African Journal of Disability最新文献

Background: COVID-19 had an impact on all sections of society, including people with disabilities.

Objectives: The authors aimed to explore the needs and experiences of people with disabilities in Zambia during the COVID-19 pandemic.

Method: In this hermeneutic phenomenological study, we used a semi-structured interview guide to collect data from a purposive and snowball sample of 40 people with disabilities and their caregivers. The participants were from 11 districts in 6 provinces in Zambia. The in-depth interviews were done between July 2022 and November 2022. Data were managed in NVivo and analysed using reflexive thematic analysis.

Results: The three themes included: (1) awareness and experience of public health measures on COVID-19 among people with disabilities; (2) experience of othering and stigmatisation as people with disability during the COVID-19 pandemic and (3) experience of COVID-19 symptoms and having COVID-19 among people with disabilities.

Conclusion: Interventions were largely unresponsive to the needs of people with disabilities, exacerbating the risk of exposure to infection. In future, adaptations like emergency risk communication in braille, audio and sign language interpretation in adapted communication formats should be made. Further studies are needed to quantify the gaps in access to health, explore policies and strategies to improve health outcomes for people with disabilities in LMICs like Zambia.

Contribution: The findings may contribute to the development and enhancement of policies and interventions responsive to the needs of people with disabilities in future pandemics in the Zambian context.

Background: Diabetes mellitus (DM) is a global health concern that has greatly affected South Africa. The gap in the current management of DM has resulted in complications such as lower extremity amputations (LEAs) and death. Eastern Cape province reflects this struggle, with disparities in access to healthcare and poor health outcomes. Understanding survival rates and associated factors between the urban Livingstone Hospital and the rural Nelson Mandela Academic Hospital can improve health interventions and outcomes.

Objectives: This study compared the survival rate of patients in urban areas and those in rural areas.

Method: This retrospective cohort study was conducted in an urban and a rural hospital by reviewing existing medical records of diabetic patients who underwent an LEA between 2016 and 2019.

Results: The retrospective cohort study examined 439 diabetic-related LEA cases. This study found that residing in rural areas significantly decreased the risk of mortality by 62% compared with living in the urban areas. Factors such as haemoglobin A1c (HbA1c) levels, nephropathy, cardiovascular disease, human immunodeficiency virus (HIV), other comorbidities and level of amputation significantly influenced survival probabilities.

Conclusion: Survival analysis indicated a significant difference in the 3-year survival probabilities of the two groups, favouring rural residency (p = 0.001). The biggest cause for concern between the two regions was uncontrolled blood glucose levels as this resulted in high mortality rates.

Contribution: Insights from this study have shown that introducing podiatry and orthotics at primary healthcare (PHC) could improve foot care and reduce diabetic-related LEAs and mortality.

Background: While all women are at risk of gender-based violence (GBV), it is essential to acknowledge that women are not a homogenous group and that women who are Deaf may experience GBV differently. This study aimed to answer the question: What are the perceptions and experiences of GBV among women who are Deaf?

Objectives: The study's objectives were to explore and describe these women's understanding of GBV terminology, their perceptions of GBV and challenges regarding support strategies in place to respond to their unique circumstances.

Method: A qualitative study with four workshops was conducted with 60 participants. The data collected were analysed using thematic analysis.

Results: The results yielded three themes that intrinsically spoke to women's understanding of GBV terminology, perception of GBV and challenges accessing support. The results highlight that women who are Deaf are at a greater risk of GBV. Participants emphasised the importance of exploring the perceptions of GBV among men who are Deaf. Findings also indicated women's challenges when seeking support.

Conclusion: The findings underscore the necessity of offering specific assistance to Deaf women facing GBV. Based on the study findings, it can be concluded that those providing support in GBV matters should receive specialised training in GBV, including Deaf culture and South African sign language.

Contribution: The study findings contribute to the field of disability and the development of effective GBV strategies and programmes that are inclusive of women who are Deaf within a South African context.

