Do children with disabilities have the same opportunities to play as children without disabilities? Evidence from the multiple indicator cluster surveys in 38 low and middle-income countries.

Background: Play is essential for the cognitive, social, and emotional development of all children. Disparities potentially exist in access to play for children with disabilities, and the extent of this inequity is unknown. Methods: Data from 212,194 children aged 2-4 years in 38 Low and Middle-Income Countries were collected in the UNICEF supported Multiple Indicator Cluster Survey (2017-2020). Disability was assessed by the Washington Group-Child Functioning Module. Logistic regression models were applied to investigate the relationship between disability and play opportunities, controlling for age, sex, and wealth status. Meta-analysis was used to pool the estimates (overall, and disaggregated by sex), with heterogeneity assessed by Cochran's Q test. Findings: Children with disabilities have approximately 9% fewer play opportunities than those without disabilities (adjusted RR [aRR] = 0.88, 95% CI = 0.82-0.93), and this varied across countries. Mongolia and Democratic Republic of São Tomé and Príncipe had the lowest likelihood of play opportunities for children with disabilities ((aRR = 0.26, 95% CI = 0.09-0.75; aRR = 0.46, 95% CI = 0.23-0.93, respectively). Moreover, children with disabilities are 17% less likely to be provided with opportunities to play with their mothers (aRR = 0.83, 95% CI: 0.73-0.93), which is further reduced for girls with disabilities (aRR = 0.74, 95% CI: 0.60-0.90) compared to their peers without disabilities. The associations varied by impairment type, and children with communication and learning impairments are less likely to have opportunities for play with aRR of 0.69 (95% CI: 0.60-0.79) and 0.78 (95% CI: 0.71-0.86), compared to those without disabilities, respectively. Interpretation: Children with disabilities are being left behind in their access to play and this is likely to have negative impacts on their overall development and well-being. Funding: HK and TS are funded by HK's NIHR Global Research Professorship (NIHR301621). SR is funded by a Rhodes Scholarship. This study was funded by the Programme for Evidence to Inform Disability Action (PENDA) grant from the UK Foreign, Commonwealth and Development Office.

Securing the supply of benzathine benzylpenicillin: a global perspective on risks and mitigation strategies to prevent future shortages.

Benzathine benzylpenicillin is a globally indispensable medicine. As a long-lasting injectable penicillin, it serves as the primary treatment for syphilis, group A streptococcal infections, rheumatic fever and rheumatic heart disease. A competitive market and low profit margins, compounded by limited visibility of demand, have resulted in a decreased number of active pharmaceutical ingredient (API) manufacturers. By 2016, only three Chinese API manufacturers remained, continuing to supply to the global market today. Recurring global shortages, a consequence of supply and demand imbalances, indicate underlying market risks. Therefore, the need for mitigation strategies is imperative.

Provision of rehabilitation for congenital conditions.

Considerable progress has been made in saving the lives of children younger than 5 years. Nevertheless, these advances have failed to help all children thrive, particularly children with disabilities. We describe the increasing prevalence of disability among children and adolescents. We evaluate the current situation regarding children with disabilities and rehabilitation in the context of health systems, particularly those in low- and middle-income countries. Within the newborn health agenda, congenital anomalies often require early intervention and rehabilitation. We provide Argentina as an example of a country where rehabilitation for congenital anomalies is integrated into the health system. We argue that congenital anomalies that require rehabilitation have the potential to strengthen rehabilitation systems and policies by: strengthening coordination between primary care and rehabilitation; identifying and understanding pathways that allow families to engage with services; providing human resources for rehabilitation; and building systems and resources that support assistive technology and rehabilitation. We propose ways for countries to prioritize and integrate early identification, referral and care for children with congenital anomalies to strengthen health systems for all. We identify opportunities to expand policy and planning and to design service delivery and workforce strategies through World Health Organization guidelines and frameworks for rehabilitation. We argue that the global health community must act to ensure that rehabilitation services to support functioning from birth are well established, accepted and integrated within health systems, and that disability is prioritized within child health. These steps would strengthen health systems, ensure functioning from birth and make rehabilitation accessible to all.

