1
|
Gelli A, Duchoslav J, Gladstone M, Gilligan D, Katundu M, Maleta K, Quisumbing A, Bliznashka L, Ahun M. Impact evaluation of a maternal and child cash transfer intervention, integrated with nutrition, early childhood development, and agriculture messaging (MAZIKO-IE): a study protocol for a cluster-randomised controlled trial. Trials 2024; 25:46. [PMID: 38218938 PMCID: PMC10790253 DOI: 10.1186/s13063-023-07782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 11/06/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Children in Malawi face high rates of malnutrition and are at risk of not reaching their developmental potential. Community-based childcare centres (CBCCs) can be cost-effective platforms for scaling-up early childhood development (ECD) and nutrition social behaviour change (SBC) interventions. However, evidence also suggests potential synergies from coupling nutrition SBC with cash transfers (CT), given that rural households in Malawi face high levels of poverty and recurring extreme lean season food-security shocks. The Maziko trial is aimed at evaluating the effectiveness and cost-effectiveness of using CBCCs and parenting care groups as platforms to improve maternal diets and child nutrition and development by providing nutrition-sensitive SBC and CT intervention packages in communities already receiving a standard of care Government SBC program. METHODS We designed a 3-year cluster-randomised controlled trial in two districts of Malawi, including 156 communities randomised to one of four treatment arms: (1) standard of care (SoC) arm: receiving the standard Government SBC program; (2) SBC arm: receiving the SoC intervention with additional nutrition-sensitive SBC activities to improve nutritious food production, diets, and care practices for young children; (3) low CT arm: SoC plus SBC plus a maternal and child cash transfer ~ 17 USD per month; and (4) high CT arm: SoC plus SBC plus a maternal and child CT ~ 43 USD per month. The trial will enrol pregnant women and children < 2 years of age. The primary outcomes are maternal diet assessed using the mean probability of adequacy and child development assessed using the Malawi Developmental Assessment Tool. Intermediate outcomes along the programme impact pathways will also be measured, including maternal mental health, maternal empowerment, child feeding practices, and child nutritional status. DISCUSSION This is the first study to examine the impact and synergies of combining ECD SBC with nutrition-sensitive SBC and CTs on maternal and child outcomes during the first 1000 days. The findings from this evaluation will inform national ECD and nutrition programmes. TRIAL REGISTRATION ISRCTN ISRCTN53055824. Registered on 7 March 2022.
Collapse
|
2
|
Farrow A, Al-Jaishi AA, O'Donnell S, Palmeter S, Georgiades S, Chen YJ, McPhee PG, Edjoc R. Functional difficulties in children and youth with autism spectrum disorder: analysis of the 2019 Canadian Health Survey on Children and Youth. Health Promot Chronic Dis Prev Can 2024; 44:9-20. [PMID: 38231089 PMCID: PMC10849611 DOI: 10.24095/hpcdp.44.1.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
INTRODUCTION This study examined the prevalence of functional difficulties and associated factors in Canadian children/youth aged 5 to 17 years diagnosed with autism spectrum disorder (ASD). METHODS We analyzed data from the 2019 Canadian Health Survey on Children and Youth (CHSCY), a nationally representative survey of Canadian children/youth that used the Washington Group Short Set on Functioning (WG-SS) to evaluate functioning in six daily tasks. For each functional domain, binary outcomes were derived (no/some difficulty, a lot of difficulty/no ability). We used logistic regression to identify associations between demographic characteristics, educational experiences, and perceived mental and general health and the most common functional difficulties, namely those related to remembering/concentrating, communication and self-care. All estimates were weighted to be representative of the target population. The bootstrap method was used to calculate variance estimates. RESULTS Analysis of the records of 660 children/youth with ASD revealed that the most common functional difficulties were remembering/concentrating (22%; 95% CI: 18-27), communicating (19%; 95% CI: 15-23) and self-care (13%; 95% CI: 10-17). Lower perceived mental health was associated with increased functional difficulties with remembering/concentrating. ASD diagnosis at a lower age and lower perceived general health were associated with increased functional difficulty with communication. Parental expectations for postsecondary education were associated with decreased functional difficulty for self-care. CONCLUSION One or more functional difficulties from the WG-SS was present in 39% of Canadian children/youth aged 5 to 17 years with ASD. Functional difficulties with remembering/concentrating, communication and self-care were most common.
Collapse
Affiliation(s)
- Amy Farrow
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | | | | | - Stelios Georgiades
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Yun-Ju Chen
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Patrick G McPhee
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | | |
Collapse
|
3
|
Rotenberg S, Davey C, McFadden E. Association between disability status and health care utilisation for common childhood illnesses in 10 countries in sub-Saharan Africa: a cross-sectional study in the Multiple Indicator Cluster Survey. EClinicalMedicine 2023; 57:101870. [PMID: 36895804 PMCID: PMC9989629 DOI: 10.1016/j.eclinm.2023.101870] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Approximately 70 million children in sub-Saharan Africa (SSA) are disabled, yet little is known about the prevalence of and care-seeking patterns for common childhood illnesses, such as acute respiratory infection (ARI), diarrhoea, and fever. METHODS Data were from 10 SSA countries with data available from 2017 to 2020 in the UNICEF-supported Multiple Indicator Cluster Survey (MICS) online repository. Children aged 2-4 years who completed the child functioning module were included. Using logistic regression, we examined the association between disability and ARI, diarrhoea and fever in the past two weeks and care-seeking behaviour for these illnesses. Using multinomial logistic regression, we examined the association between disability and the type of health care providers from which caregivers sought care. FINDINGS There were 51,901 children included. Overall, there were small absolute differences in illnesses between disabled and non-disabled children. However, there was evidence disabled children had a greater odds of ARI (aOR = 1.33, 95% C.I 1.16-1.52), diarrhoea (aOR = 1.27, 95% C.I. 1.12-1.44), and fever (aOR = 1.19 95% CI 1.06-1.35) compared to non-disabled children. There was no evidence that caregivers of disabled children had a greater odds of seeking care for ARI (aOR = 0.90, 95% C.I 0.69-1.19), diarrhoea (aOR = 1.06, 95% C.I. 0.84-1.34), and fever (aOR = 1.07, 95% C.I 0.88-1.30) compared to caregivers of non-disabled children. Caregivers of disabled children had a higher odds of seeking care from a trained health worker for ARI (aOR = 1.76, 95% C.I. 1.25-2.47) and fever (aOR = 1.49, 95% C.I. 1.03-2.14) or non-health professional (aOR = 1.89, 95% C.I. 1.19-2.98) for ARI than from an unspecified health facility worker compared to caregivers of non-disabled children, but no associations were not seen for diarrhoea. INTERPRETATION While the data showed relatively small absolute differences, disability was associated with ARI, diarrhoea and fever and caregivers of disabled children sought care from trained health workers for ARI and fever more than non-disabled children. The overall small absolute differences show closing gaps in illness and access to care may be possible, but highlights that more research on illness severity, care quality, and outcomes should be conducted to further assess health inequities for disabled children. FUNDING SR receives funding from the Rhodes Trust.
