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Purpose: This article aimed to examine quality of life (QoL) among persons with paraplegic spinal cord injury (SCI), to determine their socio-demographic details, and to measure the different levels of performance in correlation with the International Classification of Functioning, Disability and Health (ICF).

Method: A descriptive cross–sectional study was conducted with a structured questionnaire to collect information from 45 persons with paraplegic SCI. Data was collected by purposive sampling technique and face-to-face interviews.

Results: Most of the participants (47%, n=21) were in the age group of 20-30 years, with a mean age of 33.53 (± 11.14) years. There were more men (89%, n=40) than  women (11%, n=5) and the ratio was 8:1. The most common occupation was farming (27%, n=12), followed by daily labour (22%, n=10). Fall from a height (58%, n=26) was the most common cause of injury. A high percentage of participants (36%, n=16) rated their quality of life (QoL) as poor. Depression was felt very often (44%, n=20), where as happiness lasted for only a little while (38%, n=17).Older participants faced problems at work more often than younger persons. Males and those who worked in public places faced problems in dressing or bathing independently. Married participants were more dissatisfied regarding income and the amount of work they were able to do. Those who had met with road accidents had more emotional problems than others. Association analysis showed that by increasing happiness and decreasing depression participants’ quality of life could improve.

Conclusion: The study demonstrated that spinal cord injury greatly affects quality of life (QoL) and gives rise to more problems, especially in the areas of physical and mental health. It is necessary to take steps to improve the physical and emotional status of paraplegic spinal cord injury clients, as this will eventually lead to improvement in their quality of life

Background: There is an urgent global need to strengthen rehabilitation services for people with disabilities. In sub-Saharan Africa, rehabilitation services for people with communication disabilities continue to be underdeveloped. A first step in strengthening services for people with a communication disabilities is to understand the composition and conditions of the current workforce.

Objectives: This research describes a sample of the speech and language therapists (SLTs) working in SSA (excluding South Africa). This study explores the characteristics of this workforce, including their demographics, education, experience and geographical stability.

Method: A mixed-methods survey was used to collect data from SLTs within Anglophone countries of SSA. Completed surveys were received from 33 respondents working in 44 jobs across nine countries. Analysis included descriptive and non-parametric inferential statistics. This study reports on a subset of descriptive and quantitative data from the wider survey.

Results: A background profile of SLTs across the region is presented. Results indicated that the workforce of SLTs comprised a mix of local and international SLTs, with university-level education. Local SLTs were educated both within and outside of Africa, with more recent graduates trained in Africa. These data reflected the local emergence of speech and language therapy training in SSA.

Conclusion: This sample comprised a mix of African and international SLTs, with indications of growing localisation of the workforce. Workforce localisation offers potential advantages of linguistic diversity and stability. Challenges including workforce support and developing culturally and contextually relevant SLT practices are discussed.
 

Background: Epidemiological information on childhood disability provides the basis for a country to plan, implement and manage the provision of health, educational and social services for these vulnerable children. There is, however, currently no population-based surveillance instrument that is compatible with the International Classification of Functioning, Disability and Health (ICF), internationally comparable, methodologically sound and comprehensively researched, to identify children under 5 years of age who are living with disability in South Africa and internationally. We conducted a descriptive pilot study to investigate the sensitivity and specificity of translated versions of the Ages and Stages Questionnaire Third Edition (ASQ-III) and the Washington Group on Disability Statistics/UNICEF module on child functioning (WG/UNICEF module) as parent-reported measures. The aim of our study was to identify early childhood disabilities in children aged 24–48 months in a rural area of South Africa, to determine the appropriateness of these instruments for population-based surveillance in similar contexts internationally.

Methods: This study was conducted in the Xhariep District of the Free State Province in central South Africa, with 50 carers whose children were registered on the South African Social Security Agency (SASSA) database as recipients of a grant for one of the following: Care Dependency, Child Support or Foster Care. The researchers, assisted by community healthcare workers and SASSA staff members, conducted structured interviews using forward–backward translated versions of the ASQ-III and the WG/UNICEF module.

Results: Both measurement instruments had a clinically meaningful sensitivity of 60.0%, high specificity of 95.6% for the ASQ-III and 84.4% for the WG/UNICEF module, and the two instruments agreed moderately (Kappa = 0.6).

