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Purpose: Persons with disabilities affecting lower-limb function use ankle- foot-orthoses (AFO) and knee-ankle-foot-orthoses (KAFO) on a regular basis. However, the effectiveness of these devices in daily use is seldom evaluated, especially in the developing world. This study aimed to evaluate user satisfaction with lower-limb orthotic devices while performing a broad spectrum of daily life activities in Pakistan, and to document the desired outcomes.

Method: A survey was conducted among orthotic device users in the out-patient departments of three hospitals in Lahore, Pakistan. The survey questionnaire was devised by adapting the Prosthetic Evaluation Questionnaire to suit orthotics evaluation. Fifty-four AFO and KAFO users participated in the study.

Results: Most users felt comfortable while walking on even surfaces with their orthoses. However, donning/doffing these, climbing stairs and performing certain routine activities were considered problematic for most people. Energy conservation was the most desired AFO feature, while the KAFO users wanted automatic knee-joint function.

Conclusion and Implications: Overall satisfaction with the existing lower- limb orthoses is adequate. Yet, significant improvements are needed in terms of energy efficiency and comfort while walking on different terrains. Further research is required in order to improve the functioning of the existing orthotic devices.

Purpose: Effective menstrual hygiene management is vital to the health, well- being, dignity, empowerment, mobility and productivity of girls and women. This study was conducted to ascertain menstrual hygiene management challenges and coping strategies of adolescents with disabilities in the Kumasi Metro of Ghana.

Method: An exploratory study design with qualitative approach was employed to select 18 participants. Data was collected through in-depth interviews and focus group discussions, and then transcribed and categorised into specific themes.

Results: Females with visual impairment had difficulty in maintaining good menstrual hygiene because of problems in detecting menstrual blood, inability to fix sanitary pads appropriately and wash underwear properly, and anxiety and stress from not knowing whether their period has started. The problems of those with physical impairment were related to inaccessible washrooms, long hours of being seated on the part of wheelchair-users, and difficulty in fixing sanitary pads for those with upper limb impairment. For those with hearing impairment, the main challenge was the communication barrier between them and their significant others whenever they needed help.

Conclusion: There are common challenges faced by all girls across the globe with regard to menstrual hygiene management. Adolescent females with disability however face additional challenges with regard to MHM. Those with physical disability encounter accessibility challenges, while the main challenge for the deaf and those with speech problems is communication. The visually impaired live in anxiety due to fear of staining their clothes.

Purpose: This study investigated the attitudes of secondary school teachers towards students with blindness or partial sight in selected states in Nigeria.

Method: The authors utilised the modified version of a previous instrument to collect data from 306 secondary school teachers in Nigeria. Six basic questions were established to address: respondents’ attitudes towards inclusion; training acquired related to teaching; knowledge pertaining to policy and legislation; confidence levels to teach students with disabilities.; impact of geographical location; and differences in attitudes by the variables of subject(s) taught, school level taught, and years of teaching experience.

Results: Attitudes of participants were mixed but were generally positive. The level of training was low, with teachers showing limited knowledge of policy and legislation. A little over a quarter (27%) of them lacked confidence in teaching. There were differences in attitudes related to the geographical location of respondents. Those who taught at the senior secondary school level tended to have higher attitude scores on average than their counterparts at the junior secondary school level.

Conclusion and Limitations: This study used self-report measures, although observations and interviews could be additional ways to evaluate the attitudes of participants throughout the country. Moreover, in-service programmes may need to be implemented to increase teachers’ knowledge base and expand their experiences in line with established policies and legislation.

Purpose: The main objective of this paper was to assess environmental accessibility for people with vision, hearing and speech disabilities in Mongolia, with particular focus on public buildings and public transportation.

Methods: A standardised internationally-used questionnaire, consisting of 29 questions, was used for the accessibility of public buildings assessment.  The questionnaire results were grouped into categories and descriptive statistics were obtained. To determine quality and accessibility to public transportation a standardised sheet, consisting of 51 questions from the internationally accepted SERVQUAL, was used. This model is commonly used for measurement of the discrepancies between actual performance and customer expectations.

Result: Assessment of public buildings in Mongolia revealed that they were moderately accessible for people with vision, hearing and speech disabilities. The assessment of public transportation found that the discrepancy between actual performance and customer expectation is the highest across all indicators for people with hearing and speech impairments.

Conclusion: The research findings indicated a strong need to pay closer attention to the current environmental unfriendliness and inaccessibility faced by people with vision, hearing and speech disabilities.

Purpose: The need for suitable assistive technology is growing all over the world, not only for people with disabilities but also for the ageing population with functional decline and non-communicable diseases. Access to assistive technology promotes access to education, employment and active societal participation. The aim of this study was to assess the self-reported need by persons with disabilities and by people who were 65 years and older without disabilities in the Northern Province of Sri Lanka, for assistive products; and to identify barriers to accessing these assistive products.

Method: This mixed-methods pilot study included 76 participants who were either persons with disabilities or their caregiver or persons 65 years and older, from the Northern Province of Sri Lanka, affected by the now-ended 30-year civil war.  To ascertain trends in the local need for assistive products, a translated version of the World Health Organisation’s Priority Assistive Products List of 50 items was used. In addition, semi-structured interviews with key participants were conducted, to gain some insights into the barriers to accessing assistive products. 

Results: The most widely used assistive products among persons with disabilities were connected to war-related injuries. In contrast, those used by the older age group of persons without disabilities were connected to non-communicable diseases and age-related frailty. The assistive products requested by both groups were aids to promote independence in daily activities and to support access to education and employment. The emergent themes included affordability, employment, independence in activities of daily living, stigma and psychological impact, and a lack of awareness and guidance in the use of assistive devices.

