Food and nutrition security in persons with disabilities. A scoping review

Food security and disability in South Africa: an analysis of General Household Survey data

PURPOSE

We investigated the relationship between disability and food security in South Africa using data from the General Household Survey (GHS).

MATERIALS AND METHODS

Regression models were utilised with GHS data (2014-2018) to gauge the likelihood of food insecurity (the dependent variable) among individuals with disabilities. Socioeconomic and demographic traits of the 2018 GHS sample were analysed. All estimates were weighted and represented nationally at the individual level.

RESULTS

In this study population (32 187) of food insecure people, 9.64% are disabled. Food insecurity impacts more Black people with disabilities (91%) versus those without disabilities (90%), and disabled women (65%) versus nondisabled women (58%). Most reside in KwaZulu-Natal. Those with disability grants lower food insecurity odds, while child support grant recipients face higher odds. Household size and education are significant predictors, while marital status and gender are not.

CONCLUSION

This study data justifies the need for disability-inclusive food security programmes in South Africa, especially amid crises like COVID-19. Significantly, there is a nil data finding about people with eating/swallowing disabilities whose needs intersect with food security. This emphasises the need for inclusive data collection that operates within a food sovereignty framework to increase the visibility of people with disabilities.

Status and factors related to hemoglobin concentration of people with vs. without disability-using nationwide claims check-up database

Background

Blood hemoglobin level is a key indicator of organ function and health status throughout the life course. As hemoglobin-related health problems are gaining attention, many studies on factors related to hemoglobin concentration are being conducted, yet few researches have been conducted targeting persons with disabilities. Furthermore, researches that consider the association between blood hemoglobin and the regional level health welfare resources are rare. This study aimed to explore the factors related to blood hemoglobin concentration among people with and without disability, and to contribute to the development of future nutritional policies and projects for persons with disabilities.

Methods

A health insurance claims database with check-ups provided by the National Health Insurance Services (NHIS) was used. One-to-three propensity score matching was conducted between participants with and without disabilities. In addition to the individual clinical and health behavioral aspects based on the claims data, regional-level data of healthcare and social welfare resources was also collected, and multi-level analysis was conducted to identify factors associated with low blood hemoglobin level.

Results

A total of 1,697 participants with disability and 5,091 without disabilities were yielded. Disability was significantly associated with lower hemoglobin level, even after propensity score matching. Sex, BMI, health behaviors, and clinical indicators were significantly associated with the blood hemoglobin level. Furthermore, region-level welfare budget was a significant factor among persons with disability.

Conclusion

Our findings confirmed the significant association between disability and lower hemoglobin level. Regional health and welfare resources, as well as individual characteristics should be considered in implementation of further nutrition and health policies for persons with disabilities. Further studies are needed to understand of health outcomes of low hemoglobin level.

Neurodivergence, intersectionality, and eating disorders: a lived experience-led narrative review

Autistic people and those with attention deficit hyperactivity disorder are at a high risk of developing an eating disorder. While there is limited evidence on the relationship between other forms of neurodivergence and eating disorders, research suggests associations between giftedness, intellectual disability, obsessive-compulsive disorder, psychosis, Tourette's syndrome, and disordered eating. Factors underlying disordered eating and/or eating disorder risk for neurodivergent people are multifaceted and complex, encompassing a wide range of intertwined psychosocial, environmental, and biological processes. Moreover, research shows that neurodivergent individuals experience poorer treatment outcomes compared to neurotypical individuals. However, there is a paucity of research in this area overall. More specifically, lived experience-led research remains rare, despite its critical role for improving individualised eating disorder care, as well as mental healthcare more broadly. Indeed, the importance of eating disorder care individuation is increasingly being recognised, particularly within the context of neurodivergence, given the heterogeneous experiences and support needs of neurodivergent people affected by disordered eating and/or eating disorders. Furthermore, despite documented overlaps between various forms of neurodivergence (e.g., co-occurring autism and attention deficit hyperactivity disorder), research looking at eating disorders in the context of neurodivergence through a transdiagnostic perspective is scarce. This lived experience-led narrative review aims to shed light on the intersectional factors underlying elevated disordered eating and/or eating disorder risk for neurodivergent individuals. First, an overview of prevalence data is provided, followed by a thematic framework identifying factors underlying disordered eating and/or eating disorder risk in relation to neurodivergence. A critical appraisal of current eating disorder research and care is then offered before suggestions for neurodiversity-affirming eating disorder care are made. In this view, this paper offers a foundation for future empirical work in this nascent field of inquiry by providing a lived experience-led, transdiagnostic, and intersectional account of eating disorders in the context of neurodivergence.

Lived experiences of diabetes self-management among persons with disabilities in rural Tamil Nadu - a case study approach

BACKGROUND

People with disabilities have numerous challenges in diabetes self-management. Poor self-management leads to the worsening of disability and secondary complications of diabetes. This study was conducted to explore the challenges in diabetes self-management and the factors influencing diabetes self-management among people with disabilities.

METHODS

We conducted 16 case studies among people with physical, neurological, visual, hearing, and multiple disabilities who were affected by diabetes. We adopted a thematic content analysis approach to analyse the data.

RESULTS

People with disabilities have challenges in adopting healthy diets as they are unable to purchase and consume fruits and vegetables which are costly, unavailable, and inaccessible. They have difficulty in doing physical activity due to lack of inclusive public spaces which are inaccessible, lack of motivation, and dependence on others for their mobility. Irregular drug supply in the public health system and unaffordable cost of drugs hamper adherence to medications. Laboratories are inaccessible to people with disabilities thus preventing monitoring of blood sugars. They have poor quality of life, life with pain and mental health issues, which prevent adoption of self-management behaviors. The intersectionality of age and gender with disability worsens self-management behaviors. Inaccessible health system, poor quality of health care and insensitive health care providers further complicate self-management.

CONCLUSION

This study documents the challenges faced by persons with disabilities in practicing diabetes self management. There is a need for public health policy and planning that is inclusive of persons with disabilities to make access to diabetes care universal.

The Sustainable Development Goals: A framework for addressing participation of persons with complex communication needs in South Africa

BACKGROUND

Participation in society is the cornerstone to living a meaningful, connected, and healthy life. Persons with complex communication needs, however, often have restricted opportunities to participate in everyday contexts and situations. Reasons for this include societal attitudinal barriers, as well as limited knowledge and skills about augmentative and alternative communication (AAC) to enhance participation. Enhancing participation of persons with complex communication needs requires a holistic and multi-faceted approach. The 17 Sustainable Development Goals (SDGs) with their disability-inclusive agenda provide an impetus for shaping the approach of the Centre for Augmentative and Alternative Communication (CAAC) in enhancing participation of persons with complex communication needs in South Africa.

PURPOSE

This paper aims to provide a reflective description and application of the work conducted by the CAAC in addressing the SDGs in South Africa.

RESULT

Research and training conducted by the CAAC is shown to be aligned to five SDGs, namely zero hunger (SDG 2), good health and well-being (SDG 3), quality education (SDG 4), decent work and economic growth (SDG 8) and peace, justice, and strong institutions (SDG 16), with a focus on reaching these goals in order to benefit persons with complex communication needs.

CONCLUSION

The paper demonstrates that, despite some gains in addressing the SDGs, research and clinical practice still needs to be on these and the remaining SDGs. Furthermore, there is a need to also find ways to integrate the SDGs to ensure participation of persons with complex communication needs in major life activities and society.