with 8 development professionals. The findings indicate that the community-based rehabilitation approach has had some influence, as respondents appeared cognisant of key principles of the approach in relation to persons with disabilities. However, detailed knowledge of the approach is mainly limited to the field of health, and there were few current examples of the approach being implemented. These results illustrate the challenges of implementing community-based rehabilitation specifically, as well as broader issues related to the transfer of international policy ideas to the Global South. Points of interest Community-based rehabilitation is a way of helping people with disabilities in low-income countries where services are limited Development organizations in Gulu, Uganda (like the local government and non-governmental organizations) think that this approach is a good way to support people with disabilities Only a few of the people interviewed for this study had a strong understanding of the community-based rehabilitation approach, and these people mostly worked in the health sector There were no examples of community-based rehabilitation programs in Gulu at the time of the study, but some projects (mostly in the health field) used some ideas drawn from the approach Local development organizations find it difficult to apply policy ideas like community-based rehabilitation, especially when they do not have consistent funding

Rehabilitation Engineering: A perspective on the past 40-years and thoughts for the future

Over the past four decades, there have been breakthroughs in communication, mobility and tools to manipulate objects. Probably the most important transformation has been the growing inclusion of people with disabilities into the prioritization, conceptualization, and design of new assistive devices. Advances in technology, demands from people with disabilities, and changes in cultural perceptions have made noteworthy changes in the technologies that have improved lives, and affected transformations that benefit both individuals and society. People with disabilities lives have been improved but there is still much to be done. Unfortunately, people with disabilities in low income countries have lagged people in higher income countries in benefitting from technical and social changes. Assistive devices have benefitted from the availability of powerful, portable computing power, from small low-power sensors, from new materials, from rapid prototyping and flexible manufacturing. There are exciting emerging technologies that show promise for future advances.

Health related quality of life in children with spina bifida in Uganda

BackgroundStudies on health related quality of life (HRQOL) of children with disabilities in low income countries are limited. ObjectiveTo inform interventions for children with spina bifida in low income countries, HRQOL of children with spina bifida and siblings, predictors, relationships between HRQOL and parental stress in Uganda were examined. MethodsDemographic, impairment, daily, social functioning data, and HRQOL using the KIDSCREEN-10 were collected from 39 children, 33 siblings, and 39 parents from a cohort of families of children with spina bifida. T-tests, correlations, analysis of variance and regression analysis were used to compare means between children with spina bifida and their siblings, understand relationships between variables, and identify predictors of HRQOL. ResultsChildren with spina bifida (N = 39) had lower HRQOL compared to their siblings (N = 33) (t = −3.868, p < .001 parental; t = −3.248, p = .002 child ratings). Parents (N = 39) indicated higher parental stress for their child with spina bifida (t = 2.143, p = 0.036). HRQOL child outcomes were predicted by the presence of hydrocephalus (β = −.295, p = 0.013) for children with spina bifida, and daily functioning levels (β = .336, p = 0.038), and parental support (β = .357, p = 0.041) for siblings specifically. Parent rated HRQOL outcomes were predicted by parental distress (β = −.337, p = 0.008), incontinence (β = .423, p = 0.002), and daily functioning levels (β = .325, p = 0.016) for children with spina bifida. ConclusionsTo improve HRQOL investment in neurosurgical care, community based rehabilitation, incontinence management, and parental support are required. A combination of child friendly semi-structured and creative research methods are recommended to study HRQOL.

Abstract P140: High Poverty Among Patients With Noncommunicable Diseases in Rural Haiti

Background: Noncommunicable diseases (NCDs) are a major and growing cause of death and disability in low-income countries, and contribute a substantial portion of outpatient clinic visits. Poverty can be a major barrier to accessing healthcare in rural low-income countries. The objective of this study is to describe the demographics and socioeconomic status of patients attending an NCD clinic in rural Haiti, where poverty is highly prevalent. Methods: We analyzed routinely collected clinic data from adult patients in rural Haiti presenting to the NCD clinic at Hôpital Universitaire de Mirebalais. We collected data during routine initial clinic visits from July 2013 through October 2016. We performed descriptive statistics to assess patient demographics and socioeconomic status using available data. We evaluated poverty based on the Multidimensional Poverty Index by evaluating 9 indicators within three dimensions: health, education, and standard of living - we did not assess electricity. We assessed deprivation within each indicator. The “poorest” patients were defined as those deprived in 4 of the 9 poverty indicators. We also assessed measures of catastrophic health spending. Results: A total of 518 adults were included, with 72% (373/508) women. The mean overall age was 52.8 years (SD 14.7) and 21% (108/518) were 40 years old or younger. Of the patients, 32% had only hypertension, 18% had only diabetes, 32% had both diabetes and hypertension, 5% had heart failure, and 13% had no recorded diagnosis. 45% of patients travel more than 1 hour for clinic visits. Almost half (49%, 146/296) of adults sold belongings and 61% (178/292) borrowed money to pay for healthcare. Among the poverty measures, the top indicators with deprivation were cooking fuel with charcoal or wood (96%, 290/302), child death in household (70%, 169/243), and no household members completing primary school (25%, 83/324), lack of household assets (25%, 79/313), poor sanitation (19%, 59/304), dirt floor (16%, 50/304), and lack of improved drinking water (9%, 29/308). Of all patients, 21% (78/378) were among the poorest. Throughout Haiti, however, 55% of the population are among the poorest. There were more patients among the poorest living closer to the hospital (27%) than living farther away (10%). Interpretation: The great majority of patients were middle-aged women, with predominantly hypertension and/or diabetes. Socioeconomic deprivation was high among many poverty indicators and most patients experienced catastrophic health spending. At this clinic in rural Haiti, the proportion of patients presenting for care who are among the poorest is less than that overall in Haiti. Patients who travel far distances have less poverty. Health systems for chronic disease management in rural low-income countries must account for patient poverty.

