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Functional outcome of stroke inpatients according to human immunodeficiency virus status: A feasibility study

HARTLEY, Tasneem
BURGER, Marlette
ESTERHUIZEN, Tonya M
INGLIS-JASSIEM, Gakeemah
March 2020

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Background: Stroke in human immunodeficiency virus positive (HIV+) individuals is becoming an increasing concern. Being significantly younger than typical stroke patients, the impact of functional challenges on quality of life and burden on society becomes more eminent.

 

Objectives: This feasibility study aims to determine the requirements for a large descriptive cohort, to adequately describe the functional outcome of stroke patients with varying HIV status.

 

Method: All stroke patients meeting the inclusion criteria were recruited over a 6-month period at a South African inpatient rehabilitation centre. Data were collected on admission and discharge using outcome measures including the Barthel Index (BI), Berg Balance Scale (BBS) and the use of assistive devices used to describe independence with activities of daily living (ADL), mobility and safety post-stroke. Statistical analysis was performed using Stata version 14.2.

 

Results: The feasibility study identified appropriate procedures and barriers to a successful study in addition to describing preliminary data on participant demographics, relevant medical history and functional outcomes post-stroke. Limitations that affected feasibility included minimal recruitment sites, length of data collection period, timely communication of participant discharge plans and dates, and confirmation of participant HIV status. An appropriate comparison between sub-groups could not be made because of disproportionate group sizes, median age differences and no assessor blinding.

 

Conclusion: To increase generalisability and the understanding of the unique HIV+ stroke profile, multiple recruitment sites, longer data collection periods, assessor blinding and age-matched groups with HIV status confirmation are recommended.

 

 

African Journal of Disability, Vol 9, 2020

Investigation of physical and functional impairments experienced by people with active tuberculosis infection: A feasibility pilot study

Van ASWEGEN, Heleen
ROOS, Ronel
McCREE, Melanie
QUINN, Samantha
MER, Mervyn
August 2019

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Background: Tuberculosis (TB) remains a significant healthcare problem. Understanding physical and functional impairments that patients with active TB present with at the time of diagnosis and how these impairments change over time while they receive anti-TB therapy is important in developing appropriate rehabilitation programmes to optimise patients’ recovery.

 

Objectives: The aim of this study was to assess the acceptability, implementation and practicality of conducting a prospective, observational and longitudinal trial to describe physical and functional impairments of patients with active TB.

 

Method: A feasibility pilot study was performed. Patients with acute pulmonary TB admitted to an urban quaternary-level hospital were recruited. Physical (muscle architecture, mass and power, balance, and breathlessness) and functional (exercise capacity) outcomes were assessed in hospital, and at 6 weeks and 6 months post-discharge. Descriptive statistics were used to analyse the data.

 

Results: High dropout (n = 5; 41.7%) and mortality (n = 4; 33.3%) rates were observed. Limitations identified regarding study feasibility included participant recruitment rate, equipment availability and suitability of outcome measures. Participants’ mean age was 31.5 (9.1) years and the majority were human immunodeficiency virus (HIV) positive (n = 9; 75%). Non-significant changes in muscle architecture and power were observed over 6 months. Balance impairment was highlighted when vision was removed during testing. Some improvements in 6-minute walk test distance were observed between hospitalisation and 6 months.

 

Conclusion: Success of a longitudinal observational trial is dependent on securing adequate funding to address limitations observed related to equipment availability, staffing levels, participant recruitment from additional study sites and participant follow-up at community level. Participants’ physical and functional recovery during anti-TB therapy seems to be limited by neuromusculoskeletal factors.

 

 

African Journal of Disability, Vol 8, 2019

Disability and HIV

UNAIDS
August 2017

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This report highlights existing key evidence on the relationship between disability and HIV. It discusses the concrete steps needed for a person-centred, disability-inclusive HIV response that allows for increased participation of people with disabilities and integrates rehabilitation within the continuum of HIV care. Globally, it is estimated that 1 billion people (15% of the world’s population) have a disability. Of those aged over 15 years, approximately 110–190 million (2.2–3.8%) experience significant disabilities. Disability is increasing in prevalence due to ageing populations, trauma, accidents and the increase in chronic health conditions, including HIV. Persistent discrimination against and exclusion of people with disabilities, in particular women and girls with disabilities, increases their vulnerability, including their risk of HIV infection.
 

