Examining the association between perceived stigma, its correlates, and restrictions in participation among persons with disabilities in Nepal: a cross-sectional study.

BACKGROUND: Disability stigma in low- and middle-income countries is one of the most persistent and complex barriers limiting persons with disabilities (PwDs) from enjoying their rights and opportunities. Perceived stigma among PwDs and its impact on participation restriction is rarely assessed in Nepal. OBJECTIVE: This study aimed to measure the extent of perceived stigma by PwDs, identify its relationships with specific demographic factors, and assess the impact on social participation. METHODS: A cross-sectional survey was conducted between May and July 2022 among PwDs in Nepal, with a sample of 371. The Explanatory Model Interview Catalog (EMIC) stigma scale and P-scale suitable for people affected by stigmatized conditions were used, and the generated scores were analyzed. One-way ANOVA was performed to determine group differences for sociodemographic variables, and linear regression and correlational analysis were used to identify their association and measure the strength and direction of the relationship. RESULTS: The mean stigma score was 16.9 (SD 13.8). 42% of respondents scored higher than the mean. The scores differed significantly by disability type, caste and ethnicity, education, occupation, and household wealth. Over 56% reported participation restriction, and 38% had severe/extreme restriction. Approximately 65% of participants with intellectual disabilities, 53% with multiple disabilities, and 48.5% of persons with severe or profound disabilities experienced severe or extreme restrictions. Perceived stigma had a positive correlation with Disability type (r = 0.17, P < 0.01) and negative correlations with Severity of disability (r= -0.15, P < 0.05), and Household wealth (r= -0.15, P < 0.01). Education was inversely associated with both stigma (r= -0.24, P < 0.01), and participation restriction (ß= -9.34, P < 0.01). However, there was no association between stigma and participation restriction (ß= -0.10, P > 0.05). CONCLUSION: All participants exhibited stigma in general; however, the severity varied based on disability type, level of education, and sociocultural circumstances. A large proportion of participants reported facing a high degree of restrictions in participation; however, no association was detected between perceived stigma and participation restriction. A significant negative linear correlation was observed between education and participation restriction. Stigma reduction programs focusing on education and empowerment would be especially important for overcoming internalized stigma and increasing the participation of PwDs.

Indication and Outcome of Paediatric Keratoplasty at a Tertiary Referral Eye Hospital in Nepal.

INTRODUCTION: Paediatric keratoplasty is rarely performed surgery with high risk of graft failure. Developing countries have not benefited due to lack of sufficient facilities and trained surgeons. OBJECTIVES: The objectives of the study were to analyze the indications and its outcome in terms of vision and graft survival. MATERIALS AND METHODS: This retrospective chart review used electronic medical records from January 2017 to December 2019 of all consecutive patients aged upto18 years or below that underwent paediatric keratoplasty after ethical approval at Tilganga Institute of Ophthalmology. Outcome was defined as anatomical or visual success and graft clarity. Different demographic and surgical parameters were studied among 59 eyes of 48 patients. RESULTS: Mean age of recipient was 12.23± 3.81 years. Majority 37 (52.5%) had unilateral grafts with keratoconus being the most common 24 (40.6%) acquired non-traumatic indication. Mean post-operative best corrected visual acuity 0.6 Logmar was significantly (p <0.001) low as compared to preoperative 1.3 Logmar. Overall graft survival rate was 47 (78%) at one-year follow-up; keratoconus accounting for 24 (100%). Major factors in contributing for graft failure were rejection, infection, and glaucoma. CONCLUSION: A good outcome in terms of anatomical and visual success was achieved in our study. Keratoconus has an excellent graft survival. Visual rehabilitation by cycloplegic refraction should be done to prevent amblyopia. Enhancing the training of surgeons and addressing challenges faced in a paediatric population will help decrease corneal blindness among paediatric patients in the future.