Psychosocial challenges of children with disabilities in Sekhukhune District, Limpopo province of South Africa: Towards a responsive integrated disability strategy

Disability, and everything it encompasses, presents major challenges to individuals, families and communities worldwide. Children with disabilities (CWD) are marginalised and excluded in most societies. Discrimination and prejudice towards CWD are compounded by poverty, lack of essential services and support and sometimes a hostile and inaccessible environment. Objectives: The study sought to examine the psychosocial challenges experienced by CWD in the Sekhukhune district of Limpopo province, South Africa. Based on the identified, articulated and expressed challenges, the study sought to recommend improvement of the existing Integrated National Disability Strategy (INDS) for greater responsiveness to the needs of CWD at both provincial and local levels. Method: The interpretivist qualitative mode of enquiry was the chosen methodology for this study. Phenomenology and descriptive research designs guided the study. Purposive sampling was employed, and data were collected from 36 participants using three triangulated methods: individual in-depth interviews, focus group discussions and key informant interviews. Thematic data analysis was used to analyze data. Results: The findings revealed that CWD in Sekhukhune experienced numerous challenges which affected their social functioning, development and general well-being. Aggravating factors included stigma, labelling and discrimination; disability-specific discrimination and bullying; exclusive education; sexual exploitation; lack of governmental support and poor implementation of disability-specific policies, amongst others. Conclusion: The provisions of the INDS to promote inclusion, integration, mainstreaming and equitable access to resources and services remained an ideal rather than a reality for CWD in Sekhukhune.

Intelligence quotient of neurologically impaired children attending neurology clinic in a nigerian tertiary institution

Background: The need to identify the intellectual capability of neurologically impaired children dictates their educability which can be estimated through their intelligence quotient (IQ). Draw-a-man test for IQ estimation is available, easy and has been validated in Nigeria. Method: Through a prospective, cross-sectional study that lasted 12 months (January-December, 2011), children aged 4 years and above attending neurology clinic were recruited once they have no severe motor or sensory limitations affecting their upper limbs and can obey the instruction to draw a person. Anthropometry was carried out on them and they were comfortably seated to draw a person. The parents or caregivers were instructed not to make any suggestion or hint to them and no time limit was given. Their drawings were assessed using the 52 parameters of Ziler and interpreted accordingly. Ethical procedures were adhered to. The analysis was done using SPSS version 16 and an interactive calculation tool for chi-square tests of goodness of fit and independence. Results: Seventy-five (45 male, 30 female) children met the inclusion criteria. Their clinical conditions were Epilepsy 48 (64%), Cerebral Palsy 6 (8%), ADHD 5 (6.7%), Down Syndrome 4 (5.3%), Speech/Hearing impairment 3 (4.0%), Hypothyroidism 2 (2.7%) and 7 (9.3%) others. Their ages ranged from 4 years to 16 years (mean±SD = 9.7± 3.8 years). Their IQ distribution were Normal 4 (5.3%), Borderline 12 (16.0%), Mild Mental Retardation 16 (21.3%), Moderate Mental Retardation 19 (25.3%), Severe and Profound Mental Retardation 24 (32.0%) with no significant difference in relation to their birth order. Conclusions: Ninety-six per cent of the study population had IQ below normal. Epilepsy was the commonest condition seen in the Paediatric Neurology clinic and all categories of IQ are seen among children with epilepsy

Family perceptions of intellectual disability: understanding and support in Dar es Salaam

When attempting to understand the construct of intellectual disability in different contexts, speaking to family members in addition to the individual with the disability may provide new insight about understandings of and responses to intellectual disability in society and may help to identify the forms of support that are available or needed to ensure the quality of life of people with disabilities. This article outlines and discusses interviews that were conducted in Dar es Salaam, Tanzania, with family members of children and adults with intellectual disabilities. These interviews explore how families came to understand that their child had an intellectual disability, the availability of family support, and family hopes and dreams for the future, and were a part of a wider exploratory study that gathered insight from individuals with disabilities, families, and other providers of support to explore understandings and perceptions of disability in Dar es Salaam. Understanding family experiences will help researchers; policy makers, non-governmental organisations, and others to identify family strengths and family support needs which can ultimately improve family quality of life and the quality of life of the member with a disability