Collapse
Affiliation(s)
- Sara Rotenberg
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
- Corresponding author.
| | - Calum Davey
- International Center for Evidence in Disability, London School of Hygiene and Tropical Medicine, UK
| | - Emily McFadden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| |
Collapse
|
4
|
Wang C, Dopko RL, Clayborne ZM, Capaldi CA, Roberts KC, Betancourt MT. Investigating the association between sleep and aspects of mental health in children: findings from the Canadian Health Survey on Children and Youth. Health Promot Chronic Dis Prev Can 2022; 42:466-478. [PMID: 36383158 PMCID: PMC9903851 DOI: 10.24095/hpcdp.42.11/12.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Sufficient sleep and good quality sleep are crucial aspects of children's healthy development. While previous research has suggested associations between sleep and positive mental health, few studies have been conducted in Canadian children. METHODS This study used data from the 2019 Canadian Health Survey on Children and Youth. Parents of children aged 5 to 11 years (N = 16 170) reported on their children's sleep habits and mental health. Descriptive statistics were used to calculate means and percentages for sleep and mental health indicators. Logistic regression was used to compare mental health outcomes by meeting sleep duration recommendations (9-11 hours of sleep vs. < 9 or > 11 hours of sleep), sleep quality (difficulties getting to sleep) and having enforced rules for bedtime. RESULTS Overall, 86.2% of children aged 5 to 11 years met sleep duration recommendations (9-11 hours of sleep), 90.0% had high sleep quality and 83.1% had enforced rules for bedtime. While 83.0% of children had high general mental health, mental health diagnoses were reported for 9.5% of children, and 15.8% of children required or received mental health care. High sleep quality was consistently associated with better mental health, enforced rules for bedtime were associated with some negative mental health outcomes and meeting sleep duration recommendations tended not to be associated with mental health outcomes. CONCLUSION Sleep quality was strongly associated with mental health among children in this study. Future research should explore longitudinal associations between sleep and mental health in Canadian children.
Collapse
Affiliation(s)
- Chinchin Wang
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montréal, Quebec, Canada
| | | | - Zahra M Clayborne
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
| | | | | | | |
Collapse
|
5
|
Jolley E, Bechange S, Mankhwazi M, Mbukwa Ngwira J, Murphy R, Schmidt E, Lynch P. Measuring the impact of a training intervention for early childhood centre staff on child development outcomes: Findings from a cluster randomized control field trial in rural Malawi. Child Care Health Dev 2022; 48:736-743. [PMID: 35112380 PMCID: PMC9541562 DOI: 10.1111/cch.12981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evidence from low-income settings around early education interventions that can improve young children's development is sparse, particularly with regard to the most marginalized children. This study used a two-arm parallel cluster randomized control design to evaluate the impact of an adapted staff training programme on the developmental outcomes of children attending community-based early learning centres in Thyolo district, rural Malawi. METHODS At baseline we randomly selected 48 centres, from each of which 20 children were randomly selected, although data from one centre was incomplete resulting in 932 children from 47 centres. Centres were randomly allocated to either the intervention or control arm. Twelve months later, follow-up data were collected from 44 centres. At baseline and endline, community-based childcare centre (CBCC) managers provided information about the centre, and parents/guardians provided information on the children, including the primary outcomes of age-standardized development scores in the language and social domains, measured using the Malawi Developmental Assessment Tool. Children in the bottom 2.5 percentile of either domain were considered to have a delay; a third outcome variable, Any Delay, was developed to indicate children with a delay in either or both domains. Centre-level mean scores were calculated, and linear regression models were constructed to assess differences between baseline and endline and between allocation groups. RESULTS Analysis of the difference between baseline and endline measures in the allocation groups shows a non-significant reduction in delay associated with the study intervention across all domains. Adjustment for baseline characteristics within the CBCCs showed little impact on the magnitude of the observed effect, and the difference remained non-significant. CONCLUSIONS Despite no observed differences between allocation groups, the data did indicate a positive change in the intervention groups in both domains, particularly language. Community-based early learning in Malawi holds tremendous potential for promoting inclusive development and learning.
Collapse
Affiliation(s)
- Emma Jolley
- Health and Disability ResearchSightsaversHaywards HeathUK
| | | | | | | | - Rachel Murphy
- Health and Disability ResearchSightsaversHaywards HeathUK
| | - Elena Schmidt
- Evidence, Research and InnovationsSightsaversHaywards HeathUK
| | - Paul Lynch
- Inclusive Education, School of EducationUniversity of GlasgowGlasgowUK
| |
Collapse
|
6
|
Galbraith N, Kingsbury M. Parental Separation or Divorce, Shared Parenting Time Arrangements, and Child Well-Being: New Findings for Canada. CANADIAN STUDIES IN POPULATION 2022. [DOI: 10.1007/s42650-022-00068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
7
|
Zia N, Bachani AM, Kajungu D, Galiwango E, Loeb M, Diener-West M, Wegener S, Pariyo G, Hyder AA. Understanding child disability: Factors associated with child disability at the Iganga-Mayuge Health and Demographic Surveillance Site in Uganda. PLoS One 2022; 17:e0267182. [PMID: 35427403 PMCID: PMC9012358 DOI: 10.1371/journal.pone.0267182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/04/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction There is scarcity of data on children with disabilities living in low-and-middle-income countries, including Uganda. This study describes disability prevalence and explores factors associated with different disability categories. It highlights the value of using a standardized, easy-to-use tool to determine disability in children and contextualizing disability in children in light of their developmental needs. Methods A cross-sectional study was conducted between September 2018–January 2019 at the Iganga-Mayuge Health and Demographic Surveillance Site in Uganda. Respondents were caregivers of children between 5–17 years and were administered an in-depth Child Functioning Module (CFM). The outcome variable, disability, was defined as an ordered categorical variable with three categories–mild, moderate, and severe. Generalized ordered logit model was applied to explore factors associated with disability categories. Results Out of 1,842 caregivers approached for the study, 1,439 (response: 78.1%) agreed to participate in the study. Out of these 1,439, some level of disability was reported by 67.89% (n = 977) of caregivers. Of these 977 children with disability, 48.01% (n = 692) had mild disability and 15.84% (n = 228) had moderate disability, while 3.96% (n = 57) had severe disability. The mean (SD) score for mild disability was 2.22±1.17, with a median of 2. The mean and median for moderate disability was 5.26±3.28 and 4 (IQR:3–6), and for severe disability was 14.23±9.51 and 12 (IQR:6–22). The most common disabilities reported were depression (54.83%) and anxiety (50.87%). Statistically significant association was found for completion of immunization status and school enrollment when controlled for a child’s age, sex, having a primary caregiver, age of mother at child’s birth, family system, family size and household wealth quintile. Conclusion This study suggests association between incomplete immunization status and school enrollment for children with disability. These are areas for further exploration to ensure inclusive health and inclusive education of children with disabilities in Uganda.
