Assessing deaf and hearing children's communication in Brazil.

UNLABELLED: In Brazil there are no specific tests for either signed or spoken language for deaf children. A protocol evaluating communicative abilities independent of modality of communication (sign language or spoken language), and comprising assessments of (a) pragmatic profile; (b) modality of communication and linguistic level; (c) complexity of communication; and (d) style and efficacy of communication between parent and child was administered to 127 deaf and hearing children. The children, aged 3-6 years old, were distributed in three groups: 20 with severe hearing loss, 40 with profound hearing loss and 67 normally hearing. Deaf children were found to be delayed, independent of their linguistic level and preferred modality of communication. The protocol in this study proved to be an useful instrument for gathering relevant information about the three groups of preschool children's communicative abilities, and particularly suitable for use in countries where standardized assessments are not available. LEARNING OUTCOMES: The reader will be introduced to the use of an assessment protocol comprising its development, application and data analysis. The reader will be informed about assessment of deaf children's preferred modality of communication, by the participation of a bilingual (sign language user) professional. Communication abilities can be assessed independently of the linguistic modality. In developing countries in general, where simple and easy to administer assessments tools are scarce, such a protocol is of specific value.

Prevalence, pattern and risk factors for undernutrition in early infancy using the WHO Multicentre Growth Reference: a community-based study.

This cross-sectional study set out to determine the prevalence, pattern and risk factors for undernutrition during early infancy in a setting with substantial non-hospital births against the backdrop of limited evidence on nutritional status in the first three months of life based on an exclusively breast-fed reference population. Undernutrition based on z-scores below -2 for weight-for-age, height/length-for-age and body-mass-index-for-age among infants (0-3 months) attending clinics for routine Bacille de Calmette-Guérin (BCG) immunisation in Lagos, Nigeria from July 2005 to March 2008 was determined using current World Health Organisation's Multicentre Growth Reference (WHO-MGR). Maternal and infant factors associated with undernutrition were explored with multivariable logistic regression analyses. Of the 5888 full-term infants enrolled 51% were born outside hospital and 99.4% were exclusively breast-fed. 811 (13.8%) were underweight (weight-for-age), 1802 (30.8%) were stunted (height/length-for-age) and 579 (10.0%) were wasted (body-mass-index-for-age). Altogether, 3635 (61.6%) infants were not undernourished while 192 (3.3%) were undernourished by all three nutritional measures. Intrauterine growth restriction was a significant contributor to undernutrition. Maternal age, multiple pregnancies and gender were associated with all nutritional indices. Additionally, maternal education, ownership/type of residence, parity, antenatal care, place of delivery and hyperbilirubinaemia were predictive of underweight, stunting and wasting. We conclude that undernutrition is prevalent in the first three months of life in this population and can be detected early at routine immunisation clinics shortly after birth. Maternal/perinatal history offers valuable predictors in resource-poor communities where the majority of births occur outside hospital.

Systematic synthesis of community-based rehabilitation (CBR) project evaluation reports for evidence-based policy: a proof-of-concept study.

BACKGROUND: This paper presents the methodology and findings from a proof-of-concept study undertaken to explore the viability of conducting a systematic, largely qualitative synthesis of evaluation reports emanating from Community Based Rehabilitation (CBR) projects in developing countries. METHODS: Computer assisted thematic qualitative analysis was conducted on recommendation sections from 37 evaluation reports, arising from 36 disability and development projects in 22 countries. Quantitative overviews and qualitative summaries of the data were developed. RESULTS: The methodology was found to be feasible and productive. Fifty-one themes were identified and the most important ones of these are presented to illustrate the significance of the method. The relative priorities of these themes indicated that "management" issues were the primary areas in which recommendations were made. Further analysis of themes reflected the emphasis evaluators placed on the need for enhanced management, organisational, personnel and administrative infrastructure in CBR projects. Evaluators consistently recommended that CBR projects should be more connected and collaborative at governmental, organisational, political and community levels. The synthesis also noted that evaluators questioned the emphasis in CBR on project expansion and income generation. CONCLUSION: The application of the synthesis methodology utilised in this proof-of-concept study was found to be potentially very beneficial for future research in CBR, and indeed in any area within health services or international development in which evaluation reports rather than formal "research evidence" is the primary source material. The proof-of-concept study identified a number of limitations which are outlined. Based on the conclusions of 37 evaluation reports, future policy frameworks and implementation strategies in CBR should include a stronger emphasis on technical, organisational, administrative and personnel aspects of management and strategic leadership.

