Browsing by Subject "Disability"

Now showing 1 - 7 of 7
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    Open Access
    Access to assistive technology in two Southern African countries
    (BioMed Central, 2018-10-19) Matter, Rebecca A; Eide, Arne H
    Background Millions of people in Southern Africa are deprived of basic human rights such as the right to education and work because of the large and growing unmet demand for assistive technologies (AT). Evidence is needed to better characterize the lack of AT access. Methods This study serves to identify the sociodemographic factors that are associated with access to AT in two countries in Southern Africa, Botswana and Swaziland. To achieve this aim, logistics regression was applied to a subset of variables from two Living Conditions Studies, nationally representative surveys that were conducted in Southern Africa (2014 and 2010). Results In Botswana, 44% of people who needed AT did not receive it, while in Swaziland the unmet need was 67%. Among the sociodemographic variables tested, the type of disability was the most important factor in determining AT access in both countries. The likelihood of AT access was highest in both countries for those who had mobility limitations (i.e., difficulty walking/climbing stairs) [Botswana: 6.4 odds ratio (OR) = 6.4., 95% confidence internal (CI) (3.6–11.3); Swaziland: OR = 3.2, CI (1.4–7.3)], in comparison to those with non-mobility types of disabilities. Conclusions These findings provide support for governments and other stakeholders in the AT sector to prioritize AT to address the large unmet demand, and expand the range of AT products provided so that people with hearing, seeing, self-care, communication and cognition difficulties have equal access to AT as those with mobility impairments. A step toward achieving these aims is to inventory AT product types that are commonly covered through the public sector in each country, and identify common gaps (e.g., daily living aids). Advancing the AT sector as a whole within Southern Africa will require large scale qualitative studies that achieve a comprehensive understanding of the bottlenecks in regional AT supply, procurement, and delivery systems.
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    Access to health care for persons with disabilities in rural South Africa
    (2017) Vergunst, R; Swartz, L; Hem, K-G; Eide, A H; Mannan, H; MacLachlan, M; Mji, G; Braathen, S H; Schneider, M
    BACKGROUND: Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at "triple vulnerability" - poverty, disability and rurality. This study explored issues of access to health care for persons with disabilities in an impoverished rural area in South Africa. METHODS: The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons in terms of access to health care between persons with disabilities and persons with no disabilities were explored. The approach to data analysis included quantitative data analysis using descriptive and inferential statistics. Frequency and cross tabulation, comparing and contrasting the frequency of different phenomena between persons with disabilities and persons with no disabilities, were used. Chi-square tests and Analysis of Variance tests were then incorporated into the analysis. RESULTS: Persons with disabilities have a higher rate of unmet health needs as compared to non-disabled. In rural Madwaleni in South Africa, persons with disabilities faced significantly more barriers to accessing health care compared to persons without disabilities. Barriers increased with disability severity and was reduced with increasing level of education, living in a household without disabled members and with age. CONCLUSIONS: This study has shown that access to health care in a rural area in South Africa for persons with disabilities is more of an issue than for persons without disabilities in that they face more barriers. Implications are that we need to look beyond the medical issues of disability and address social and inclusion issues as well.
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    Access to health care for persons with disabilities in rural South Africa
    (BioMed Central, 2017-11-17) Vergunst, R; Swartz, L; Hem, K.-G; Eide, A H; Mannan, H; MacLachlan, M; Mji, G; Braathen, S H; Schneider, M
    Background: Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at “triple vulnerability” – poverty, disability and rurality. This study explored issues of access to health care for persons with disabilities in an impoverished rural area in South Africa. Methods: The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons in terms of access to health care between persons with disabilities and persons with no disabilities were explored. The approach to data analysis included quantitative data analysis using descriptive and inferential statistics. Frequency and cross tabulation, comparing and contrasting the frequency of different phenomena between persons with disabilities and persons with no disabilities, were used. Chi-square tests and Analysis of Variance tests were then incorporated into the analysis. Results: Persons with disabilities have a higher rate of unmet health needs as compared to non-disabled. In rural Madwaleni in South Africa, persons with disabilities faced significantly more barriers to accessing health care compared to persons without disabilities. Barriers increased with disability severity and was reduced with increasing level of education, living in a household without disabled members and with age. Conclusions: This study has shown that access to health care in a rural area in South Africa for persons with disabilities is more of an issue than for persons without disabilities in that they face more barriers. Implications are that we need to look beyond the medical issues of disability and address social and inclusion issues as well.
