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A high level of unmet communication need exists amongst children with developmental disabilities in sub-Saharan Africa. This study investigated preliminary evidence of the impact associated with a home-based, caregiver-implemented intervention employing AAC methods, with nine children in rural Kenya who have complex communication needs. The intervention used mainly locally-sourced low-tech materials, and was designed to make use of the child's strengths and the caregiver's natural expertise. A pretest-posttest design was used in the study. Data were gathered using an adapted version of the Communication Profile, which was based on the International Classification of Functioning, Disability, and Health (ICF) framework. The non-parametric Wilcoxon signed-rank test was applied to data from the first two sections of the Communication Profile-Adapted. Qualitative analysis was conducted on the final section. The data provided evidence of statistically significant positive changes in caregiver perceptions of communication at the levels of Body Structure and Function, and Activities for Communication. Also, analysis of the Participation for Communication section revealed some expansion to the children's social activities. The potential impact of the home-based intervention would benefit from investigation on a larger scale. Limitations of the study are discussed.

To examine the relevance of the International Classification of Functioning, Disability and Health (ICF) to CBR monitoring and evaluation by investigating the relationship between the ICF and information in published CBR monitoring and evaluation reports.A three-stage literature search and analysis method was employed. Studies were identified via online database searches for peer-reviewed journal articles, and hand-searching of CBR network resources, NGO websites and specific journals. From each study "information items" were extracted; extraction consistency among authors was established. Finally, the resulting information items were coded to ICF domains and categories, with consensus on coding being achieved.Thirty-six articles relating to monitoring and evaluating CBR were selected for analysis. Approximately one third of the 2495 information items identified in these articles (788 or 32%) related to concepts of functioning, disability and environment, and could be coded to the ICF. These information items were spread across the entire ICF classification with a concentration on Activities and Participation (49% of the 788 information items) and Environmental Factors (42%).The ICF is a relevant and potentially useful framework and classification, providing building blocks for the systematic recording of information pertaining to functioning and disability, for CBR monitoring and evaluation. Implications for Rehabilitation The application of the ICF, as one of the building blocks for CBR monitoring and evaluation, is a constructive step towards an evidence-base on the efficacy and outcomes of CBR programs. The ICF can be used to provide the infrastructure for functioning and disability information to inform service practitioners and enable national and international comparisons.

PURPOSE: To develop a conceptual model representing the impact of musculoskeletal impairments (MSIs) in the lives of children in Malawi. METHOD: A total of 169 children with MSIs (CMSIs), family and other community members participated in 57 interviews, focus groups and observations. An inductive approach to data analysis was used to conceptualise the impact of MSIs in children's day-to-day lives. RESULTS: The main themes that emerged were Indignity, Exclusion, Pain and Hunger. Indignity represents various affronts to children's sense of inherent equal worth as human beings, for example when bullied by peers. Exclusion refers to CMSIs being excluded from three core daily activities: school, play and household chores. Some CMSIs experienced Pain, for example as an outcome of striving to participate. Children with severe mobility impairments were at increased risk of Hunger, having less access to food outside the home and placing a burden of care on the family that could restrict household productivity. Household Poverty was therefore included in the model, as this household impact was inseparable from the impact on CMSIs. CONCLUSION: It is recommended that rehabilitation interventions are planned and evaluated with consideration to their impact on Exclusion, Indignity, Pain, Hunger and Household Poverty using multi-faceted partnerships.

The Poverty Reduction Strategy of the Ugandan Government identified provision of microfinance as one of its interventions. Despite the known connection between poverty and people with disabilities, it remains unclear to what extent this intervention includes or accommodates them. This study seeks to gain a better understanding of how people with physical and sensory disabilities access existing microfinance services in the Bushenyi District of Uganda. Qualitative and quantitative methodologies are used. The findings suggest that people with disabilities are not necessarily denied access to microfinance if they meet the desired requirements. These relate to adequate savings or collateral and perceived trustworthiness. These are seen to be key determinants of success and can be linked to impaired functioning relating to limited mobility, distance, poorer access to information and disabled people’s own negative attitudes. Increasing access and utilization of microfinance services by people with disabilities ...

PURPOSE: The objective of this study is to develop a culturally relevant community-based intervention for children with communication disabilities in Kenya through a community/researcher partnership. The resulting intervention is for use in a randomized control trial which will be reported at a later stage. METHOD: Using a qualitative approach, initial data was collected through focus group discussions with women, disabled people and traditional dancers. The groups examined the needs, problems and challenges faced by disabled children and their families. This generated the content and structure for a series of participatory workshops with a further two women's groups. These workshops strove to generate a culturally relevant community-based intervention programme for children with communication disabilities and their families. The content and balance of the resulting intervention was observed to be different from existing programmes described in the literature. Notably it included many culturally appropriate strategies for increasing social integration and raising community awareness. RESULTS: The process of generating a locally relevant community-based rehabilitation intervention is potentially transferable and has particular relevance to the estimated 80% of the world where there are no formal rehabilitation services for children with disabilities and where women's groups are a strong element of local culture. CONCLUSION: (i) Community/researcher partnerships can be used to develop interventions; (ii) such interventions are different from those imported from other cultures; and (iii) this process is transferable and can be part of the preparations for a Randomized Control Trial.

This discussion paper focuses on using the International Classification of Functioning, Disability and Health (ICF) as a universal framework to examine health status outcome measures and clinical assessments. It reports challenges experienced whilst linking some assessment tools used by the allied health professions to the ICF. These included: establishing a common understanding of the ICF categories and structure; developing a common understanding of the linking rules; establishing the meaningful concepts contained in the assessment tools, and establishing the consensus in the linking process. It is recognized that the ICF does offer a standardized framework for describing health status, but on-going dialogue and debate between professions is required for reaching a standardized linking process. Ways to increase the reliability of the linking process will be critical to its success. The challenges described in linking the assessment tools to the ICF, can make a further contribution to that debate, and en...

Uganda has made much progress towards including disabled people in its mainstream development, particularly in the political agenda. The exact process by which this has been achieved and the relationship between this and international guidelines and legislation are not known. This study undertakes to examine this from two specific perspectives: (1) How do international documents relevant to disabled people relate to national legislation in Uganda? (2) What can this comparison, together with the perceptions of stakeholders, tell us about how the legislation and services could improve? International legislation and Ugandan legislation is reviewed and compared. Data from 5 semi‐structured key informant interviews and 6 focus group discussions involving a total of 38 people are collected and analysed. The themes arising from the data are related to the documents, legislation, policies and other relevant literature. The results examine the barriers to service provision; the role of change; the importance of re...

Under the Universal Primary Education (UPE) programme in Uganda, which was implemented in 1997, the idea of integrated education was put into practice. Today children with disabilities are enrolled in regular primary schools in the whole country. After three years of experience with UPE, the aim of this study was to examine the views of teachers about their needs for training and support regarding the task of teaching children with disabilities in ordinary classrooms. A qualitative approach was chosen using individual interviews, focus group discussions with teachers, pupils and head teachers, and observations in classrooms. Three primary schools in different districts of Uganda were selected as research sites. For a number of reasons data collection from the pupils proved problematic but generally the findings confirmed the information drawn from the review of literature. In addition to the high teacher-pupil ratio, there is an alarming lack of resources in the schools and an urgent need for teacher trai...