A comparative exploration of the thoughts of parents and therapists regarding seating equipment for children with multiple and complex needs.

PURPOSE: We investigated the opinions of parents and therapists of children using adaptive seating systems in order to understand their common areas of interest or disagreement. METHOD: Parents and therapists participated in answering a questionnaire regarding their child's response to, and comfort in their individual adaptive seating system. The children all had a motor disorder involving all four limbs and did not have verbal communication skills. Questionnaire was analysed using non-parametric statistics for quantitative questions and by keyword analysis of qualitative questions. The results were then further categorized into the domains of the International Classification of Functioning, Disability and Health (ICF). RESULTS: Parents and therapists showed differences in key areas: Parents concentrated on personal and environmental factors to explain their satisfaction or otherwise of the chair, whereas therapists concentrated on body function and structures; to the exclusion of all other domains of seated function. CONCLUSIONS: Based on these findings, we suggest further investigation of these seating systems, concentrating on the activity and participation of the children themselves, although considering all domains of functioning.

Field testing of the ACCESS materials: a portfolio of materials to assist health workers to identify children with disabilities and offer simple advice to mothers.

Children in less-developed countries with mild to moderate disabilities often remain unidentified until school age. Delayed identification leads to less successful interventions for most children and risks secondary disabilities. The disability group at the Centre for International Child Health was funded to address this issue by developing a screening portfolio. The field testing of this portfolio is reported here. The results collected through quantitative analysis of the children brought for screening, and the fact that the field workers identified disabilities in children over the age of 2 years with over 82% accuracy when compared with professionals, suggests that health workers can be taught to use the portfolio effectively. Among younger children the accuracy is poorer. Field workers can additionally be trained to give advice to mothers and/or refer where appropriate. Equally important, results from focus group discussions with both health workers and parents, and questionnaires to health workers, demonstrate that both groups found the process clear and useful. Parents liked the process and found the advice materials helpful. Several health workers made comments about how the portfolio's use helped to develop positive attitudes towards disability and improved their own self-confidence.

Knowledge, personal risk and experiences of HIV/AIDS among people with disabilities in Swaziland.

Although there has been research focused on the disabling consequences of HIV/AIDS, there has been very little documented information about HIV/AIDS for individuals with disability prior to infection. There is evidence to suggest that people with disabilities face inequalities in accessing health information and services. The aim of this study was to explore whether disabled and non-disabled young adults in Swaziland perceive HIV/AIDS similarly. A qualitative study using focus-group discussions was conducted. Four focus groups were conducted with a total of 56 non-disabled adults (aged 16-29 years) and four focus groups were conducted with a total of 32 adults with either a physical or hearing disability (aged 18-32 years). The focus-group schedule explored knowledge about HIV/AIDS, personal risk and experiences of health-seeking practices. Information and awareness about HIV/AIDS was good in both rural and urban areas among the non-disabled participants, who obtained their information from a wide range of sources. In contrast, participants with disability, who obtained information about HIV/AIDS from a limited range of sources, lacked knowledge about HIV/AIDS and were misinformed about modes of transmission. Women with disabilities described experiences of sexual exploitation and abuse, which was perceived to be higher among disabled women than their non-disabled peers; they felt this was because disabled women were perceived to be 'free' from the HIV virus by non-disabled men. Further research is necessary to enable HIV/AIDS programmes to address the specific needs of people with disabilities.

Feeding difficulties in disabled children leads to malnutrition: experience in an Indian slum.

The aim of the present study was to explore the nature, extent and probable causes of nutritional deficiencies among children with disabilities living in Dharavi, a slum in Mumbai, India. A cross-sectional study was conducted to investigate whether the nutritional status of children with disabilities, aged 2-6 years (n 141), was worse than that of non-disabled sibling controls (n 122) and neighbour controls (n 162). Data on food patterns, anthropometry, micronutrient status and feeding difficulties reported by parents were collected. The mean weight for age of the children with disabilities (-2.44 (SD 1.39) Z scores; n 120) was significantly lower (P<0.05) compared with the sibling (-1.70 (SD 1.20) Z scores; n 109) and neighbour (-1.83 (SD 1.290) Z scores; n 162) control groups. The children with disabilities had significantly lower (P<0.05) mean haemoglobin levels (92 (SD 23) g/l; n 134) compared with siblings (102 (SD 18) g/l; n 103) and neighbours (99 (SD 18) g/l; n 153). Relative risk (RR) analysis indicated that the disabled children with feeding difficulties were significantly more likely (P<0.05) to be malnourished, by the indicator of weight for age (RR 1.1; 95 % CI 1.08, 1.20) compared with the disabled children without a feeding difficulty. They were also significantly more likely to be malnourished using the indicators of height for age (RR 1.3; 95 % CI 1.19, 1.43) and weight for height (RR 2.4; 95 % CI 1.78, 3.23) compared with the disabled children without a feeding difficulty. Feeding difficulties were identified as a risk factor for vulnerability to inadequate nutritional status among children with disabilities.

