Provision and use of physical rehabilitation services for adults with disabilities in Rwanda: A descriptive study

Physical rehabilitation interventions address functional deficits caused by impairments that affect someone's performance. Whilst rehabilitation is important, it is assumed that these services are either minimal or nonexistent in low-resource settings. Our data expand on the data from the Situation Assessment of Rehabilitation in the Republic of Rwanda report to describe rehabilitation services and who access them at public and semiprivate facilities (primarily funded by the private sector).Objectives: This article describes the use of the outpatient physical rehabilitation services across nine health facilities, the characteristics of adults attending these health facilities and some of the facilitators and barriers they encounter when attending rehabilitation. Method: Data were collected between September and December 2018 from the heads of departments and adult patients attending outpatient rehabilitation services funded by the government, international nongovernmental organizations or faith-based organizations. Results: Two hundred and thirteen adults were recruited from nine facilities. There is a sixfold difference in the number of rehabilitation personnel between public and semiprivate hospitals in these facilities' catchment areas. However, most participants were recruited at public facilities (186 [87%]), primarily with physical disorders. Patients reported that family support (94%) was the most crucial facilitator for attending rehabilitation, whilst transportation cost (96%) was a significant barrier. Conclusion: Rehabilitation service availability for Rwandan adults with disabilities is limited. Whilst family support helps patients attend rehabilitation, transportation costs remain a significant barrier to people attending rehabilitation. Strategies to address these issues include developing triage protocols, training community health workers and families. Contribution: Data on rehabilitation service provision in Rwanda and most African countries are either non-existent or very limited. These data contain important information regarding the services provided and the people who used them across different health facilities (public versus private) and urban versus rural settings). To improve rehabilitation service provision, we first need to understand the current situation. These data are an important step to better understanding rehabilitation in Rwanda

Exploring the role and lived experiences of people with disabilities working in the agricultural sector in northern Nigeria

It is estimated that over 75.0% of households in sub-Saharan Africa are involved in agriculture, and the majority of the poor in rural areas rely on agriculture for their livelihoods. One billion people living with disabilities in low- and middle-income countries are argued to make up the poorest of the poor, yet to our knowledge, no literature has captured the livelihood of people living with disabilities in the context of farming in Nigeria, specifically northern Nigeria where most of the households are involved in agriculture and related activities. Objectives: This article reports on findings from a study that sought to understand disability in the context of northern Nigerian farming, with a particular focus on the role and lived experiences of people living with disabilities working in the agricultural sector. Method: A survey questionnaire was developed and captured the experiences of 1067 people living with disabilities working in the agricultural sector across five states (Adamawa, Bauchi, Jigawa, Kaduna and Yobe) in northern Nigeria. Results: Findings indicate that people with disabilities are actively participating in agricultural activities for several reasons, which specifically included 'forced to and for survival'. When participants reported needing care, this was predominantly provided by family members. Findings also showed that participants with disabilities experienced several economic and sociocultural challenges because of their impairments. Conclusion: This study adds to the very limited literature on farmers living with disabilities in sub-Saharan Africa and so highlights the need for more research to be conducted with farmers living with disabilities in Nigeria, particularly female farmers living with disabilities. These will provide more evidence pertaining to the experiences of farmers living with disabilities in order to provide effective disability- and gender-inclusive agricultural and entrepreneurship programs in Nigeria. Contribution: The results of this research reveal important insights relating to the experiences of farmers living with disabilities in northern Nigeria, which can contribute to informing future developmental projects to achieve effective inclusion and actively benefit people living with disabilities.

Strategies employed in coping with physical disabilities acquired during adulthood in rural South Africa