Collapse
Affiliation(s)
- Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Abdulgafoor M. Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dan Kajungu
- Iganga-Mayuge Health and Demographic Surveillance Site, Makerere University School of Public Health, Kampala, Uganda
| | - Edward Galiwango
- Iganga-Mayuge Health and Demographic Surveillance Site, Makerere University School of Public Health, Kampala, Uganda
| | - Mitchell Loeb
- Washington Group on Disability Statistics, Hyattsville, Maryland, United States of America
| | - Marie Diener-West
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Stephen Wegener
- Department of Physical Medicine and Rehabilitation, Division of Rehabilitation Psychology and Neuropsychology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - George Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Adnan A. Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| |
Collapse
|
8
|
Dunne TF, Chandna J, Majo F, Tavengwa N, Mutasa B, Chasekwa B, Ntozini R, Prendergast AJ, Humphrey JH, Gladstone MJ. Performance of the UNICEF/UN Washington Group tool for identifying functional difficulty in rural Zimbabwean children. PLoS One 2022; 17:e0274664. [PMID: 36112574 PMCID: PMC9480986 DOI: 10.1371/journal.pone.0274664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Over one billion people live with disability worldwide, of whom 80% are in developing countries. Robust childhood disability data are limited, particularly as tools for identifying disability function poorly at young ages. METHODS A subgroup of children enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial (a cluster-randomised, community-based, 2x2 factorial trial in two rural districts in Zimbabwe) had neurodevelopmental assessments at 2 years of age. We evaluated functional difficulty prevalence in HIV-exposed and HIV-unexposed children using the Washington Group Child Functioning Module (WGCFM), comparing absolute difference using chi-squared or Fisher's exact tests. Concurrent validity with the Malawi Developmental Assessment Tool (MDAT) was assessed using logistic regression with cohort MDAT score quartiles, linear regression for unit-increase in raw scores and a Generalised Estimating Equation approach (to adjust for clusters) to compare MDAT scores of those with and without functional difficulty. A 3-step, cluster-adjusted multivariable regression model was then carried out to examine risk factors for functional difficulty. FINDINGS Functional Difficulty prevalence was 4.2% (95%CI: 3.2%, 5.2%) in HIV-unexposed children (n = 1606) versus 6.1% (95%CI: 3.5%, 8.9%) in HIV-exposed children (n = 314) (absolute difference 1.9%, 95%CI: -0.93%, 4.69%; p = 0.14). Functional difficulty score correlated negatively with MDAT: for each unit increase in WGCFM score, children completed 2.6 (95%CI: 2.2, 3.1) fewer MDAT items (p = 0.001). Children from families with food insecurity and poorer housing were more at risk of functional difficulty. INTERPRETATION Functional difficulty was identified in approximately 1-in-20 children in rural Zimbabwe, which is comparable to prevalence in previous studies. WGCFM showed concurrent validity with the MDAT, supporting its use in early childhood.
Collapse
Affiliation(s)
- Thomas Frederick Dunne
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Jaya Chandna
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume Tavengwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Batsirai Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Andrew J. Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, United Kingdom
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Melissa J. Gladstone
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
9
|
Mactaggart I, Hasan Bek A, Banks LM, Bright T, Dionicio C, Hameed S, Neupane S, Murthy GVS, Orucu A, Oye J, Naber J, Shakespeare T, Patterson A, Polack S, Kuper H. Interrogating and Reflecting on Disability Prevalence Data Collected Using the Washington Group Tools: Results from Population-Based Surveys in Cameroon, Guatemala, India, Maldives, Nepal, Turkey and Vanuatu. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9213. [PMID: 34501803 PMCID: PMC8431177 DOI: 10.3390/ijerph18179213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022]
Abstract
The Washington Group (WG) tools capture self-reported functional limitations, ranging from 6 domains in the Short Set (SS) to 11 in the Extended Set (ESF). Prevalence estimates can vary considerably on account of differences between modules and the different applications of them. We compare prevalence estimates by WG module, threshold, application and domain to explore these nuances and consider whether alternative combinations of questions may be valuable in reduced sets. We conducted secondary analyses of seven population-based surveys (analyses restricted to adults 18+) in Low- and Middle-Income Countries that used the WG tools. The prevalence estimates using the SS standard threshold (a lot of difficulty or higher in one or more domain) varied between 3.2% (95% Confidence Interval 2.9-3.6) in Vanuatu to 14.1% (12.2-16.2) in Turkey. The prevalence was higher using the ESF than the SS, and much higher (5 to 10-fold) using a wider threshold of "some" or greater difficulty. Two of the SS domains (communication, self-care) identified few additional individuals with functional limitations. An alternative SS replacing these domains with the psychosocial domains of anxiety and depression would identify more participants with functional limitations for the same number of items. The WG tools are valuable for collecting harmonised population data on disability. It is important that the impact on prevalence of use of different modules, thresholds and applications is recognised. An alternative SS may capture a greater proportion of people with functional domains without increasing the number of items.
Collapse
Affiliation(s)
- Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (L.M.B.); (T.B.); (S.H.); (T.S.); (S.P.); (H.K.)
| | - Ammar Hasan Bek
- Relief International, Istanbul 34087, Turkey; (A.H.B.); (A.P.)
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (L.M.B.); (T.B.); (S.H.); (T.S.); (S.P.); (H.K.)
| | - Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (L.M.B.); (T.B.); (S.H.); (T.S.); (S.P.); (H.K.)
| | - Carlos Dionicio
- Center for Research in Indigenous Health, Wuqu’ Kawoq, Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 4001, Guatemala;
| | - Shaffa Hameed
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (L.M.B.); (T.B.); (S.H.); (T.S.); (S.P.); (H.K.)
| | | | - GVS Murthy
- Indian Institute of Public Health, Hyderabad 122002, India;
| | | | - Joseph Oye
- Sightsavers Cameroon, Yaounde P.O. Box 4484, Cameroon;
| | - Jonathan Naber
- Range of Motion Project, P.O. Box 100915, Denver, CO 80250, USA;
| | - Tom Shakespeare
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (L.M.B.); (T.B.); (S.H.); (T.S.); (S.P.); (H.K.)
| | | | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (L.M.B.); (T.B.); (S.H.); (T.S.); (S.P.); (H.K.)