Conclusion: The findings highlight the need for policies and practices to be informed by local socio-cultural, historical and geographical realities.

Purpose: People who use wheelchairs face a range of physical, social, and economic barriers to regular participation in their communities. These barriers may be more acute in countries such as Bangladesh which are affected by poverty and often lack the physical infrastructure or resources necessary to create inclusive or accessible environments. This research aimed to identify: (a) the barriers and facilitators to accessibility faced by wheelchair users in Bangladesh; (b) how these barriers affect the inclusion of wheelchair users in Bangladeshi society; and (c) what could be done to improve accessibility and inclusion for wheelchair users in Bangladesh.

Methods:  This participatory action research (PAR) project used Photovoice and semi-structured interviews to identify barriers and facilitators to accessibility for people who use wheelchairs in Bangladesh.

Results: Participants mentioned a number of barriers in public spaces, such as roads, missing or inadequate ramps, inaccessible restrooms, and negative attitudes. There were also participants who had made their home environments more accessible with accommodations such as ramps, arrangement of space, and low countertops/work spaces. Women wheelchair users seemed to face greater barriers to access, as compared to men, in a range of community spaces and activities. Participants’ recommendations for improvement targeted government stakeholders and included greater focus on road infrastructure, particularly during flooding in the rainy season, and modifications to the public transportation system.

Conclusion: A key goal of the study was to identify barriers and facilitators, and use the information gathered to promote social change on the ground. Future research and action should encourage more people to get involved in removing barriers for people with disabilities, in Bangladesh as well as globally

Purpose: In low- and middle-income countries, reliable and disaggregated disability data on prevalence, participation and barriers is often not available. This study aimed to estimate disability prevalence, determine associated socio-demographic factors and compare access in the community between people with and without disability in Dehradun district of Uttarakhand, India, using the Rapid Assessment of Disability Survey.

Methods: A cross-sectional population-based survey was conducted on a sample of 2431 adults, selected using a two-stage cluster randomised sampling technique. The survey comprised an interviewer-administered household survey and an individual survey measuring disability, wellbeing and participation.  For each person with disability, an age and sex-matched control (without disability) was selected. In addition to prevalence, the difference in participation and barriers faced by people with and without disability were analysed.

Results and Conclusions: The prevalence of disability was 6.8% (95% CI 5.8-7.8) with significant associations with age, sex, economic status, education and employment. Psychosocial distress (4.8%) and mobility impairment (2.7%) were the most common disabilities identified. The study showed that people with disabilities had significantly less access to services than those without disability, and the barriers reported most often were lack of information, transport and physical inaccessibility.

Purpose: Rehabilitation with assistive devices is of great benefit to people with limb disabilities, enabling them to lead independent and productive lives. While assistive devices improve the quality of life of persons with lower limb disabilities by facilitating activities of daily living, there are also many barriers to their use. This study aims to describe these barriers among community-dwelling persons with lower limb disabilitiesin central Sri Lanka.

Methods: A community survey was conductedmong adults between 18 and 59 years of age, to find persons with lower limb disabilities in Kandy Municipal Council area, in the central province of Sri Lanka. This was followed by purposive sampling to select a sub-sample of 12 individuals with unilateral lower limb disabilities for a qualitative study using in-depth interviews. Unilateral lower limb disabilities were identified using a clinical examination and World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). A qualitative thematic content analysis was used to evaluate the interview text.

Results: Participants described several barriers in using assistive devices, such as unaffordable assistive technology like wheelchairs and artificial limbs, unavailability of appropriate assistive technology, difficulties associated with repair and maintenance, and problems in accessibility. Limited knowledge of modern technology also restricted their choice of better devices. Psychological barriers and stigma in using assistive devices directly affected their social lives and day-to-day activities as well.

Conclusion and Implications: People with lower limb disabilities face multiple barriers in using assistive devices. These barriers need to be addressed by improving local infrastructure and accessibility facilities, public awareness and funding, and ensuring continuous supply and maintenance services.

Purpose: Persons with disabilities face additional barriers in accessing primary healthcare services, especially in developing countries. Consequently the prevalence of secondary health conditions is higher among this population. This study aims to explore the perceived barriers to access primary healthcare services by persons with disabilities in the Western region of Nepal.

Methods: 10 primary healthcare providers and 11 persons with disabilities (physically or visually impaired) were selected by non-governmental organisations from the hilly and lower areas. Based on the International Classification of Functioning and the health accessibility model of Institute of Medicine, semi-structured interviews were conducted and analysed using analytical induction.

Results: In general, healthcare providers and persons with disabilities reported similar barriers. Transportation and the attitude of family members and the community were the main environmental barriers. Even with assistive devices, people still depend on their families. Financial barriers were lack of funds for health expenses, problems in generating an income by persons with disabilities themselves, and the low socio-economic status of their families. Personal barriers, which affect help-seeking behaviour in a major way, were most often mentioned in relation to financial and socio-environmental barriers. Low self-esteem of the person with disability determines the family’s attitude and the motivation to seek out healthcare. Lastly, poor public awareness about the needs of persons with disabilities was reported.

Conclusions: Besides the known physical environmental barriers, this study found several environmental, financial and personal barriers that also affect access to primary healthcare. In particular, the attitudes of families and poor financial conditions seem to be interrelated and greatly influence help-seeking behaviour.