Psychosocial Impacts of Mentally Retarded Children on Parents in Sudan

This study was conducted on a community sample from Khartoum state; Sudan to explore the psychological and social impacts of the mentally retarded child on his/her parents. The study hypothesized that these effects are directly related to the age; number of handicapped children in the family as well as the degree of mental retardation Methods and population: Seven centers for teaching and training of handicapped children were recruited in Khartoum State. Ninety-one children aged 5-16 years were randomly selected and their intelligence quotient (I.Q) was etermined. Interviews for 82 mothers and 64 fathers of these children were held using a standardized anonymous questionnaire including socio-demographic data and information about the psychological and social impacts of the disability of children on their parents. The parents also completed the Hospital Anxiety and Depression Scale (HADS) to assess the presence of anxiety and depression. Results and discussion: The parents reported different psychological effects when they realized the children's disability. However; they tend to overcome their problem and become adapted to the situation. Sometimes; problems arise in the marital life and in social participation. The research showed that most parents suffered from degrees of anxiety and depression ranging mainly from severe to moderate. The number; age or degree of retardation of the children did not affect the social and psychological impacts on the parents significantly. The study recommends preventative measures to reduce the factors that lead to mental retardation. It also recommends the provision of rehabilitation services and training of children in schools and special institutes; besides supporting their families psychologically and socially to reduce their burden

Psycho-Legal Issues Surrounding the Rape of Children and Adolescents with Mental Retardation

The rape of individuals with mental retardation poses challenges for the judicial system as well as for the survivors themselves. As a result; the courts tend to refer these individuals for forensic mental health examination to assist them in proceeding with criminal trials. This sequence of events may appear unusual; considering that these individuals have already suffered significant trauma; and yet have to undergo mental health evaluation before the trial can begin. The questions posed by the courts to mental health experts deal with the cognitive assessment of the rape survivor; the survivor's ability to testify; and her/his capacity to consent to sexual intercourse. The paper provides an outline of this situation within the authors' work context in the KwaZulu-Natal Midlands; and also engages in a critical discussion of the issues involved in such forensic examinations; taking into consideration the implications for the expert witness and her/his approach to such examinations

Long-Term Care of Children and Adolescents with Intellectual Disabilities and Severe Physical Abnormalities

Objective: This study sets out to review the clinical profile and treatment program of children and adolescents with intellectual disability in Waverley Care Center (WCC). Method: A retrospective review was done of users from January to December 2004. Reviewed parameters included age; gender; length of stay; DSM IV diagnoses; current medical treatment; and level of functioning and mobility according to the Therapeutic Classification System for Children (TCS). Results: A total of 179 users were receiving care. Although the mean age of users was 14 to 15 years; their ages ranged from 3 to 34 years. The gender ratio of users was 1 (female) to 1.6 (male). The average length of stay was 6.73 years and the range of stay from 0.5 to 29 years. Attention deficit hyperactivity disorder was diagnosed in eight children and pervasive disorders were suspected in some. Intellectual impairment ranged from severe to profound. Specific interventions with regard to severe physical impairments were made by occupational therapy and physiotherapy. Conclusion: Due to the extent of their physical disabilities requiring full-time nursing care; discharge and placement back in the community remained a rare option for most users in the study group

Monitoring the severity of iodine deficiency disorders in Uganda

Iodine deficiency disorders (IDD) cover a variety of pathological conditions including goitre; mental retardation and perinatal mortality in millions of individuals globally. IDD was initially identified as a problem in 1970 and was confirmed in 1991. In 1993; the Ugandan government introduced a policy of Universal Salt Iodization (USI) requiring all household salt to be iodized. After 5 years this study evaluates the USI programme. Objectives: To determine goitre prevalence rate; establish the proportion of household consuming iodized salt and determine the levels of iodine intake in the sample districts. Methods: A sample of 28880 school children aged 6-12 years from 72 primary school in 6 districts of Uganda was studied in October 1999. Goitre was established by palpation; salt iodine was analysed by thiosulphate titration; while urinary iodine was analyzed using ICCIDD recommended method F in which iodine is detected colorimetrically at 410nm. Results: The over all total goitre rate was 60.2down from 74.3 in 1991 and visible goitre was 30down from 39.2in 1991. The proportion of households taking adequately iodized salt was 63.8and the median urinary iodine was 310ug/L. Whereas 36of 95 urine samples analyzed in 1991 had urinary iodine below 50ug/L; only 5of the 293 urine samples studied in 1999 had the same urine levels. This represents a considerable improvement in iodine intake which is confirmed by the fact that 63.8of the study households consume adequately iodized salt. If maintained and evenly spread; this will enable Uganda to control IDD. Conclusion: USI has improved iodine intake in Uganda. However; iodine malnutrition is still a severe public health problem because some communities in this study such as in Kisoro still have low iodine consumption; while others such as Luwero now have iodine excess. The latter is likely to predispose to hypertthyroidism. Recommendation: The national set standard of household salt iodine of 100ppm be revised. Locally produced salt be iodized; and a national iodine monitoring programme be instituted to ensure evenly spread consumption of adequately iodized salt by all communities in the country