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    Catastrophic health expenditure and impoverishment in households of persons with depression: a cross-sectional, comparative study in rural Ethiopia
    (2019-07-11) Hailemichael, Yohannes; Hanlon, Charlotte; Tirfessa, Kebede; Docrat, Sumaiyah; Alem, Atalay; Medhin, Girmay; Lund, Crick; Chisholm, Dan; Fekadu, Abebaw; Hailemariam, Damen
    Abstract Background The extent of catastrophic health expenditure and impoverishment associated with depression in low-and middle-income countries is not known. The aim of this study was to estimate the incidence and intensity of catastrophic out-of-pocket (OOP) health expenditure, level of impoverishment and coping strategies used by households of persons with and without depression in a rural Ethiopian district. Methods A comparative cross-sectional survey was conducted, including 128 households of persons with depression and 129 households without. Depression screening was conducted using the Patient Health Questionnaire, nine item version (PHQ-9). People in the depression group were classified into high and low disability groups based on the median value on the World Health Organization Disability Assessment Schedule (WHODAS) polytomous summary score. Health expenditure greater than thresholds of 10 and 25% of total household consumption was used for the primary analyses. The poverty headcount, poverty gap and normalized poverty gap were estimated using retrospective recall of total household expenditure pre- and post-OOP payments for health care. Linear probability model using binreg command in STATA with rr option was used to estimate risk ratio for the occurrence of outcomes among households with and without depression based on level of disability. Results Catastrophic OOP payments at any threshold level for households with depression and high disability were higher than control households. At the 10% threshold level, 24.0% of households of persons with depression and high disability faced catastrophic payments compared with 15.3% for depression and low disability and 12.1% for control households (p = 0.041). Depression and high disability level was an independent predictor of catastrophic OOP payments: RR 2.1; 95% CI:1.1, 4.6. An estimated 5.8% of households of persons with depression and high disability were pushed into poverty because of paying for health care compared with 3.5% for households of persons with depression and low disability and 2.3% for control households (p = 0.039). Conclusions Households of people with depression and high disability were more likely to face catastrophic expenditures and impoverishment from OOP payments. Financial protection interventions through prepayment schemes, exemptions and fee waiver strategies need to target households of persons with depression.
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    Embodying virtue in employment: Exploring the employment experiences of people with disabilities
    (2018) Bam, Armand; Ronnie, Linda
    Research on the employment experiences of people with disabilities (PWD), on a global level, is limited. While South Africa has a well-defined legislative framework that has been determined in consultation with disabled people's organisations, compliance with legislation appears to have failed to ensure that employment targets are met, or rather, it has overlooked the underemployment of PWD. As a response to the challenges, this study explored the employment experiences of PWD. A qualitative, explorative, multiple case study approach was employed. Twelve participants were selected using a purposive technique. Semi-structured interviews were used to collect data and provided insight into how PWD viewed their world. The interviews were supplemented through document analyses, and various modes of observation provided additional insight into each of the cases. The process of analysing the interview data followed an inductive approach during which three broad themes were identified. Factors influencing Employment elaborated on the participants' pre-employment experiences of gaining access to employment, which were shown to be impacted by various environmental barriers. Early Experiences of Inclusion at the Workplace established that induction and orientation processes were opportunities for educating co-workers about disability. However, the disclosure of disability did not guarantee improved employment experiences for the research participants. Feeling part of a team promoted early experiences of acceptance. Accommodation in the Workplace determined that PWD's accommodation requests were often evaluated and considered in terms of the costs to employers, and primarily focused on technology to improve their productivity. The need for personal assistance for the PWD in the study was found to be unavoidable. A conceptual model is presented as an alternative framework. It offers insight into how to improve disabled individuals' employment experiences to organisations and their management, and people with disabilities themselves. The model suggests that organisations operating from within a virtue framework can facilitate equal opportunities for employees. Organisations are to be more competitive, innovative and creative, and improve their sustainability. The experiences of PWD could be improved through establishing working communities within organisations as these distribute decisionmaking. The climate for organisational inclusion could also be improved by the working community's ability to redefine work and equip PWD appropriately, thereby promoting organisational citizenship, with benefits to both the organisation and individual.