Applied research on disability in Africa : general mapping

INTERNATIONAL FOUNDATION OF APPLIED DISABILITY RESEARCH (FIRAH)
2014

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“The goal of this literary review is to report on existing knowledge about applied research on the African continent, regarding the living conditions of people with disabilities, poverty, violence and sexual abuse especially regarding children and women with disabilities, community-based rehabilitation and employment”

HIV-related disability in HIV hyper-endemic countries : a scoping review

HANASS-HANCOCK, Jill
et al
September 2013

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This article presents the results of the first scoping review to examine the extent, nature and range of disability among people living with HIV in HIV hyper-endemic countries. The studies indicate that people living with HIV experience a variety of disabilities. Impairments in body structure/function comprise the majority of data, with particular focus on mental function. Data on activity limitations and participation restriction were limited, however, they were recorded. They indicate severe impact on people’s life and possible adherence. The review argues that the time has come to elevate the focus holistically on health and life-related consequences of living with HIV and to integrate disability into the discussions and approaches to HIV care

World Journal of Aids, Vol 3, No 3

HIV/AIDS and Disability Organizations in South Africa

Poul Rohleder
Leslie Swartz
Arne Henning Eide
Nora Groce
Marguerite Schneider
January 2010

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Despite the seriousness of the HIV epidemic globally, and in South Africa in particular, little is known about how HIV/AIDS affects disabled people. One important and little explored area is the role that organisations that represent disabled people or that work on behalf of disabled people, are playing in addressing the HIV/AIDS epidemic among the disabled people they represent or serve. This paper presents the findings of a nationwide survey of disability organisations in South Africa. The purpose of this study was to explore the role of disability organisations in addressing the HIV epidemic among disabled people in South Africa. The findings suggest that while organisations recognise the importance of providing HIV education, and many have taken steps to do so, disabled people are largely excluded from general HIV prevention messages. Disabled people also have significant difficulties in accessing general health care, relevant for HIV testing and treatment. In a country trying to manage serious social problems with limited resources, this paper highlights the need for increased cooperation and collaboration between relevant parties in order to facilitate the changes necessary for disabled people to access needed health information and care.

Disability in national strategic plans on HIV and AIDS : a review on the national response to the interrelations of disability and HIV in eastern and southern Africa|Final report

GRANT, Kitty
STRODE, Ann
HANNASS-HANCOCK, Jill
December 2009

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This report examines national AIDS and HIV strategic plans (NSPs) in eastern and southern Africa and includes findings, discussions and best practice examples on the integration of disability throughout the countries. "Generally, the findings of the report show that less than 50% of the countries in Eastern and Southern Africa recognise disability as an issue of concern, or specifically recognise the vulnerability of people with disabilities to HIV and AIDS within their NSPs. Furthermore, it found that even where countries have recognised disability as an issue, there is limited specific guidance within the NSP on HIV-related service provision to meet the needs of people with disabilities. Only one country, South Africa, showed extensive integration of disability into the various focus areas of its NSP." The report concludes with recommendations and provides detailed appendices of national reports for each country surveyed

South African national HIV prevalence, incidence, behavior and communication survey 2008 : turning a tide among teenagers ?

SHISANA, O
et al
2009

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"South Africa has the largest burden of HIV/AIDS and is currently implementing the largest antiretroviral treatment (ART) programme in the world. It is therefore fitting that South Africa is the first in the world to conduct three repeated national HIV population-based surveys to help monitor our response as a nation to the HIV/AIDS epidemic. This report is the third in a time series of population-based HIV seroprevalence surveys which started in 2002 and were repeated in 2005 and again in 2008"

Growing pains : how poverty and AIDS are challenging childhood

SWIFT, Anthony
MAHER, Stan
2008

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This report looks at projects and programmes that aim to respond to the needs of very young children in southern and eastern Africa whose lives have been affected by both poverty and HIV. What is highlighted in the interventions that are examined is the effort of human beings in caring and supporting people and sharing resources

Community-based worker systems : guidelines for practitioners

MBULLU, Patrick
et al
September 2007

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These guidelines aim to assist practitioners and implementing partners to run Community Based Worker systems (CBW) more effectively, maximising impacts to clients of the service, empowering communities, empowering the CBWs themselves, and assisting governments to ensure that services are provided at scale to enhance livelihoods

Tell me more : children's rights and sexuality in the context of HIV/AIDS in Africa

THOMSEN, Sarah C
2007

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This report explores the strategies that children have developed for dealing with sexuality and relationships in the face of HIV and AIDS; and provides stakeholders with a coherent rights and youth-oriented knowledge base for the development of a sexual and reproductive health agenda for advocacy. It gives an overview of sexual rights with a focus on children’s rights, including their access to sexual and reproductive health information, as endorsed by relevant international conventions and policies. It also looks at the concept of sexuality and the sexual development of children. The report includes a summary of children’s reflections on issues of sexuality and their coping mechanisms for preventing the transmission of HIV and AIDS. Based on these findings, the report makes recommendations for effective responses that would support children’s existing coping mechanisms and enhance their ability to protect themselves