Background: The African Network for Evidence-to-Action in Disability (AfriNEAD) is a leading role player in Africa promoting evidence-informed policies and practices for disability inclusion on the continent. This article presents findings of a desktop review that explored trends of disability research in the AfriNEAD affiliated countries.

Objectives: The review explored trends of research that has been published by members of the disability research community who are contributing to AfriNEAD Conferences.

Method: A Google scholar search was conducted using names of researchers who presented articles at the first six AfriNEAD Conferences, recording peer-reviewed journal publications by each author according to the eight AfriNEAD research focus areas. This was followed by a hand search of all articles published in the African Journal of Disability from AfriNEAD affiliated countries.

Results: There is an exponential increase in the number of peer reviewed journal publications from AfriNEAD affiliated countries over the last two decades. Collaborations are common among authors within the same African country. International collaborations are common among authors from Africa with authors from the Global North.

Conclusion: African researchers need to network and collaborate more across Africa, to promote disability research in countries where research is scarce and to focus more on research areas that are not receiving attention.

Contribution: The desktop exploration is a first step for AfriNEAD to get a baseline understanding of published disability research in the countries affiliated to the network. Further research is required to understand these trends and to provide evidence necessary to address the identified gaps.

Background: Recently, attention has been paid to how rehabilitation not only provides medical treatment and instrumental skills but also impacts psychological well-being and identity. We all have psychological structures that discipline the self, enforcing norms internalised during early life and exacting judgments when we fail to 'make the grade'. In cases of congenital disabilities, rehabilitation interventions may span many years, involving strict programmes of therapy, exercise and self-discipline. These regimes may align with internalised rules in harmful ways, as striving for functional improvements takes on a moral dimension, affecting psychological health and empowered disability identities.

Objectives: This study explores rehabilitation by examining the experiences of adults with congenital disabilities, who have undergone childhood medical and rehabilitative interventions.

Method: This study was based on the experience of a psychoanalytic psychotherapist working with adults with disability, and presents composite case material to illustrate how interactions with medical authority figures, such as rehabilitation professionals, can have a formative influence on self-identity and entitlement to inclusion.

Results: The findings vividly reflected how 'medical socialisation' created meanings of disability that were enacted and repeated well into adulthood.

Conclusion: The discipline of rehabilitation still has much to do in examining its value-laden assumptions and practices, and how these may shape the internal and relational worlds of people with disability.

Contribution: This article contributes to the debate in critical rehabilitation studies, focussing on the issue of constructions of disability which may be communicated to people with disability, with implications for self-advocacy and the growth of the disability movement.

Background: Obuntu Bulamu is a Ugandan intervention promoting inclusive education for children with disabilities. This culturally appropriate approach, based on the Ubuntu philosophy, utilises peer-to-peer support activities for children, parents and teachers.

Objectives: To effectively measure the intervention's impact on disability inclusion, the study aimed to select, adapt and test classroom observation instruments suitable for the Ugandan context.

Method: Three structured classroom observation tools were selected and piloted in 10 primary schools in Wakiso District: The Classroom Observation Checklist (CoC), the Teacher-Pupil Observation Tool (T-POT) and the Interaction Engagement Scale (IES). These tools were adapted to ensure cultural relevance and applicability within Ugandan school settings.

Results: Factors like class size, teaching methods, cultural relevance, language and ease of use influenced the suitability of the selected tool. The CoC emerged as a more effective tool with a strong internal consistency (Cronbach's alpha of 0.80) for capturing inclusiveness and peer-to-peer support in the classroom compared to the T-POT and IES.

Conclusion: The study findings emphasise the significance of adapting and testing tools in specific cultural contexts and low-income country settings and considering culturally contextual factors like class size, teaching methods, language complexity and ease of use when measuring disability inclusion in primary schools.

Contribution: The selection of a classroom observation tool for the Obuntu Bulamu randomised control trial contributed to African disability knowledge and practices designed on and for the continent.

Background: The greatest challenge for persons with disabilities is that of securing and maintaining employment, because of the limitations associated with being visually impaired.