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    The effects of graded motor imagery and its components on phantom limb pain and disability in upper and lower limb amputees: a systematic review protocol
    (BioMed Central, 2016-09-01) Limakatso, Katleho; Corten, Lieselotte; Parker, Romy
    Background: Phantom limb pain (PLP) is characterized by the anatomical shifting of neighbouring somatosensory and motor areas into a deafferented cortical area of the brain contralateral to the amputated limb. It has been shown that maladaptive neuroplasticity is positively correlated to the perception of PLP in amputees. Recent studies support the use of graded motor imagery (GMI) and its component to alleviate the severity of PLP and disability. However, there is insufficient collective empirical evidence exploring the effectiveness of these treatment modalities in amputees with PLP. This systematic review will therefore explore the effects of GMI and its individual components on PLP and disability in upper and lower limb amputees. Methods: We will utilize a customized search strategy to search PubMed, Cochrane Central register of Controlled Trials, MEDLINE, Embase, PsycINFO, PEDro, Scopus, CINAHL, LILACS, DARE, Africa-Wide Information and Web of Science. We will also look at clinicaltrials.gov (http://www.clinicaltrials.gov/), Pactr.gov (http://www.pactr.org/) and EU Clinical trials register (https://www.clinicaltrialsregister.eu/) for ongoing research. Two independent reviewers will screen articles for methodological validity. Thereafter, data from included studies will be extracted by two independent reviewers through a customized pre-set data extraction sheet. Studies with a comparable intervention and outcome measure will be pooled for meta-analysis. Studies with high heterogeneity will be analysed through random effects model. A narrative data analysis will be considered where there is insufficient data to perform a meta-analysis. Discussion: Several studies investigating the effectiveness of GMI and its different components on PLP have drawn contrasting conclusions regarding the efficacy and applicability of GMI in clinical practice. This systematic review will therefore gather and critically appraise all relevant data, to generate a substantial conclusion and recommendations for clinical practice and research on this subject.
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    Trading-off income and health: AIDS and the disability grant in South Africa
    (Cambridge University Press, 2004) Nattrass, Nicoli
    The number of disability grant recipients in South Africa is rising sharply, largely because of the AIDS pandemic. Now that the government is ‘rolling out’ antiretroviral treatment, many people living with AIDS stand to lose their grants as a result of restored health. Given South Africa’s high unemployment rates and lack of adequate welfare provision for the unemployed, those who do not find work will suffer a significant decline in income. They thus face a stark choice: to go on antiretroviral treatment and lose their disability grant, or avoid treatment and keep the grant for the rest of their (shorter) lives. Some may opt to start treatment, and then when the disability grant expires, discontinue their medication in order to become eligible once more for the disability grant. Such behaviour will foster drug resistance, thereby undermining the antiretroviral treatment rollout and exacerbating the AIDS pandemic. This is a direct consequence of a welfare system that does not provide support for the unemployed and that places poor people in a situation of having to choose between health and income. Replacing the disability grant with a basic income grant would help address the problem.