Des progrès considérables ont été réalisés pour sauver la vie des enfants de moins de cinq ans. Pourtant, ces avancées n'ont pas permis à tous les enfants de s'épanouir, en particulier lorsqu'ils présentent un handicap. Dans ce document, nous faisons état de la prévalence croissante du handicap chez les enfants et adolescents. Nous évaluons la situation actuelle des enfants porteurs de handicap ainsi que leur réadaptation au sein des systèmes de santé, surtout dans les pays à revenu faible et intermédiaire. Dans le cadre du programme de santé néonatale, les anomalies congénitales nécessitent souvent des interventions et une réadaptation rapides. Nous utilisons l'exemple de l'Argentine, un pays où la réadaptation fait partie intégrante du système de santé en cas d'anomalie congénitale. Nous estimons que les anomalies congénitales impliquant une réadaptation sont susceptibles de renforcer les systèmes et mesures en la matière grâce à: l'amélioration de la coordination entre les soins primaires et la réadaptation; l'identification et la compréhension des parcours qui permettent aux familles d'entrer en contact avec de tels services; la mise à disposition de ressources humaines compétentes dans ce domaine; et enfin, grâce au développement des mécanismes et ressources qui soutiennent les technologies d'assistance et la réadaptation. Nous proposons aux pays des pistes favorisant un diagnostic précoce, un transfert et une prise en charge des enfants souffrant d'anomalies congénitales, afin de consolider le système de santé et d'en faire bénéficier l'ensemble de la population. En outre, nous recensons les moyens d'étoffer les politiques et programmes, mais aussi d'élaborer des stratégies de prestation de services et de gestion des effectifs conformes aux lignes directrices et cadres relatifs à la réadaptation formulés par l'Organisation mondiale de la Santé. Selon nous, la communauté sanitaire internationale doit agir pour faire en sorte que les services de réadaptation soient pris en compte, acceptés et intégrés dans les systèmes de santé afin de contribuer au bon fonctionnement dès la naissance, et que le handicap figure parmi les priorités en ce qui concerne la santé infantile. De telles actions renforceraient les systèmes de soins de santé, assureraient un développement optimal dès la venue au monde et rendraient la réadaptation accessible à toutes et tous.

Se han hecho progresos considerables para salvar la vida de los niños menores de 5 años. Sin embargo, estos avances no han permitido que todos los niños prosperen, en particular los niños con discapacidades. En este artículo, se describe la creciente prevalencia de la discapacidad entre los niños y adolescentes. Se evalúa la situación actual de los niños con discapacidad y la rehabilitación en el contexto de los sistemas sanitarios, en particular los de los países de ingresos bajos y medios. Dentro de los programas de salud neonatal, las anomalías congénitas suelen requerir una intervención y rehabilitación tempranas. Se menciona a Argentina como ejemplo de un país en donde la rehabilitación de las anomalías congénitas está integrada en el sistema sanitario. Se argumenta que las anomalías congénitas que requieren rehabilitación tienen el potencial de fortalecer los sistemas y las políticas de rehabilitación mediante: el fortalecimiento de la coordinación entre la atención primaria y la rehabilitación; la identificación y la comprensión de las vías que permiten a las familias participar en los servicios; la provisión de recursos humanos para la rehabilitación; y la creación de sistemas y recursos que apoyen la tecnología de asistencia y la rehabilitación. Asimismo, se proponen mecanismos para que los países den prioridad e integren la identificación, derivación y atención tempranas de los niños con anomalías congénitas, con el fin de fortalecer los sistemas sanitarios para todos. Se identifican las oportunidades para ampliar la política y la planificación y para diseñar estrategias de prestación de servicios y de personal a través de las directrices y los marcos de la Organización Mundial de la Salud para la rehabilitación. Se sostiene que la comunidad sanitaria mundial debe actuar para asegurar que los servicios de rehabilitación para apoyar el funcionamiento desde el nacimiento estén bien establecidos, aceptados e integrados dentro de los sistemas sanitarios, y que se dé prioridad a la discapacidad dentro de la salud infantil. Estas medidas reforzarían los sistemas sanitarios, asegurarían el funcionamiento desde el nacimiento y harían que la rehabilitación fuera accesible para todos.

Applying market shaping approaches to increase access to assistive technology in low- and middle-income countries.

Development outcomes are inextricably linked to the health of the marketplace that delivers products and services to people in low- and middle-income countries (LMIC). Shortcomings in the market for assistive technology (AT) contribute to low access in LMIC. Market shaping is aimed at improving a market's specific outcomes, such as access to high quality, affordable AT, by targeting the root causes of these shortcomings. The paper summarizes the findings of market analyses conducted under the UK aid funded AT2030 programme in support of ATscale and aims to discuss how market shaping can help more people gain access to the AT that they need and what are the best mechanisms to unlock markets and commercial opportunity in LMICs. The paper also explores how market shaping for AT markets could be part of a mission-oriented approach AT policy. A mission-oriented approach can help accelerate progress toward a common objective among stakeholders, at country or global level. While market-shaping activities direct the outcomes of the market toward a specific end goal, such as access to quality, affordable products and services, missions are more comprehensive and include other policy interventions and stakeholder collaborations in order to create a robust and sustainable structure.