Society places people with physical disabilities acquired during adulthood in disadvantaged positions, especially when they cannot participate in activities like their non-disabled counterparts. The situation can be worse for individuals who acquire disabilities during adulthood, where they have to learn to cope with the adulthood-acquired physical disabilities. Objectives: This study aimed to identify the types of physical disabilities acquired during adulthood and their causes and explore how participants defined their disabilities and the coping strategies they used. Methods: The study used a phenomenological research design. Five adults (three women, two men) with adulthood-acquired disabilities were purposefully selected from a rural area in Limpopo, South Africa. Data were collected using semi-structured interviews. Thematic analysis was used to generate themes about coping strategies study participants used. Results: The results show four types of adulthood-acquired disabilities amongst the participants: visual impairment, paraplegia, weakened muscles which led to bilateral amputation, loss of function on both hands and legs. Participants' meanings of their physical adulthood-acquired disabilities ranged from a punishment, pain, not a bother, black magic, to results of doing wrong things to someone. In coming to terms with their adulthood-acquired disabilities, participants used problem- and emotion-focused strategies. Four themes from the participants' responses were spiritual support, social support, substance dependency, access to health and rehabilitation services. Conclusion: The study contributes to understanding the experiences of individuals who acquired disabilities in adulthood, how they define their disabilities and the divergent coping strategies they use. This study established that participants used problem-focused, positive emotion-focused and negative emotion-focused coping strategies.

Transport experiences of people with disabilities during learnerships

Transport is a known national barrier for people with disabilities in South Africa. It is similarly identified as a barrier in learnerships and economic opportunity programmes. This article discusses the extent to which transport is a barrier during learnerships for students with disabilities. The Department of Transport administered an online evaluation questionnaire to a random sample of students with disabilities. Results were coded in terms of 'barriers to access' and 'barriers to participation'. The data were organised into themes. The collated evidence is discussed in this article. The findings demonstrated that transport barriers were present in different modes of transport and different parts of the travel chain. However, the findings also demonstrated the negative impact of transport on the learnership experience and economic opportunities. The findings indicated that inaccessible transport is an integral cause of learnership incompletion for students with disabilities, where the universal accessibility of both transport and the built environment are a prerequisite need. Most students with disabilities reported that transport was not a barrier to learnership participation or that problems with transport could be resolved. Nevertheless, it was one of the identified barriers that negatively affected learnership participation experiences. It was a significant barrier to learnership completion for students with the most severe experience of disability. The sample consisted of only 32 students and a high number of unspecified responses. Evidence from other studies indicates that transport for all persons with disabilities remains a barrier warranting further examination, because public transport has remained inaccessible for over 23 years. Further research is required to verify this study and to investigate learnership cost­benefit for all students

Towards interventions on school dropouts for disabled learners amidst and post-COVID-19 pandemic

Background: Despite objective arguments for inclusive education, there is a dearth of mechanisms to reduce dropouts amongst disabled learners in the extant literature. Thus, this article is one of the outputs of a study, which was conducted after a consistent observation of dwindling numbers of disabled learners who succeed in basic education in South Africa. Of late, the dropout rate increased because of adherence to lock down regulations amidst the coronavirus disease 2019 (COVID-19) pandemic. This triggered the need for research on co-creating interventions to mitigate the rate of dropouts amongst disabled learners. Objective: The article explores underlying obstacles that induce school dropouts for disabled learners amidst and post-COVID-19 and postulates interventions accordingly. Methods: Descriptive-narrative research upheld reality as emerging from empirical experiences of parents and guardians of disabled children, heads of primary and secondary schools, social workers, the Department of Social Development and Basic Education, and provincial associations for disabled persons that focus on children. Lived experience-based opinions were obtained from provinces with different economic growth, namely, Limpopo and Gauteng. Forty-one in-depth one-on-one interviews and two focus group discussions used Google Meet. The collected data were analysed using Creswell's qualitative data analysis framework (steps) and Atlas.ti.8. Results: The findings show a consistent pattern that the COVID-19 pandemic exacerbated the parents and guardians' fear of exposing and risking their learners to the health crisis. Based on the parents and guardians' narrative, mainstream school administrations discriminate and are unwilling to enrol disabled learners. Furthermore, the narrative from the school leadership shows that teachers use exclusive teaching and learning methods for the enrolled disabled learners because of ignorance, misconception, misunderstanding, misinterpretation of disability, disability inclusion, and reasonable accommodation. Conclusion: Based on the finding, it is clear that dropouts amongst disabled learners can be alleviated by using a systematic multi-stakeholder local community-based intervention approach. This, therefore, implies that government authorities and agencies should incorporate disability into mainstream policies that guide planning, budgeting, staffing, and mobilisation of other resources. This would ideally enhance the provision of learning opportunities to disabled learners whilst supporting their diverse educational needs without dichotomies set by 'ability and disability', or normal and abnormal. In this manner, inclusive education can contribute to the educational success of disabled learners through developing sustainability and resilience amongst disabled learners.