Rheumatic Heart Disease Treatment Cascade in Uganda.

Rheumatic heart disease (RHD) is a leading cause of premature death and disability in low-income countries; however, few receive optimal benzathine penicillin G (BPG) therapy to prevent disease progression. We aimed to comprehensively describe the treatment cascade for RHD in Uganda to identify appropriate targets for intervention. Using data from the Uganda RHD Registry (n=1504), we identified the proportion of patients in the following care categories: (1) diagnosed and alive as of June 1, 2016; (2) retained in care; (3) appropriately prescribed BPG; and (4) optimally adherent to BPG (>80% of prescribed doses). We used logistic regression to investigate factors associated with retention and optimal adherence. Overall, median (interquartile range) age was 23 (15-38) years, 69% were women, and 82% had clinical RHD. Median follow-up time was 2.4 (0.9-4.0) years. Retention in care was the most significant barrier to achieving optimal BPG adherence with only 56.9% (95% confidence interval, 54.1%-59.7%) of living subjects having attended clinic in the prior 56 weeks. Among those retained in care, however, we observed high rates of BPG prescription (91.6%; 95% confidence interval, 89.1%-93.5%) and optimal adherence (91.4%; 95% confidence interval, 88.7-93.5). Younger age, latent disease status, and access to care at a regional center were the strongest independent predictors of retention and optimal adherence. Our study suggests that improving retention in care-possibly by decentralizing RHD services-would have the greatest impact on uptake of antibiotic prophylaxis among patients with RHD in Uganda.

Acute respiratory infection, diarrhoea and fever in young children at-risk of intellectual disability in 24 low- and middle-income countries

ObjectivesThis study aims to (1) estimate the prevalence of acute respiratory infection (ARI) symptoms, diarrhoea and fever in the previous two weeks among 3–4 year old children who are/are not at-risk of intellectual disability in 24 low- and middle-income countries and (2) to investigate possible inequities in access to treatment among affected children. Study designCross-sectional survey. MethodsSecondary analysis of Rounds 4 and 5 UNICEF Multiple Indicator Cluster Surveys (MICS) from 24 low- and middle-income countries (n = 99,934 children). ResultsPooled estimates indicated that young children at-risk of intellectual disability in low-income countries were significantly more likely than their peers to have reported symptoms of ARI and diarrhoea in the previous 2 weeks, and significantly less likely to have received appropriate treatment. Pooled estimates indicated that in middle-income countries children at-risk of intellectual disability were significantly more likely than their peers to have reported symptoms of ARI, diarrhoea and fever during the previous 2 weeks. Symptomatic children at-risk of intellectual disability were significantly less likely than their peers to have received antibiotics/antimotility medication for diarrhoea or antibiotics for ARI symptoms, but significantly more likely to be prescribed anti-malarials for fever. ConclusionsThese results indicate the existence of significant inequalities and possible inequities in the exposure to and the treatment of three major infectious diseases among children who are/are not considered at-risk of intellectual disabilities in low- and middle-income countries.

Transport and Access to Inclusive Education in Mashonaland West Province, Zimbabwe

Lack of accessible transportation is considered a major barrier to education for children with disabilities—children already far less likely to attend school. While millions of children face challenges with getting to school, including long distances, poor roads, lack of transport and safety issues, these can be compounded for children with disabilities. Yet there is little data from low and middle-income countries on the nature and extent of this exclusion, or on attempted solutions. This paper explores some practical options for improving transport as part of providing inclusive education for children with disabilities in low income countries, as well applying concepts of transport-related social exclusion in such contexts. The paper reviews a project designed to improve sustainable transportation to school for children with disabilities in four districts in Mashonaland West Province, Zimbabwe. The most common solution was three wheel motorbikes (tricycles) with trailers. Whilst not been unproblematic, teachers, parents and the wider communities overwhelmingly agree that they have supported children with disabilities to attend school. Obviously tricycles are not the only component needed for an inclusive education system, but they are a start. The paper also highlights some crucial gaps in current approaches, key among which is the fact the most government departments work in silos. Whilst inclusive education is strongly supported by the Zimbabwean Government, there is a lack of joined up thinking between transport and education ministries. Without stronger collaboration across ministries children with disabilities will continue to experience avoidable barriers and transport-related social exclusion.