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (L.M.B.); (T.B.); (S.H.); (T.S.); (S.P.); (H.K.)
| |
Collapse
|
10
|
Setting the record straight on measuring SDG 4.2.1. LANCET GLOBAL HEALTH 2021; 9:e910-e911. [PMID: 34143990 DOI: 10.1016/s2214-109x(21)00229-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 11/21/2022]
|
11
|
Afiaz A, Masud MS, Mansur M. Impact of child's cognitive and social-emotional difficulties on child abuse: Does mother's justification of intimate partner violence also play a role? CHILD ABUSE & NEGLECT 2021; 117:105028. [PMID: 33774516 DOI: 10.1016/j.chiabu.2021.105028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/20/2021] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Violence against children has been a persistent problem in developing nations. The adverse effects of physical violence bear a considerable impact on children's physical and psychological development resulting in both short and long-term issues. OBJECTIVE The aim of this study was to explore whether children with cognitive and social-emotional difficulties (CSEDs) were at a higher risk of experiencing physical abuse and whether mothers' views on intimate partner violence (IPV) were also related to physical abuse against children. PARTICIPANTS AND SETTING The Bangladesh Multiple Indicator Cluster Survey-2019 was used with a sample of 27,086 children aged 5-14. METHODS Generalized linear modelling along with a machine learning method of classification trees was employed to investigate the important sociodemographic characteristics and identify the most vulnerable groups of children based on their likelihood of exposure to household-violence. RESULTS Nearly 62.5 % of the children were physically abused by their mothers. Children with CSEDs were 53 % (OR 1.53; 95 % CI: 1.41, 1.67) more likely to experience physical abuse and mothers' justification of IPV was associated with a 16 % higher risk (OR 1.16; 95 % CI: 1.08, 1.26). Moreover, younger children aged 11 or below belonged to the high-risk groups of experiencing abuse. CONCLUSIONS The findings suggest that violence against children is widespread in Bangladesh, especially in children having CSEDs. Mothers' acceptance of IPV was also associated with increased abusive practice against children. Sincere focus on these issues is imperative if Bangladesh intends to achieve the sustainable development goal 16.2 of eradicating all forms of violence against children and ensure their safe development.
Collapse
Affiliation(s)
- Awan Afiaz
- Institute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, 1000, Bangladesh.
| | - Mohammad Shahed Masud
- Institute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, 1000, Bangladesh.
| | - Mohaimen Mansur
- Institute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, 1000, Bangladesh.
| |
Collapse
|
12
|
Olusanya BO, Hadders-Algra M, Breinbauer C, Williams AN, Newton CRJ, Davis AC. Setting the record straight on measuring SDG 4.2.1 - Authors' reply. Lancet Glob Health 2021; 9:e912. [PMID: 34143991 PMCID: PMC7613532 DOI: 10.1016/s2214-109x(21)00256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/17/2021] [Indexed: 01/05/2023]
Affiliation(s)
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Division of Developmental Neurology, Department of Paediatrics, Groningen, Netherlands
| | | | - Andrew N Williams
- Virtual Academic Unit, Northampton General Hospital, Northampton, UK
| | - Charles R J Newton
- KEMRI-Wellcome Trust Research Program, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Adrian C Davis
- Population Health Science, London School of Economics, London, UK
| |
Collapse
|
13
|
Olusanya BO, Hadders-Algra M, Breinbauer C, Williams AN, Newton CRJ, Davis AC. The conundrum of a global tool for early childhood development to monitor SDG indicator 4.2.1. LANCET GLOBAL HEALTH 2021; 9:e586-e587. [PMID: 33640036 PMCID: PMC7613544 DOI: 10.1016/s2214-109x(21)00030-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/27/2022]
|
14
|
Skylstad V, Aber H, Bakken V, Dierkes J, Iversen SA, Kisaakye E, Kühl MJ, Nalugya JS, Rayamajhi D, Sebuwufu D, Skar AMS, Skokauskas N, Valeckaite N, Wamani H, S Engebretsen IM, Babirye JN. Child alcohol use disorder in Eastern Uganda: screening, diagnostics, risk factors and management of children drinking alcohol in Uganda (TREAT C-AUD): a mixed-methods research protocol. BMJ Paediatr Open 2021; 5:e001214. [PMID: 34345718 PMCID: PMC8322685 DOI: 10.1136/bmjpo-2021-001214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/13/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Following a finding of alcohol use among children aged 5-8 years old in Mbale, Uganda, this project investigates the magnitude of alcohol and substance use among children ged 6-13 years old and related household, community, school, health system and clinical factors. METHODS The project includes four larger work packages (WPs). WP1 comprises management, WP2 and 3 include the scientific components and WP4 includes integration of results, dissemination, policy and implementation advice. This protocol presents the planned research work in WP 2 and 3. WP2 comprises the adaptation and validation of the alcohol use screening tool Car-Relax-Alone-Forget-Family and Friends-Trouble (CRAFFT) to the age group and setting. WP3 comprises four substudies (SS). SS1 is a cross-sectional community household survey with an estimated sample size of 3500 children aged 6-13 years and their caregivers. We apply cluster sampling and systematic sampling within the clusters. Data collection includes a structured questionnaire for caregiver and child, measuring social and demographic factors, mental health status, alcohol and substance use, nutrition history and anthropometry. Urine samples from children will be collected to measure ethyl glucuronide (EtG), a biological marker of alcohol intake. Further, facilitators, barriers and response mechanisms in the health system (SS2) and the school system (SS3) is explored with surveys and qualitative assessments. SS4 includes qualitative interviews with children. Analysis will apply descriptive statistics for the primary outcome of establishing the magnitude of alcohol drinking and substance use, and associated factors will be assessed using appropriate regression models. The substudies will be analysed independently, as well as inform each other through mixed methods strategies at the stages of design, analysis, and dissemination. ETHICS AND DISSEMINATION Data protection and ethical approvals have been obtained in Uganda and Norway, and referral procedures developed. Dissemination comprises peer-reviewed, open access research papers, policy recommendations and intersectoral dialogues.Trial registration numberClinicaltrials.gov 29.10.2020 (NCT04743024).
Collapse
Affiliation(s)
- Vilde Skylstad
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Harriet Aber
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Victoria Bakken
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jutta Dierkes
- Department of Clinical Medicine, Centre for Nutrition, Mohn Nutrition Research Laboratory, University of Bergen, Bergen, Norway.,Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Silje Akselberg Iversen
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Esther Kisaakye
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Melf-Jakob Kühl
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Joyce Sserunjogi Nalugya
- School of Public Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Psychiatry, Mulago National Referral Hospital, Kampala, Uganda
| | - Divya Rayamajhi
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Deogratious Sebuwufu
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ane-Marthe Solheim Skar
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.,Section for Implementation and Treatment Research, Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Norbert Skokauskas
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Neda Valeckaite
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Henry Wamani
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ingunn Marie S Engebretsen
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | | | | |
Collapse
|
15
|
A Rehabilitation Framework for Children Living With HIV in South Africa: Reaching Consensus for a Resource-Poor Community. J Assoc Nurses AIDS Care 2020; 31:228-240. [PMID: 31764208 DOI: 10.1097/jnc.0000000000000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although rehabilitation frameworks for adults living with HIV are developing steadily, interventions to ensure the integration of rehabilitation into the routine care of children living with HIV-related disabilities lags. We sought to explore perceptions of, and gain expert consensus on, a rehabilitation framework for children living with HIV. Experts in HIV pediatric care in South Africa engaged in a Delphi survey, based on findings from a context-specific rehabilitation framework for adults. Consensus was determined by an a priori threshold of 80% agreement and an interquartile range of 1 or lower on criteria to be included as essential or useful in the framework. Experts agreed that enhancing access to patient-centered care through decentralization and training of health care and community care workers in the use of disability screening tools at each point of care needed to be included in the framework. Strengthening multiprofessional team collaboration was also seen as fundamental.