Challenges faced by parents of children with learning disabilities in Opuwo, Namibia

Background: Parenting children with learning disabilities requires a high level of knowledge and access to resources, information and services.In developing countries, however, these resources and services are not always available. Parents in Namibia, a developing country, therefore face challenges addressing children's learning and other developmental disabilities, including challenges related to preventative and supportive interventions.Objective: This research focuses on challenges faced by parents as they parent children with learning disabilities in Opuwo, Namibia. Method: In-depth interviews were conducted with eight parents regarding the challenges they face in parenting their children with learning disabilities. Thematic analysis enabled the researchers to identify, analyse and report on themes that emerged from the qualitative interview data.Results: Analysis of the interviews indicated that some participants had only a vague understanding of learning disabilities, as they did not have access to essential knowledge about this phenomenon. They also lacked an awareness of the availability of programmes, services and policies meant to benefit their children with learning disabilities. Participants voiced that they, their children with learning disabilities and community members have stereotypes and prejudices regarding learning disabilities. In this study, most of the children with learning disabilities were raised by single, unemployed parents who seemed to have access to less support from external sources than married couples parenting children with learning disabilities. These single parents are usually not married and because of lack of financial support from the other parent, the majority of them indicated that they struggle to meet the financial and material needs of their children.Conclusion: The researchers concluded that the participants in this study experience a range of challenges in parenting their children with learning disabilities. The main challenges emanate from financial instability, as well as lack of knowledge regarding services and programmes for children with learning disabilities. This lack of knowledge on the part of participants could indicate poor policy education by policy implementers at grass-roots level

The Effects of Iron Deficiency and Anaemia on Primary School Learners' Scholastic Performance

Background. Iron deficiency anaemia (IDA) is a preventable cause of cognitive impairment and other negative effects on the academic potential of learners. Objectives. To determine the local prevalence of IDA among grade 2 learners in a resource-poor community and to evaluate the association between IDA and the learners' scholastic performance. Methods. This was a case-control observational design study. Data were collected using a stadiometer and an electronic scale; HemoCue Hb 201+ system and official grade 1 school reports. Results. The point prevalence of IDA was found to be 9.8% (n=19); with a higher prevalence among girls (58%). There was no statistically significant difference between the performances of the two groups (p=0.511) in mathematics. There was a statistically significant difference for life skills (p=0.00017); and the difference between the groups in literacy or languages approached statistical significance (p=0.071). Conclusions. The results of this study suggest that IDA is prevalent and may have negative effects on learners' scholastic performances. Such negative effects warrant early preventive measures so as to avoid the possibilities of school failure; drop-out and poor productivity in adulthood

Neurofibromatosis in Children as Seen in the University of Port Harcourt Teaching Hospital

Background: Neurofibromatosis (NF) is transmitted as an autosomal dominant trait but 50of new cases appear because of mutation. The disease can be confounded by a broad spectrum of complications; such as various kinds of osseous lesions; stenosis of the renal arteries; optic glioma; and learning disabilities and disfigurement. Aim : To determine the prevalence; pattern of presentation and outcome of neurofibromatosis in children in the University of Port Harcourt Teaching Hospital. Method: This was a prospective study done from 1st June 2004 to 30th May 2009. All the children who presented with neurofibromatosis over the 5- year period were studied. Data collected included age; sex; and reasons for presentation. Definitive diagnosis was made using the National Institute of Health Diagnostic Criteria. Data was entered into excel and analyzed using SPSS. Simple statistics; frequency and percentages were used. Results: The total number of children seen over the period of study was 12;443 children. Out of these; 18(0.19) had neurofibromatosis. All (100) had the type 1 variety. None had type 2 variety. The patients' ages ranged between 5 and 16 years. There was a positive family history in 13 (72.2) of them. All the patients had cafe au- lait spots. Clinically the predominant forms of the neurofibromas were cutaneous 15(83.3); subcutaneous 10(55.6); and plexiform 5(27.8). None of the patients died. Five cases with huge masses causing pain and disfigurement had surgical intervention. Conclusion: Neurofibromatosis is not rare in this environment. This neurocutaneous inherited genetic disorder is a common cause of morbidity. Multidisciplinary management reduces the disease burden borne by affected individuals