Objectives: This study aims to explore the employment challenges of securing and maintaining employment faced by persons with visual impairments.

Method: A qualitative research approach with an exploratory research design was employed. A non-probability sampling method using the snowball sampling technique was adopted. A semi-structured interview was conducted with a total of n = 9 participants, and the data were analysed using the thematic analysis method.

Results: The findings indicate that persons with visual impairment continue to face adverse challenges, especially in the quest of securing employment. Discrimination, isolation, rejection and lack of recognition are key issues that continue to persist in their life experiences, from the tertiary to post-tertiary level.

Conclusion: Persons with visual impairment need continued support from various stakeholders as far as employment opportunities are concerned. There is a need to sensitise stakeholders, at all levels, on the challenges encountered by persons with visual impairment in their employment journey for effective inclusion and diversity management.

Contribution: The findings can aid in the development of an all-round model of support and optimal functioning for persons with visual impairment from grassroots level to post-tertiary education and in workplaces.

Background: Population-based data show high proportions of severe cases of cerebral palsy (CP) in resource-poor regions such as sub-Saharan Africa, where most children have potentially preventable risk factors (factors that may increase the likelihood of CP occurrence but can be mitigated through medical interventions).

Objectives: This study aimed to describe the demographic and clinical profile of children living with CP accessing services at Tygerberg Hospital over a period of 10 years (2010-2020), identify the potential gaps in care (proportion of individuals in a country requiring but not receiving suboptimal or inadequate care), and comparison with a similar study at the same centre two decades ago.

Method: This 10-year retrospective study investigated causes and morbidities in children with CP, attending a central hospital in the Western Cape, South Africa.

Results: A total of 613 children with CP were identified. Perinatal causes were predominant, especially in 57.7% (n = 354) of the cohort: perinatal asphyxia (41.1%) and preterm birth (16.6%). Postnatal causes constituted 15.2% (n = 93), which included tuberculous meningitis (3.6%) and bacterial meningitis (3.6%). The most common complications were intellectual impairment (61.8%; n = 379); epilepsy (30.8%; n = 189) and visual impairment (54.7%; n = 234). A third of the cohort had severe CP, classified as Gross Motor Function Classification System IV and V (38%).

Conclusion: Most of the previously documented main drivers of CP are still present and the implementation of healthcare prevention strategies remains inadequate.

Contribution: This study provides longitudinal evidence to confirm that CP in a South African setting is associated with a high burden of potentially preventable causes.

Background: Increasing functional limitations and disabilities have raised the need for comprehensive rehabilitation services at the primary healthcare (PHC) level, particularly in low- and middle-income countries. To support the integration of these services into PHC in South Africa, assessing outcomes from the service users' perspectives is essential.

Objectives: This study examined service users' views on their PHC rehabilitation outcomes in a Metropolitan District of Gauteng, South Africa. The aim was to understand perceived changes in activity limitations and participation restrictions following the rehabilitation intervention.

Method: A quantitative survey design, including self-rating measurements and structured interviews, was employed. Thirty-eight rehabilitation service users from eight clinics and community health centres were purposively sampled. Participants rated their pre- and post-rehabilitation levels of difficulty in activity limitations and participation restrictions, with open-ended questions providing additional insights. Data analysis used descriptive statistics, quantitative content analysis, and non-parametric tests.

Results: Significant improvements in mobility, self-perception, and quality of life were reported by both adult and child service users. Caregivers of child service users also noted positive experiences (p = 0.019) in community, social, and civic life.

Conclusion: This study highlights the perceived positive changes experienced by PHC rehabilitation service users in addressing functional limitations and disabilities. It underscores the effectiveness of integrated rehabilitation service delivery in improving user outcomes.

Contribution: The findings offer valuable insights into how rehabilitation interventions enhance functional abilities, social participation, and overall well-being. By focusing on activity limitations and participation restrictions from service users' perspectives, this study supports the priority of providing person-centred rehabilitation services at the PHC level.