Collapse
|
16
|
Connolly S, Carlin A, Johnston A, Woods C, Powell C, Belton S, O’Brien W, Saunders J, Duff C, Farmer O, Murphy M. Physical Activity, Sport and Physical Education in Northern Ireland School Children: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186849. [PMID: 32961784 PMCID: PMC7559058 DOI: 10.3390/ijerph17186849] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 11/16/2022]
Abstract
Internationally, insufficient physical activity (PA) is a major health concern. Children in Northern Ireland (NI) are recorded as having the lowest levels of PA in the United Kingdom (UK). To date, validated and representative data on the PA levels of NI school children are limited. The aim of this study was to provide surveillance data on self-reported PA, sport and physical education (PE) participation of school children in NI. Differences between genders and factors associated with PA were also examined. A representative sample of primary (n = 446) and post-primary (n = 1508) children was surveyed in school using validated self-report measures. Findings suggest that PA levels are low, with a minority of children (13%) meeting the PA guidelines (primary pupils 20%, post-primary pupils 11%). NI school children have lower levels of PA, PE and sports participation than UK and European peers. A trend of age-related decline across all the domains of PA was apparent. The data presented highlighted that females are less likely to achieve PA guidelines, children from lower socio-economic background participate in school and community sport less often, and that enjoyment and social support are important variables in PA adherence. Policy solutions that would support implementation e.g., mandatory minimum PE time, whole school approaches to PA promotion and targeted investment in schools, particularly in areas of deprivation and for females, are suggested.
Collapse
Affiliation(s)
- Sinead Connolly
- Centre for Exercise Medicine, Physical Activity and Health, Sport and Exercise Sciences Research Institute, Ulster University Jordanstown Campus, Shore Road, BT37 0QB Newtownabbey, Ireland; (A.C.); (A.J.); (M.M.)
- Correspondence:
| | - Angela Carlin
- Centre for Exercise Medicine, Physical Activity and Health, Sport and Exercise Sciences Research Institute, Ulster University Jordanstown Campus, Shore Road, BT37 0QB Newtownabbey, Ireland; (A.C.); (A.J.); (M.M.)
| | - Anne Johnston
- Centre for Exercise Medicine, Physical Activity and Health, Sport and Exercise Sciences Research Institute, Ulster University Jordanstown Campus, Shore Road, BT37 0QB Newtownabbey, Ireland; (A.C.); (A.J.); (M.M.)
| | - Catherine Woods
- Department of Physical Education and Sport Sciences, University of Limerick, V94 T9PX Limerick, Ireland;
- Physical Activity for Health Research Cluster, University of Limerick, V94 T9PX Limerick, Ireland;
- Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Cormac Powell
- Physical Activity for Health Research Cluster, University of Limerick, V94 T9PX Limerick, Ireland;
- Performance Department, Swim Ireland, Sport HQ, D15 F2CC Dublin, Ireland
| | - Sarahjane Belton
- School of Health and Human Performance, Dublin City University, D15 F2CC Dublin, Ireland; (S.B.); (C.D.)
| | - Wesley O’Brien
- School of Education, Sports Studies and Physical Education, University College Cork, T12 KX72 Cork, Ireland; (W.O.); (O.F.)
| | - Jean Saunders
- Claddagh Statistical Consultancy Services, Shannon & CSTAR@UL, University of Limerick, V94 T9PX Limerick, Ireland;
| | - Christina Duff
- School of Health and Human Performance, Dublin City University, D15 F2CC Dublin, Ireland; (S.B.); (C.D.)
| | - Orlagh Farmer
- School of Education, Sports Studies and Physical Education, University College Cork, T12 KX72 Cork, Ireland; (W.O.); (O.F.)
| | - Marie Murphy
- Centre for Exercise Medicine, Physical Activity and Health, Sport and Exercise Sciences Research Institute, Ulster University Jordanstown Campus, Shore Road, BT37 0QB Newtownabbey, Ireland; (A.C.); (A.J.); (M.M.)
| |
Collapse
|
17
|
Zia N, Loeb M, Kajungu D, Galiwango E, Diener-West M, Wegener S, Pariyo G, Hyder AA, Bachani AM. Adaptation and validation of UNICEF/Washington group child functioning module at the Iganga-Mayuge health and demographic surveillance site in Uganda. BMC Public Health 2020; 20:1334. [PMID: 32873287 PMCID: PMC7465762 DOI: 10.1186/s12889-020-09455-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 08/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The UNICEF/Washington Group Child Functioning Module (CFM) assesses child functioning among children between 5 and 17 years of age. This study adapted and validated the CFM at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Uganda. METHODS This cross-sectional study was conducted between September 2018-January 2019 at the IM-HDSS. Respondents were caregivers of children between 5 and 17 years of age who were administered modified Washington Group short set (mWG-SS) and CFM. The responses were recorded on a 4-point Likert scale. Descriptive analysis was conducted on child and caregiver demographic characteristics. Exploratory factor analysis (EFA) assessed underlying factor structure, dimensionality and factor loadings. Cronbach's alpha was reported as an assessment of internal consistency. Face validity was assessed during the translation process, and concurrent validity of CFM was assessed through comparison with disability short form. RESULTS Out of 1842 caregivers approached, 1439 (78.1%) participated in the study. Mean age of children was 11.06 ± 3.59 years, 51.4% were males, and 86.1% had a primary caregiver. Based on EFA, vision, hearing, walking, self-care, communication, learning, remembering, concentrating, accepting change, behavior control, and making friends loaded on factor 1 - "Motor and Cognition," while anxiety and depression loaded on factor 2 - "Mood". Cronbach's alpha for the overall CFM was 0.899 (good internal consistency). Cronbach's alpha for each extracted factor was excellent, motor and cognition (0.904), and mood (0.902). CFM had acceptable face validity. Spearman's rank correlation between scores of CFM and modified WG short set was 0.51 (p-value < 0.001). The overall mean CFM score was 2.47 ± 3.82 out of 39. The mean score for Mood (1.35 ± 1.42 out of 6) was higher compared to Motor and Cognition (1.12 ± 3.06 out of 33). Comparing modified WG short set and CFM Likert responses, the percent agreement was greatest for "cannot do at all." CONCLUSION CFM is a two-factor, valid and reliable scale for assessing disability in Uganda and can be applied to other similar settings to contribute towards disability data from the region. It is an easy-to-administer tool that can help in deeper understanding of context-specific burden and extent of disability in children between 5 and 17 years of age.