Beliefs about feeding practices and nutrition for children with disabilities among families in Dharavi, Mumbai.

Attitudes arise from specific experiences and emotions driven by cultural beliefs. An understanding of societal constructs regarding disability in a given culture contributes to developing strategies to meet the needs of children with disabilities by providing culturally competent services. In 1999, a series of focus-group discussions were conducted with families in a low-income community in Mumbai, India to collect qualitative information on the knowledge, skills and attitudes (KSA) regarding disability, feeding and nutrition to facilitate the development of an intervention to improve the nutritional well-being of children with disabilities. The KSA of this population of poor families has seldom been directly examined. The specific objectives of this study were (i) to describe the experiences of families with young disabled children in the local community; (ii) to identify the nutritional and feeding needs of children with disabilities; and (iii) to identify any service, environmental or attitudinal barriers to acquiring an adequate nutritional status. Content analysis of concepts in the focus groups identified four emerging themes: (i) acceptance of disability; (ii) services and needs; (iii) future; and (iv) food and nutrition. The focus-group findings enabled a broader understanding of attitudes towards disability within this population, which can have an impact on the care of the child. The findings provided insights into the content of the intervention to be helpful for local families incorporating an understanding of the cultural background of the local community that must be included alongside our understanding of the feeding impairment.

Evaluation of community-based rehabilitation programmes: a search for appropriate indicators.

Community-based rehabilitation (CBR) is a common form of service delivery and can provide services for people with disabilities in otherwise underserved areas. Despite a 20-year history of service delivery in many parts of the world by both government and non-government organization sectors, there are few indicators with which to measure the effectiveness of programmes. Among evaluations that have been undertaken there has been a tendency to describe practice rather than the effectiveness of that practice. One reason for this is the lack of robust indicators against which to measure practice. This study examines the activities and outcomes of 10 published evaluations of CBR programmes and proposes indicators for some of CBR practices based upon this examination. Readers are invited to comment upon these indicators or to try using them in their practice.

Development of a 'communication disability model' and its implication on service delivery in low-income countries.

This paper argues that higher priority should be given to the development of services which support people with communication disabilities in low income countries and that these services should be different from those in other countries. Present services for this population group have poor coverage levels, tend to be centrally located and are orientated to specialist services. WHO (Health Programme Evaluation, Geneva, WHO, 1981) argue that health services should be based on meeting people's needs. This paper describes an analysis of 'needs related' qualitative data concerning people with communication disabilities and their families in two low income countries and examines the results in relation to service development. The data was collected as part of five different studies concerning people with communication disabilities carried out in Uganda and Nigeria. Using the principles of established theory, these data helped develop, a theoretical model. This model is compared with WHO's classification of Impairment Disability and Handicap ICIDH-2 WHO (International Classification of Impairments Disabilities and Handicaps (ICIDH-2), A manual of classification relating to the consequences of diseases, Geneva, WHO. 1997a; 1999). Suggestions are made as to how this model might inform planning and practice from the perspective of the five major stakeholder groups; government and non-government organizations, people with communication disabilities, their families and professionals. Consideration is also given as to how this theory can be used to strengthen existing services, or encourage a complete paradigm shift, with the creation of different services in new and innovative ways.

Há lugar para a fonoaudiologia na reabilitaçäo baseada na comunidade (RBC) / There are space for speech and language therapists in Community Based Rehabilitation (CBR)?

Este artigo discute a questäo: sobre a possibilidade de atuaçäo de terapeutas na RBC, e especificamente a do fonoaudiólogo. Há poucas publicaçöes destes profissionais nesta área. Discute-se as terminologias referentes a deficiência, incapacidade e desvantagem bem como a prevalência de pessoas deficientes. Sä abordadas as questöes sobre: o que é a Reabilitaçäo Baseada na Cominidade (RBC); e também se a Fonoaudiologia trata das incapacidades ou das questöes relativas às deficiências e se a Fonoaudiologia atua em projetos de desenvolvimento comunitário em comunidades carentes. Sä considerados os pré-requisitos para que um profissional possa atuar na RBC e para qual populaçäo ele prestará seus serviços.