Conclusion: Since the WG/UNICEF module is quicker to administer, easier to understand and based on the ICF, it can be considered as an appropriate parent-reported measure for large-scale, population-based as well as smaller, community-specific contexts. It is, however, recommended that future research and development continues with the WG/UNICEF module to enhance its conceptual equivalence for larger-scale, population-based studies in South Africa and internationally.

Purpose: A new Mobility Disability Scale (MDS) has been developed to assess the level of mobility disability among community-dwelling individuals. For it to be used effectively, a systematic evaluation of the psychometric properties isrequired. This study was conducted to determine the concurrent validity of the MDS among community-dwelling individuals, as compared to the Functional Independence Measure (FIM) and Functional Assessment Measure (FAM).

Method: Based on the survey of a semi-urban community, purposive sampling was used to select 52 individuals with mobility disability. All of them were evaluated using MDS and FIM FAM scales at the same time. Spearman’s Rankcorrelation coefficient was used to analyse the correlation of MDS scores with the FIM FAM scale scores.

Results: MDS scores had statistically significant negative correlation with FIM FAM total scale scores (r= -0.711) and the correlation was stronger when analysed with the mobility components of FIM FAM scales (r= -0.724).

Conclusion: The MDS possesses moderate concurrent validity with an existing functional scale. This indicates that it may be a suitable tool to quantify the level of mobility disability in persons with disability living in community.

Limitation: The psychosocial domain, though important, could not be compared with any gold standard measures due to unavailability of suitable scales.

Background: Mental health service resources are inadequate in low-income countries, and families are frequently expected to provide care for their relative with a mental disorder. However, research on the consequences of care giving has been limited in low-income countries, including Zimbabwe.

Objective: The study explored the perceived impact of mental illness, reported coping strategies and reported needs of family members of persons diagnosed with bipolar affective disorder or schizophrenia attending a psychiatric hospital in Harare, Zimbabwe.

Methods: A purposive sample of 31 family members participated in in-depth interviews and focus group discussions using standardized study guides. Participants were also screened for Common Mental Disorders (CMD) using the 14-item Shona Symptom questionnaire (SSQ). Qualitative data were analyzed thematically. Statistical Package for Social Sciences (SPSS version 16) was used for quantitative data analysis.

Results: Caregivers experienced physical, psychological, emotional, social and financial burden associated with care giving. They used both emotion-focused and problem-focused coping strategies depending on the ill family members’ behaviours. Seeking spiritual assistance emerged as their most common way of coping. Twenty one (68%) of the caregivers were at risk of CMD and were referred to a psychiatrist for further management. Caregivers required support from health care professionals to help them cope better.

Conclusion: Caregivers carry a substantial and frequently unrecognized burden of caring for a family member with mental disorder. Better support is needed from health professionals and social services to help them cope better. Further research is required to quantitatively measure caregiver burden and evaluate potential interventions in Zimbabwe.
 

Background: Prevalence of communication delays or disorders is increasing, possibly because of various environmental risk factors. Selection and implementation of effective screening tools are important to detect at-risk infants as early as possible. This study aimed to evaluate the accuracy of the Parents’ Evaluation of Developmental Status (PEDS), PEDS-Developmental Milestones and PEDS tools to detect communication delays in infants (6–12 months) in a South African primary healthcare context.

Method: A comparative study design evaluated the accuracy of the PEDS tools to detect communication delays, using an internationally accepted diagnostic assessment tool, the Rossetti Infant-Toddler Language Scale (RITLS). A convenience sample of 201 infants was selected at primary healthcare clinics.

Results: Expressive and receptive language sensitivity scores were low across all three screens(ranging between 14% and 44%). The PEDS tools had high sensitivity (71%) and specificity (73%) ratings for the receptive and expressive language and socio-emotional domain in combination.

Conclusion: In the sample population, the PEDS tools did not accurately detect receptive and expressive language delays; however, communication delays in general were identified. Future research determining accuracy of the PEDS, PEDS-Developmental Milestones and PEDS tools for children aged 2–5 years in detecting communication delays should be prioritised.

Background: Providing wheelchairs without comprehensive support services might be detrimental to user satisfaction and function.

Objectives: This paper compares wheelchair user satisfaction and function before and after implementation of comprehensive wheelchair services, based on the World Health Organization guidelines on wheelchair service provision in less resourced settings, in Zimbabwe.