Prehospital Emergency Care Education for the Nepal Mountaineering Association

BackgroundPrehospital emergency care training programs are effective in reducing mortality and disability in low-income countries. Implementation of a specifically designed program in the mountainous regions of Nepal has the potential to benefit local populations, trekking and mountaineering guides, and adventure tourists. ObjectiveOur aims were to survey Nepal Mountaineering Association (NMA) members' past experiences with emergencies and medical training, characterize a geographic-specific prehospital emergency care training program, and evaluate the effectiveness and outcome of the program. MethodsSixty-two trekking guides, police officers, and students attended the 2-day training program in Pokhara, Nepal in May 2014. Training curriculum was determined in coordination with the NMA. Instructors included Tulane University faculty, surgical residents, and graduate students. Surveys identified participants' experience with emergencies, confidence in providing emergency care, and interest in future trainings. Multiple modalities were utilized to assess trainees' comprehension. ResultsParticipants rated the program as valuable and expressed desire for additional trainings. Survey results indicated that participants had prior experience with a myriad of emergencies, were more confident in managing traumatic emergencies than medical or environmental, and showed that few had previously received training in cardiopulmonary resuscitation. Areas of instruction included general first responder and geographic-specific content. Participants achieved the course objectives and documented their abilities to successfully manage simulated clinical problems. ConclusionsThe training program, an international collaboration, was documented to be successful by instructors, NMA leadership, and participants. The training program's content matched the participants' specific needs and abilities. Areas for improvement include providing content related to burns, motorcycle injuries, cold-exposure injuries, fever management, and toxicology emergencies.

Functional consequences and health-care seeking behaviour for recurrent non-specific low back pain in Zimbabwean adolescents: a cross-sectional study.

The purpose of the study was to investigate the consequences of recurrent non-specific low back pain in Zimbabwean adolescents. Recurrent non-specific low back pain is a common cause of adult disability in low-income countries. However, its impact in adolescents has been a matter of debate in the literature. A survey was conducted using a cluster sample of 544 school children between the ages of 13 and 19 years. The school children were randomly selected from government-administered secondary schools in Harare, Zimbabwe. Parental and students' response rate were 90.3 and 97.8 %, respectively. Almost a third (28.8 %) of school children reported recurrent symptoms (CI 27.8-31.6). However, the majority (84 %) of these cases were unknown to parents. Twenty-seven percent reported having sought medical treatment. On the nine-item Hanover Low Back Pain Disability Questionnaire, 71.2 % of school children had at least one activity of daily living compromised by recurrent NSLBP, especially sports participation. However, severe disability was reported in 28 % of the adolescents. Health-care seeking behaviour was not associated with the level of disability [χ (2)(1) = 0.36, p = 0.55]. Although most parents are unaware, recurrent NSLBP is common in Zimbabwean school children. However, treatment is rarely sought for the symptoms. A preponderance of adolescents with recurrent NSLBP experiences some degree of functional consequences, although severe disability is rare. There is need to raise awareness of the condition in schools and to parents. Spinal health educational programmes may need to be implemented to avert the functional consequences. Further studies are needed in the future to investigate the coping strategies for pain in adolescents.

Beginning to teach inclusively: An analysis of newly-qualified teacher pedagogy in lower primary classes in Tanzania

Inclusive pedagogies to support children with disabilities in low-income countries have been neglected, and viewed as ‘specialised’ or optional within teacher education. In contrast, this paper presents details of practices of newly qualified teachers (NQTs) in Tanzania that aim to help all learners to learn even in poorly-resourced schools. It argues that NQTs' positive attitudes and responsibility towards their students can be located in Tanzania's history and their early professional experiences, resulting in an interactionist pedagogy that normalises ‘inclusive’ practices. ‘Learning difficulties’ are relocated from a medical model of disability to a concern with improving teaching and learning for all.

A new screening instrument for disability in low-income and middle-income settings: application at the Iganga-Mayuge Demographic Surveillance System (IM-DSS), Uganda

ObjectiveThe measurement of disability in low-income countries is recognised as a major deficiency in health information systems, especially in Africa. The Iganga and Mayuge Demographic Surveillance System (IM-DSS) in Uganda...

Good results after Ponseti treatment for neglected congenital clubfoot in Ethiopia

Background and purpose — Neglected clubfoot deformity is a major cause of disability in low-income countries. Most children with clubfoot have little access to treatment in these countries, and they are often inadequately treated. We evaluated the effectiveness of Ponseti’s technique in neglected clubfoot in children in a rural setting in Ethiopia.Patients and methods — A prospective study was conducted from June 2007 through July 2010. 22 consecutive children aged 2–10 years (32 feet) with neglected clubfoot were treated by the Ponseti method. The deformity was assessed using the Pirani scoring system. The average follow-up time was 3 years.Results — A plantigrade functional foot was obtained in all patients by Ponseti casting and limited surgical intervention. 2 patients (4 feet) had recurrent deformity. They required re-manipulation and re-tenotomy of the Achilles tendon and 1 other patient required tibialis anterior transfer for dynamic supination deformity of the foot.Interpretation — This study shows that the Ponseti method with some additional surgery can be used successfully as the primary treatment in neglected clubfoot, and that it minimizes the need for extensive corrective surgery.