La prise en charge de la deficience mentale : le cas de l'institut medico-pedagogique de Vridi

Notre etude est une etude prospective menee du 04 fevrier 1999 au 02 juillet 1999 a L'IMP de Vridi; structure creee en 1971 a l'initiative de parents d'enfants handicapes psychiques et specialisee dans la prise en charge de la debilite mentale. Elle a porte sur quarante enfants dont le profil epidemiologique et clinique est le suivant : -Grand enfant ou adolescent; (82;5 pour cent) de sexe masculin (60 pour cent) residant a Abidjan (100 pour cent) de nationalite ivoirienne (87.5 pour cent) du groupe ethnique AKAN (57.5 pour cent) issu d'une famille de niveau socio-economique moyen (52;5 pour cent); -C'est le retard de langage (65 pour cent) qui donne l'alerte de l'arrieration mentale (72;5 pour cent). Celle-ci s'installe chez un enfant ne a terme (92;5 pour cent) par voie basse (95 pour cent) avec un etat neurologique moyen (40 pour cent) ou franchement mauvais (35 pour cent) et reanime (52.5 pour cent). L'etiologie retrouvee est la trisomie21 (60 pour cent) ou les sequelles de souffrance cerebrale neonatale (30 pour cent). La prise en charge proposee a l'IMP de Vridi consiste en un traitement des troubles associees a la deficience mentale; au reapprentissage des habiletes sociales; physiques et sportives; a la formation professionnelle dans le secteur informel (elevage; jardinage; patisserie) et en une initiation scolaire. La mediocrite des resultats obtenus oblige a une prevention de la deficience mentale : -Meilleur suivie des grossesses a travers les consultations prenatales pour eviter les souffrances cerebrales neonatales; -depistage et surveillance des incompatibilites RHESUS susceptibles d'entrainer des perturbations neonatales; -Prevention des traumatismes obstetricaux

Caring for neurologically impaired children: a study from Malawi

"A retrospective analysis was performed on data collected on 600 neurologically impaired children who attended outpatient ""cerebral palsy"" clinics between 1987-1990. The study looks at what types of neurological disorders are found and attitudes by parents towards impaired children"

Condicoes de enquadramento familiar da crianca deficiente mental

Condicoes de Enquadramento Familiar da Crianca Deficiente Mental e um trabalho que aborda as praticas socio-culturais ligadas a Saude Mental; a partir de um levantamento dos problemas de adaptacao social das criancas com deficiencia mental em alguns bairros suburbanos da cidade de Maputo. O estudo faz uma analise do conceito de deficiencia mental segundo os praticantes de medicina tradicional (PMT); pais e familiares de criancas deficientes mentais e analisa o papel da medicina tradicional no diagnostico e no tratamento de deficiencias mentais bem como as condicoes de integracao familiar da crianca deficiente mental. Na tentativa de uma analise comparativa do papel desempemhando pelos sectores moderno e tradicional da medicina; o presente trabalho aborda aspectos da cultura local que influem no comportamento das pessoas quanto as doencas e aos meios de as curar. Assim fez a constatacao de que entre os PMT; pais e familiares de criancas deficientes mentais; existe um conceito comum da doenca quanto as suas causas e tratamento. Segundo eles; as deficiencias mentais tem causas sobrenaturais e; consequentemente; devem ser tratadas pela medicina tradicional; chegando mesmo a ser contraindicado o tratamento pela medicina moderna/formal. Constatou ainda que existe uma concepcao segundo a qual a crianca deficiente mental e um ser do outro mundo podendo representar; perante a familia; o simbolo do seu castigo; uma dadiva dos espiritos dos ancestrais ou simplesmente a maldade de outras pessoas; nas comunidades estudadas. Por tudo isto; a medicina tradicional ocupa um lugar mais importante do que a medicina moderna/formal; no diagnostico e tratamento das deficiencias mentais; dado o facto de se crer que elas tem origem sobrenatural e que o seu tratamento passa pela invocacao dos espiritos. Em suma; a presente investigacao demonstra que as atitudes da familia em relacao a crianca deficiente mental variam com a idade da crianca; com as causas e com o modo como a familia as encara. O fim ultimo deste trabalho e contribuir no aconselhamento das familias no que diz respeito ao enquadramento e socializacao das referidas criancas; na educacao popular no tocante saude a mental da crianca e as atitudes da familia em relacao a sua educacao