Collapse
Affiliation(s)
- Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Suite E-8132, Baltimore, MD, 21205, USA.
| | - Mitchell Loeb
- Washington Group on Disability Statistics, Hyattsville, MD, USA
| | - Dan Kajungu
- Iganga-Mayuge Health and Demographic Surveillance Site, Makerere University School of Public Health, Kampala, Uganda
| | - Edward Galiwango
- Iganga-Mayuge Health and Demographic Surveillance Site, Makerere University School of Public Health, Kampala, Uganda
| | - Marie Diener-West
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephan Wegener
- Department of Physical Medicine and Rehabilitation, Division of Rehabilitation Psychology and Neuropsychology, Johns Hopkins School of Medicine, Baltimore, USA
| | - George Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adnan A Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Suite E-8132, Baltimore, MD, 21205, USA
| |
Collapse
|
18
|
Child functioning and disability in children living with human immunodeficiency virus in a semi-rural healthcare setting in South Africa. Afr J Prim Health Care Fam Med 2020. [PMCID: PMC7433250 DOI: 10.4102/phcfm.v12il.2259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Children living with HIV (CLHIV) often experience HIV-related impairment and disability. Aim The study sought to understand the level of child functioning and access to rehabilitative care in the context of South African healthcare in order to inform an integrated rehabilitative framework. Setting District level semi-rural healthcare facility in KwaZulu-Natal. Methods The Washington Group/United Nations International Children’s Emergency Fund Module on Child Functioning, was administered to carers of CLHIV aged between 5 and 10 years, and accessing care at the study setting. Results Forty-four caregivers of children receiving treatment from June 2018 to March 2019, at the facility, participated. Four (9.1%) children had difficulty with seeing, 13 (29.5%) children had difficulty with hearing and 10 (22.7%) children had difficulty with walking. In the cognitive and behavioural domains, 17 (38.6%) children reported difficulties in communication and concentration, with 16 (36.4%) children experiencing difficulties in learning and remembering. Difficulties reported in accepting change and controlling behaviour were both experienced by 23 (52.3%) children. Although many children experiencing impairments were referred for rehabilitation, many caregivers did not follow-up after the initial assessment, because of financial constraints, lack of time and transport restrictions. Conclusion Functional difficulties were frequently experienced by children living with HIV. Disability screening would be beneficial at various points of care to promote early identification and timely referral to healthcare professionals. Decentralising rehabilitative care to homes and communities could offer a solution to some of the reported barriers to accessing care.
Collapse
|
19
|
Murphy R, Jolley E, Lynch P, Mankhwazi M, Mbukwa J, Bechange S, Gladstone MJ, Schmidt E. Estimated prevalence of disability and developmental delay among preschool children in rural Malawi: Findings from "Tikule Limodzi," a cross-sectional survey. Child Care Health Dev 2020; 46:187-194. [PMID: 31925814 PMCID: PMC7027747 DOI: 10.1111/cch.12741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 01/05/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Early childhood development (ECD) is a critical stage in children's lives, influencing future development and social integration. ECD research among children with disability and developmental delay in low- and middle-income countries is limited but crucial to inform planning and delivery of inclusive services. This study is the first to measure and compare the prevalence of disability and developmental delay among children attending preschool centres in rural Malawi. METHODS A cross-sectional survey was conducted in 48 preschool centres in Thyolo district, Malawi. Data were collected from parents or guardians of 20 children per centre. Disability was ascertained using the Washington Group/UNICEF Child Functioning Module. Child development was measured using the language and social domains of the Malawi Development Assessment Tool. RESULTS A total of 960 children were enrolled; 935 (97.4%) children were assessed for disability and 933 (97.2%) for developmental delay; 100 (10.7%) children were identified as having a disability. The prevalence of disability was higher among children 5+ years (n = 60; 29.3%) than children 2-4 years (n = 40; 5.5%); 109 of 933 (11.7%) children were classified as having developmental delay, 41 (4.4%) in "language" and 77 (8·3%) in "social" domains. CONCLUSIONS This study found that disability and developmental delays are common among preschool children in Malawi. It is one of the first to measure disability and delay among children in a preschool setting in Africa.
Collapse
Affiliation(s)
| | - Emma Jolley
- Health and Disability ResearchSightsaversChippenhamUK
| | - Paul Lynch
- Vision Impairment Centre for Teaching and ResearchUniversity of BirminghamUK
| | | | | | | | | | - Elena Schmidt
- Strategic Programme Innovation, Development and Research, Sightsavers, ChippenhamUK
| |
Collapse
|
20
|
Maddocks S, Moodley K, Hanass-Hancock J, Cobbing S, Chetty V. Children living with HIV-related disabilities in a resource-poor community in South Africa: caregiver perceptions of caring and rehabilitation. AIDS Care 2019; 32:471-479. [PMID: 31426663 DOI: 10.1080/09540121.2019.1654076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The care offered to children living with HIV (CLHIV) experiencing HIV-related disability is often challenged by caregiver illness, poverty and poor support structures in and around communities. Since caregiver needs directly influences the care offered to CLHIV this paper aimed to explore the experiences of the caregivers of CLHIV in order to inform an appropriate rehabilitation model in South Africa. A qualitative enquiry using in-depth interviews with 14 caregivers (one male and thirteen females) of CLHIV experiencing disability in a peri-urban setting was conducted. Data were analysed using thematic analysis. Four themes emerged from the interviews: understanding of HIV-related disability and rehabilitation, challengers to care and well-being, enablers to care; and perceived needs of caregivers. The study revealed that caregiver burden is influenced by the availability of resources and social support services. Financial constraints, poor access to rehabilitation and reduced support networks challenged the care offered to CLHIV. The perceived needs of the caregivers in this study included appeals for improved social security, housing, accessible rehabilitation and education. Changes in government policy guiding social support, employment, education and rehabilitation interventions are needed to improve the availability of resources, education, health and well-being of CLHIV and their caregiver's in South Africa.