Estimation of benzathine penicillin G demand for congenital syphilis elimination with adoption of dual HIV/syphilis rapid diagnostic tests in eleven high burden countries.

BACKGROUND: WHO recommends use of rapid dual HIV/syphilis tests for screening pregnant women (PW) during antenatal care to prevent mother-to-child transmission. Scale-up of testing implies a need to accurately forecast and procure benzathine penicillin (BPG) to treat the additionally identified PW with syphilis. METHODS: Country-reported ANC coverage, PW syphilis screening and treatment coverage values in 2019 were scaled linearly to EMTCT targets by 2030 (constant increasing slope from 2019 figures to 95% in 2030) for 11 focus countries. Antenatal syphilis screening coverage was substituted with HIV screening coverage to estimate potential contribution of rapid dual HIV/syphilis tests in identifying additional PW with syphilis. BPG demand was calculated for 2019-2030 accordingly. RESULTS: The estimated demand for BPG (in 2.4 million unit vials) using current maternal syphilis prevalence and treatment coverage will increase from a baseline of 414,459 doses in 2019 to 683,067 doses (+65%) in 2021 assuming immediate replacement of single HIV test kits with rapid dual HIV/syphilis tests for these 11 countries. Continued scale up of syphilis screening and treatment coverage to reach elimination coverage of 95% will result in an estimated demand increase of 160%, (663,969 doses) from 2019 baseline for a total demand of 1,078,428 BPG doses by 2030. CONCLUSIONS: Demand for BPG will increase following adoption of rapid dual HIV/syphilis test kits due to increases in maternal diagnoses of syphilis. To eliminate congenital syphilis, MNCH clinical programs will need to synergize with disease surveillance programs to accurately forecast BPG demand with scale up of antenatal syphilis screening to ensure adequate treatment is available for pregnant women diagnosed with syphilis.

Shortages of benzathine penicillin for prevention of mother-to-child transmission of syphilis: An evaluation from multi-country surveys and stakeholder interviews.

BACKGROUND: Benzathine penicillin G (BPG) is the only recommended treatment to prevent mother-to-child transmission of syphilis. Due to recent reports of country-level shortages of BPG, an evaluation was undertaken to quantify countries that have experienced shortages in the past 2 years and to describe factors contributing to these shortages. METHODS AND FINDINGS: Country-level data about BPG shortages were collected using 3 survey approaches. First, a survey designed by the WHO Department of Reproductive Health and Research was distributed to 41 countries and territories in the Americas and 41 more in Africa. Second, WHO conducted an email survey of 28 US Centers for Disease Control and Prevention country directors. An additional 13 countries were in contact with WHO for related congenital syphilis prevention activities and also reported on BPG shortages. Third, the Clinton Health Access Initiative (CHAI) collected data from 14 countries (where it has active operations) to understand the extent of stock-outs, in-country purchasing, usage behavior, and breadth of available purchasing options to identify stock-outs worldwide. CHAI also conducted in-person interviews in the same 14 countries to understand the extent of stock-outs, in-country purchasing and usage behavior, and available purchasing options. CHAI also completed a desk review of 10 additional high-income countries, which were also included. BPG shortages were attributable to shortfalls in supply, demand, and procurement in the countries assessed. This assessment should not be considered globally representative as countries not surveyed may also have experienced BPG shortages. Country contacts may not have been aware of BPG shortages when surveyed or may have underreported medication substitutions due to desirability bias. Funding for the purchase of BPG by countries was not evaluated. In all, 114 countries and territories were approached to provide information on BPG shortages occurring during 2014-2016. Of unique countries and territories, 95 (83%) responded or had information evaluable from public records. Of these 95 countries and territories, 39 (41%) reported a BPG shortage, and 56 (59%) reported no BPG shortage; 10 (12%) countries with and without BPG shortages reported use of antibiotic alternatives to BPG for treatment of maternal syphilis. Market exits, inflexible production cycles, and minimum order quantities affect BPG supply. On the demand side, inaccurate forecasts and sole sourcing lead to under-procurement. Clinicians may also incorrectly prescribe BPG substitutes due to misperceptions of quality or of the likelihood of adverse outcomes. CONCLUSIONS: Targets for improvement include drug forecasting and procurement, and addressing provider reluctance to use BPG. Opportunities to improve global supply, demand, and use of BPG should be prioritized alongside congenital syphilis elimination efforts.