Method: A pre- and post-test study with a qualitative component was done. Quantitative data were collected with the Quebec User Evaluation of Satisfaction with Assistive Technology for adults and children and the ‘Functioning Every day with a Wheelchair Questionnaire’. Data were collected from 55 consecutively sampled wheelchair users, who received a new wheelchair in the study period. Qualitative data were collected through two audio recorded focus groups and two case studies and are presented through narrative examples.

Results: The proportion of adult users who were satisfied significantly increased for all wheelchair and service delivery aspects (p = 0.001 - 0.008), except follow-up (p = 0.128). The same was true for children’s post-test ratings on all variables assessed (p = 0.001 - 0.04), except training in the use of the device (p = 0.052). The biggest improvement in satisfaction figures were for comfort needs (44.3%), indoor mobility (43.2%), outdoor mobility (37.2%), safe and efficient, independent operation (33.5%) and transport (31.4%). The qualitative data illustrated user satisfaction with wheelchair features and services.

Conclusion: The wheelchair service programme resulted in significant positive changes in user satisfaction with the wheelchair, wheelchair services and function. It is recommended that the Zimbabwean government and partner organisations continue to support and develop wheelchair services along these guidelines.

Purpose: Inclusive education and post-school life are crossover issues that cut across societal lines and therefore need a multisectoral approach. This study examines the educational opportunities of children with disability and their post-school life in rural Sri Lanka.

Methods: The research was implemented with multiple sectors in a rural area of the North Central Province, from January - November 2014. Mixed methods were applied as follows: surveys with children with disability aged 2 to 18 years (n=103); case studies of children with disability who dropped out of or did not attend school (n=3); semi-structured interviews with ex-students with disability who had attended special needs classes (n=13); and, informal interviews with a CBR core group officer. Data was mainly analysed with qualitative procedures.

Results: The study consists of 3 parts. The first part revealed that in terms of the current educational opportunities among children with disability aged 2 to 18 years, approximately 31.1% utilised educational resources whereas 38.8% were at home with no special social activities. The case studies in the second part revealed the reasons for limited educational opportunities in the area and the barriers to educational access, which included family members’ attitudes and socio-economic aspects such as poverty. The third part, consisting of semi-structured interviews with ex-students with disability who received education but did not participate in the CBR activities, revealed 3 types of post-school lifestyle: ‘time mostly spent at home’, ‘household chores’ and ‘temporary agricultural work’. The interviews also indicated other barriers to post-school participation, such as a lack of network and information, negative experiences during the schooling period, and families’ priorities. 

Conclusions: Inadequate educational opportunities among children with disability and barriers to post-school social participation in rural Sri Lanka are revealed. This study argues the importance of the multisectoral approach to find unidentified children as well as to conduct comprehensive programmes.

Purpose: Hearing Impairment is one of the most neglected forms of disability. It accounts for the loss of thousands of disability adjusted life years (DALYs) worldwide (WHO, 2005). Developed countries have made some progress in the measuring and management of hearing impairment (HI), but this is still in the initial stages in developing countries such as India. The International Classification of Functioning disability and Health (ICF) has shifted the approach towards a holistic perspective in defining and measuring disability. This paper tries to measure HI from the perspective of social and emotional functioning of individuals.

Method: The sample population consisted of 1160 individuals, selected by systematic random sampling from among those who complied with inclusion criteria. 51.7% of the total respondents were females, and 48.3% were males. The participants were administered a questionnaire (Standardised) and their responses were quantified. The data was analysed using Statistical Package for Social Sciences (SPSS) version 20.

Results: Prevalence of HI was found more among males than females. 84.6% of the total population had no hearing impairment, whereas 13.7% had mild to moderate impairment, and 1.7% had significant hearing impairment. The TotalImpairment score obtained by the individuals was divided into Social Impairment score and Emotional Impairment score. Correlation and Multivariate regression analysis were used. Correlation - Age and Social Dimension Score r= 0.609,p≤0.01, n=1160, R2= 0.370; Age and Emotional Dimension score: r= 0.622, p≤0.01, n=1160, R2= 0.386; Regression- Gender and Social Dimension score b= 0.703, t (1160) = 2.988, p<0.05; Age and Total HI score b= 0.787, t (1160) =27.096, p< 0.01.

Conclusion: Measuring HI in terms of social and emotional functioning is more holistic and cost-effective, and could be used in resource-poor settings, and for initial screening in large-scale studies.