Collapse
Affiliation(s)
- Stacy Maddocks
- Department of Physiotherapy, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - Koobeshan Moodley
- Department of Physiotherapy, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - Jill Hanass-Hancock
- Department of Physiotherapy, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - Saul Cobbing
- Department of Physiotherapy, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - Verusia Chetty
- Department of Physiotherapy, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| |
Collapse
|
21
|
Kyegombe N, Banks LM, Kelly S, Kuper H, Devries KM. How to conduct good quality research on violence against children with disabilities: key ethical, measurement, and research principles. BMC Public Health 2019; 19:1133. [PMID: 31420030 PMCID: PMC6698022 DOI: 10.1186/s12889-019-7456-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 08/08/2019] [Indexed: 12/01/2022] Open
Abstract
Background Approximately one billion children experience violence every year. Violence against children is an urgent global public health concern and violation of children’s rights. It is also a risk factor for serious negative health and social outcomes and is therefore addressed within the Sustainable Development Goals (SDGs). Children with disabilities, who make up one in 20 children worldwide, are particularly vulnerable to violence although good quality data are lacking on causes and means of prevention of violence against children with disabilities. Key challenges exist in the measurement of disability and violence, which in part explains the dearth in evidence. Improving research on violence against children with disabilities This paper provides guidance on how to conduct good quality, ethical, and inclusive research on violence against children with disabilities, particularly in low-income settings. The lack of an international agreed ‘gold standard’ frustrates efforts to measure violence across settings and time. Careful consideration must be given to the design of survey tools. Qualitative and participatory research methods also offer important opportunities to explore children’s subjective understanding and experiences of violence. Challenges also exist around the measurement of disability. Disability may be measured by asking directly about disability, through self-reported functioning, or through the presence of impairments or health conditions. These approaches have strengths and limitations and should build on what children are able to do and include appropriate adaptations for specific impairments where necessary. Ethical research also requires adherence to ethical guidelines and approvals, obtaining informed consent, appropriate child protection responses, and careful consideration of interviewer-related issues including their selection, training, and welfare. Key methodological gaps remain - how to include children with severe communication challenges in research; how to respond in instances of weak child protection systems; designing sampling procedures that adequately represent children with disabilities in large-scale violence surveys; and determining how best to ask about violence safely in large-scale surveys and monitoring data. This paper further advocates for the dissemination of research results in inclusive and accessible formats. Conclusion With careful planning, challenges in collecting data on disability and violence can be overcome to generate evidence in this neglected area.
Collapse
Affiliation(s)
- Nambusi Kyegombe
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, 15, London, WC1H 9SH, UK.
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Susan Kelly
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, 15, London, WC1H 9SH, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Karen M Devries
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, 15, London, WC1H 9SH, UK
| |
Collapse
|
22
|
Skogberg N, Koponen P, Tiittala P, Mustonen KL, Lilja E, Snellman O, Castaneda A. Asylum seekers health and wellbeing (TERTTU) survey: study protocol for a prospective total population health examination survey on the health and service needs of newly arrived asylum seekers in Finland. BMJ Open 2019; 9:e027917. [PMID: 30962242 PMCID: PMC6500271 DOI: 10.1136/bmjopen-2018-027917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Health, well-being and health service needs of asylum seekers have emerged as urgent topics following the arrival of 2.5 million asylum seekers to the European Union (EU) between 2015 and 2016. However, representative information on the health, well-being and service needs of asylum seekers is scarce. The Asylum Seekers Health and Wellbeing (TERTTU) Survey aims to: (1) gather population-based representative information; (2) identify key indicators for systematic monitoring; (3) produce the evidence base for development of systematic screening of asylum seekers' health, well-being and health service needs. METHODS AND ANALYSIS TERTTU Survey is a population-based prospective study with a total population sample of newly arrived asylum seekers to Finland, including adults and children. Baseline data collection is carried out in reception centres in 2018 and consists of a face-to-face interview, self-administered questionnaire and a health examination following a standardised protocol. Altogether 1000 asylum seekers will be included into the study. Baseline data will be followed up with national electronic health record data encompassing the entire asylum process and later with national register data among persons who receive residency permits. ETHICS AND DISSEMINATION Ethical approval has been granted by the Coordinating Ethics Committee of the Helsinki and Uusimaa Hospital District. Participation is voluntary and based on written informed consent. Results will be widely disseminated on a national and international level to inform health and welfare policy as well as development of services for asylum seekers. Results of the study will constitute the evidence base for development and implementation of the initial health assessment for asylum seekers on a national level.
Collapse
Affiliation(s)
- Natalia Skogberg
- Department of Welfare, National Institute for Health and Welfare, Helsinki, Finland
| | - Päivikki Koponen
- Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Paula Tiittala
- Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland
| | - Katri-Leena Mustonen
- Department of Welfare, National Institute for Health and Welfare, Helsinki, Finland
| | - Eero Lilja
- Department of Welfare, National Institute for Health and Welfare, Helsinki, Finland
| | | | - Anu Castaneda
- Department of Welfare, National Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
23
|
Boggs D, Milner KM, Chandna J, Black M, Cavallera V, Dua T, Fink G, KC A, Grantham-McGregor S, Hamadani J, Hughes R, Manji K, McCoy DC, Tann C, Lawn JE. Rating early child development outcome measurement tools for routine health programme use. Arch Dis Child 2019; 104:S22-S33. [PMID: 30885963 PMCID: PMC6557219 DOI: 10.1136/archdischild-2018-315431] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Identification of children at risk of developmental delay and/or impairment requires valid measurement of early child development (ECD). We systematically assess ECD measurement tools for accuracy and feasibility for use in routine services in low-income and middle-income countries (LMIC). METHODS Building on World Bank and peer-reviewed literature reviews, we identified available ECD measurement tools for children aged 0-3 years used in ≥1 LMIC and matrixed these according to when (child age) and what (ECD domains) they measure at population or individual level. Tools measuring <2 years and covering ≥3 developmental domains, including cognition, were rated for accuracy and feasibility criteria using a rating approach derived from Grading of Recommendations, Assessment, Development and Evaluations. RESULTS 61 tools were initially identified, 8% (n=5) population-level and 92% (n=56) individual-level screening or ability tests. Of these, 27 tools covering ≥3 domains beginning <2 years of age were selected for rating accuracy and feasibility. Recently developed population-level tools (n=2) rated highly overall, particularly in reliability, cultural adaptability, administration time and geographical uptake. Individual-level tool (n=25) ratings were variable, generally highest for reliability and lowest for accessibility, training, clinical relevance and geographical uptake. CONCLUSIONS AND IMPLICATIONS Although multiple measurement tools exist, few are designed for multidomain ECD measurement in young children, especially in LMIC. No available tools rated strongly across all accuracy and feasibility criteria with accessibility, training requirements, clinical relevance and geographical uptake being poor for most tools. Further research is recommended to explore this gap in fit-for-purpose tools to monitor ECD in routine LMIC health services.