Another way to learn : case studies

UNITED NATIONS EDUCATIONAL, SCIENTIFIC AND CULTURAL ORGANIZATION
2007

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These case studies come from an initiative that supports non-formal education projects in Africa, South Asia, the Caribbean and Latin America. The long-term goal of these projects is to develop sustainable livelihoods for low-income, low-literate populations by addressing vulnerability to HIV and AIDS and drug misuse, a lack of education and social exclusion. Central to all of these projects are the creative and innovative methods used to communicate in a meaningful way, engage people and encourage their participation. The projects all focus on capacity building, empowerment, and creating learning opportunities. A DVD has been produced to accompany this publication

Pregnancy-related school dropout and prior school performance in South Africa

GRANT, Monica
HALLMAN, Kelly
June 2006

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Although considerable attention has been paid to the prevalence of adolescent childbearing in the less-developed world, few studies have focused on the educational consequences of schoolgirl pregnancy. Using data collected in 2001 in KwaZulu-Natal, South Africa, this paper examines the factors associated with schoolgirl pregnancy, as well as the likelihood of school dropout and subsequent re-enrollment among pregnant schoolgirls. This analysis triangulates data collected from birth histories, education histories, and data concerning pregnancy to strengthen the identification of young women who became pregnant while enrolled in school and to define discrete periods of school interruption prior to first pregnancy. We find that prior school performance - defined as instances of grade repetition or non-pregnancy-related temporary withdrawals from school - is strongly associated with a young woman's likelihood of becoming pregnant while enrolled in school, dropping out of school if she becomes pregnant, and not returning to school following a pregnancy-related dropout. Young women who are the primary caregivers to their children are also significantly more likely to have left school than are women who shared or relinquished childcare responsibilities. Furthermore, young women who lived with an adult female were significantly more likely to return to school following a pregnancy-related dropout. Given the increasing levels of female school participation in sub-Saharan Africa, our findings suggest that future studies will benefit from exploring the causal relationships between prior school experiences, adolescent reproductive behavior, and subsequent school attendance

Disability and social change : a South African agenda

WATERMEYER, Brian
et al
2006

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This book has been produced to promote the social rights of people with disabilities. It presents extensive research on the South African context of disability and society and draws upon contributions from a diverse range of specialists in the field. A key aim of the text is to unite the disability movement in South Africa through research discourse, as a means to drive processes of social change. Key sections of the book cover: theoretical approaches to disability; governmental and societal responses to disability; disability and education; disability poverty and social security; disability and service provision; disability and human spaces. This book would be of interest to anybody working in the fields of disability, development and social inclusion

Paediatric ARV roll-out in South Africa

HORIZONS PROGRAM
CAPE TOWN UNIVERSITY
2005

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The Horizons Program of the Population Council and the University of Cape Town are conducting a study to identify successful programme strategies in paediatric HIV treatment in South Africa and to determine priority knowledge gaps to be addressed by operations research. This report summarises key findings from the initial consultative workshop of expert practitioners and stake-holders, focusing on the status of providing antiretroviral therapy to children in South Africa and strategies to expand and improve services. It includes providing services to under six year olds

The impact of antiretroviral treatment on AIDS mortality : a study focusing on educators in South African public schools

REHLE, Thomas
SHISANA, Olive
2005

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This study attempts to estimate the impact of antiretroviral treatment on AIDS mortality over the next ten years, focusing on educators in South African public schools. Recently, African governments have scaled up ART initiatives, but the full potential of wider access to treatment is still unknown. The results of this study show that given that ART only delays death, AIDS mortality rate will increase over time among treated people. Further, as HIV-positive people will survive longer, an expansion of ART programmes will result on higher HIV prevalence. These findings have crucial implications for the education sector. The paper calls for new government policies aimed at increasing the number of students preparing to become teachers and raising the retirement age of educators

The development, implementation and evaluation of interventions for the care of orphans and vulnerable children in Botswana, South Africa and Zimbabwe : a literature review of evidence-based interventions for home-based child-centred development

STREBEL, Anna
2004

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This short paper gives a literature review of many programmes aimed at supporting orphans and vulnerable groups in the southern Africa region. It is not an in-depth survey, but provides a compact and accessible guide to the many different community initiatives that have been undertaken. It finishes with a short section on the lessons to be learned from care programmes

Persons with disability : study commissioned by the Corporate Planning Unit of the City of Joburg as a component of the human development agenda

WHITEHEAD, Melissa
2004

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The aim of this research is to highlight problems with, and identify gaps in, the human development agenda as they relate to persons with disability in the City of Johannesburg. The research report also gives an overview of the methodologies applied.
The report is useful for organisations and persons who want to learn more about the situation of disabled persons in Johannesburg. Also it is of interest for researchers and organisations that are developing research methodology and policy

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