Collapse
Affiliation(s)
- Dorothy Boggs
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK,International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Kate M Milner
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK,Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Jaya Chandna
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Maureen Black
- University of Maryland School of Medicine, Baltimore, Maryland, USA,Research Triangle Park, RIT International, Durham, USA
| | - Vanessa Cavallera
- Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland
| | - Tarun Dua
- Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland
| | - Guenther Fink
- Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - Ashish KC
- International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Sally Grantham-McGregor
- Institute of Child Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Jena Hamadani
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Rob Hughes
- Children’s Investment Fund Foundation, London, UK,Maternal & Child Health Intervention Research Group, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Allied Health Sciences, Dar es Salaam, Tanzania
| | - Dana Charles McCoy
- Harvard Graduate School of Education, Harvard University, Massachusetts, USA
| | - Cally Tann
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK,Neonatal Medicine, University College Hospitals NHS Trust, London, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
24
|
Sprunt B, McPake B, Marella M. The UNICEF/Washington Group Child Functioning Module-Accuracy, Inter-Rater Reliability and Cut-Off Level for Disability Disaggregation of Fiji's Education Management Information System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E806. [PMID: 30841595 PMCID: PMC6427525 DOI: 10.3390/ijerph16050806] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/23/2019] [Accepted: 02/21/2019] [Indexed: 11/30/2022]
Abstract
This paper explores the validity (sensitivity and specificity) of different cut-off levels of the UNICEF/Washington Group Child Functioning Module (CFM) and the inter-rater reliability between teachers and parents as proxy respondents, for disaggregating Fiji's education management information system (EMIS) by disability. The method used was a cross-sectional diagnostic accuracy study comparing CFM items to standard clinical assessments for 472 primary school aged students in Fiji. Whilst previous domain-specific results showed "good" to "excellent" accuracy of the CFM domains seeing, hearing, walking and speaking, newer analysis shows only "fair" to "poor" accuracy of the cognitive domains (learning, remembering and focusing attention) and "fair" of the overall CFM (area under the Receiver Operating Characteristic curve: 0.763 parent responses, 0.786 teacher responses). Severe impairments are reported relatively evenly across CFM response categories "some difficulty", "a lot of difficulty" and "cannot do at all". Most moderate impairments are reported as "some difficulty". The CFM provides a core component of data required for disaggregating Fiji's EMIS by disability. However, choice of cut-off level and mixture of impairment severity reported across response categories are challenges. The CFM alone is not accurate enough to determine funding eligibility. For identifying children with disabilities, the CFM should be part of a broader data collection including learning and support needs data and undertaking eligibility verification visits.
Collapse
Affiliation(s)
- Beth Sprunt
- Nossal Institute for Global Health, The University of Melbourne, Melbourne 3000, Australia.
| | - Barbara McPake
- Nossal Institute for Global Health, The University of Melbourne, Melbourne 3000, Australia.
| | - Manjula Marella
- Nossal Institute for Global Health, The University of Melbourne, Melbourne 3000, Australia.
| |
Collapse
|
25
|
Arnold F, Khan SM. Perspectives and implications of the Improving Coverage Measurement Core Group's validation studies for household surveys. J Glob Health 2018; 8:010606. [PMID: 29977531 PMCID: PMC6005637 DOI: 10.7189/jogh.08.010606] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Formal validation studies are of critical importance in determining whether or not household survey questions are providing accurate information on what they intend to measure. These studies supplement an array of methods used to evaluate survey questions. Methods and Findings This paper summarizes the methods used by the two major international household survey programmes - The Demographic and Health Surveys Program (DHS) and the Multiple Indicator Cluster Surveys (MICS) - to decide on possible modifications to the survey questions, nomenclature, tables, and interpretation of findings over time as additional information on the validity of the questions becomes available. Conclusions Validation studies are most useful if they are conducted in a variety of different settings in low- and middle-income countries, preferably using representative samples and procedures that replicate DHS and MICS field conditions. Pilot tests, pre-tests in each country, feedback from interviewers and survey staff, and cognitive interviewing provide additional information about how well survey questions are understood and provide accurate information. The paper provides specific examples of changes that have been made in response to findings from validation studies and changes in international recommendations.
Collapse
Affiliation(s)
- Fred Arnold
- Demographic and Health Surveys Program, ICF, Rockville, Maryland, USA
| | - Shane M Khan
- Data & Analytics, Division of Data, Research and Policy, UNICEF, New York, New York, USA
| |
Collapse
|
26
|
Sprunt B, Hoq M, Sharma U, Marella M. Validating the UNICEF/Washington Group Child Functioning Module for Fijian schools to identify seeing, hearing and walking difficulties. Disabil Rehabil 2017; 41:201-211. [PMID: 28931311 DOI: 10.1080/09638288.2017.1378929] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study investigated the seeing, hearing and walking questions of the UNICEF/Washington Group Child Functioning Module and the inter-rater reliability between teachers and parents as proxy respondents. METHODS Cross-sectional diagnostic accuracy study, two-gate design with representative sampling, comparing Module responses to reference standard assessments for 472 primary aged students in Fiji. Receiver operating characteristic curves were constructed to determine the area under the curve and optimal cut-off points. RESULTS Areas under the curves ranged from 0.823 to 0.889 indicating "good" diagnostic accuracy. Inter-rater reliability between parent and teacher responses was "good" to "excellent". The optimal cut-off determined by the Youden Index was "some difficulty" however a wide spread of impairment levels were found in this category with most children either having none or substantial impairments. CONCLUSIONS The diagnostic accuracy of the Module seeing, hearing and walking questions appears acceptable with either parents or teachers as proxy respondents. For education systems, use of the cut-off "some difficulty" with accompanying clinical assessment may be important to capture children who require services and learning supports and avoid potentially misleading categorization. Given the high proportion of the sample from special schools research is required to further test the Module in mainstream schools. Implications for rehabilitation Identification of children who are at risk of disability in Fiji is important to enable planning, monitoring and evaluating access to quality inclusive education. The UNICEF/Washington Group Child Functioning Module appears to be a practical and effective tool that can be used by teachers to identify children at risk of disability. Children identified on the UNICEF/Washington Group Child Functioning Module as having "some difficulty" or higher levels of difficulty in relation to vision, hearing or walking should be referred for further assessment and services. Rehabilitation services in Fiji need to prepare for greater numbers of referrals as the Ministry of Education increasingly rolls out the inclusive education policy, which includes identification by schools of children at risk of disability.
Collapse
Affiliation(s)
- Beth Sprunt
- a Nossal Institute for Global Health, Melbourne School of Population and Global Health , The University of Melbourne , Carlton , Australia
| | - Monsurul Hoq
- a Nossal Institute for Global Health, Melbourne School of Population and Global Health , The University of Melbourne , Carlton , Australia
| | - Umesh Sharma
- b Faculty of Education , Monash University , Clayton , Australia
| | - Manjula Marella
- a Nossal Institute for Global Health, Melbourne School of Population and Global Health , The University of Melbourne , Carlton , Australia
| |
Collapse
|