A home-based intervention using augmentative and alternative communication (AAC) techniques in rural Kenya: what are the caregivers’ experiences?

Background Caring for a child with complex communication needs associated with a developmental condition frequently adds stress to the caregiver. Furthermore, professional assistance is scarce in low-income rural settings. For such children speech is frequently unachievable. Augmentative and alternative communication provides options for supplementing or replacing speech with other techniques. The current study aimed to examine the experiences of caregivers in Kenya before and after a home-based intervention using augmentative and alternative communication techniques with children with complex communication needs. Methods Caregivers were interviewed pre- and post-intervention. The interviews were digitally recorded, transcribed and translated into English. Content analysis was applied through the stages of text familiarization and topic organization. Emergent themes and their sub-themes were identified and labelled. Connections between themes were established and interpretations made. The procedure was completed by a second researcher independently. Conflicting ideas were jointly discussed until consensus was achieved. Results Four themes emerged from the data: communication process; struggle; normality; and supernatural power. Before intervention, the caregivers acknowledged their expertise in communications with the child, while also revealing their sense of isolation, burden and pain. Normality was present as a source of comparison and also an aspirational goal. Post-intervention more positive language was used to describe the child. There was an ‘opening up’ of communication that recognized the child’s strengths and some social support systems were re-established. The power of the supernatural was recognized before and after intervention. Conclusion Caring of a child with complex communication needs presents many challenges. A home-based intervention using augmentative and alternative communication techniques appears to have been a catalyst for some positive transformations in the caregivers’ experiences, although it is not possible to attribute this change to any one aspect. The potentials of the home-based intervention would benefit from further investigation on a larger scale

Persons with disabilities as experts-by experience: Using personal narratives to affect community attitudes in Kilifi, Kenya

Background: The last decade has seen improved public awareness of disability in sub-Saharan Africa. However, negative and stereotypical views of disability still persist in many communities. We conducted a study to promote awareness of disability in rural Kenya, using a process of reflection and education. This paper reports on the second aspect – education. The research question was: How can personal narratives of living with disability affect community attitudes and responses to disability? Methods: A qualitative phenomenological approach was adopted. Twenty community-based groups involving 249 participants took part. Each group participated in one focus group discussion at baseline, to explore the members’ personal experiences and views of disability. The intervention involved three adults with disabilities sharing their personal narratives with each group. After the intervention, repeat focus group discussions were conducted with each group. Thematic analysis was carried out according to the framework method. Results: The emergent framework consisted of four main themes, organised as opposing constructs: ‘burden’ and ‘agency’, ‘sub-human’ and ‘human’. ‘Burden’ focused on the perceived hopelessness of the situation. Post-intervention revealed greater support for the ‘agency’ of persons with disabilities, evidenced by what the person could do, rather than their inability, and the relevance of support. The ‘sub-human’ to ‘human’ construct captured dehumanising and discriminating practice towards persons with disabilities on one side, and recognition of the person and inclusion in the community on the other. Whilst support and empathy were evident at the pre-intervention stage, post-intervention revealed greater recognition of people with disabilities as fellow human beings. Conclusion: This study provides a proof of concept regarding the deployment of persons with disabilities as agents for change. Exposure to experts-by-experience provided community groups with opportunities to reflect on, examine and adjust their views on disability in this rural part of Kenya. The sharing of personal narratives appeared to resonate with group members, to encourage recognition of the person and not just the disability, and to move their resolve toward ideas for collective action. Further research is needed to assess the effects of such interventions

Empowering self-help groups for caregivers of children with disabilities in Kilifi, Kenya: Impacts and their underlying mechanisms

Bringing up a child with disabilities in a low-income setting is challenged by inadequate resources, limited psycho-social support and poverty. Not surprisingly, many caregivers experience fatigue, distress and isolation. To address and investigate these issues, action was taken to set up twenty self-help groups focusing on caregiver empowerment. A realist evaluation design was adopted to evaluate impacts associated with the self-help process and to identify mechanisms determining the outcomes. Monthly monitoring visits were conducted to the groups during a ten-month set-up period, at the end of which eleven active groups remained, nine having dissolved due to disputes, corruption and extreme environmental conditions. A facilitated intervention was delivered to the active groups (N=154) over a six-month period. The members were guided to review and discuss topics such as economic empowerment, personal situation, peer support, community inclusion, access to health and education. Evaluation employed mixed methods using questionnaires (n=75) and semi-structured interviews(n=36) pre- and post-intervention. At baseline, the burden of caregiving was characterised by aloneness, challenges, stigma and discrimination. Post-intervention, caregiver agency was defined by togetherness, capacity-building, acceptance and well-being. Significant impacts associated with caregiver perceptions included increased social support, reduced severity of child’s disability and decreased effects of extrinsic factors affecting the caregiver’s role. Mechanisms of ‘handling goods and money’ and ‘social ties and support’ appeared to underpin the outcomes. Caregiver empowerment was associated with newly developed skills, social connectedness and resource mobilisation. Documentation of group processes contributes to the evidence on community-based inclusive development

Tools for better SLM knowledge management and informed decision-making in addressing land degradation at different scales: the WOCAT–LADA–DESIRE methodology

Desertification research conventionally focuses on the problem – that is, degradation – while neglecting the appraisal of successful conservation practices. Based on the premise that Sustainable Land Management (SLM) experiences are not sufficiently or comprehensively documented, evaluated, and shared, the World Overview of Conservation Approaches and Technologies (WOCAT) initiative (www.wocat.net), in collaboration with FAO’s Land Degradation Assessment in Drylands (LADA) project (www.fao.org/nr/lada/) and the EU’s DESIRE project (http://www.desire-project.eu/), has developed standardised tools and methods for compiling and evaluating the biophysical and socio-economic knowledge available about SLM. The tools allow SLM specialists to share their knowledge and assess the impact of SLM at the local, national, and global levels. As a whole, the WOCAT–LADA–DESIRE methodology comprises tools for documenting, self-evaluating, and assessing the impact of SLM practices, as well as for knowledge sharing and decision support in the field, at the planning level, and in scaling up identified good practices. SLM depends on flexibility and responsiveness to changing complex ecological and socioeconomic causes of land degradation. The WOCAT tools are designed to reflect and capture this capacity of SLM. In order to take account of new challenges and meet emerging needs of WOCAT users, the tools are constantly further developed and adapted. Recent enhancements include tools for improved data analysis (impact and cost/benefit), cross-scale mapping, climate change adaptation and disaster risk management, and easier reporting on SLM best practices to UNCCD and other national and international partners. Moreover, WOCAT has begun to give land users a voice by backing conventional documentation with video clips straight from the field. To promote the scaling up of SLM, WOCAT works with key institutions and partners at the local and national level, for example advisory services and implementation projects. Keywords: Sustainable Land Management (SLM), knowledge management, decision-making, WOCAT–LADA–DESIRE methodology

Survey of rehabilitation support for children 0-15 years in a rural part of Kenya

Abstract Purpose: Information regarding the nature, availability and distribution of rehabilitation services for children with disabilities across developing countries is scarce, and data that do exist are of variable quality. If planning and development are to progress, information about service provision is vital. The aim was to establish the scope and nature of rehabilitation support available to children with disabilities (0-15 years) and their families in rural Kenya. Method: A comprehensive sample comprising service provision in the health and special education sectors was established. Non-governmental and community-based organisations were also included. A survey of rehabilitation services was conducted through examination of service-related documentation and key informant interviews with the heads of services. Results: Rehabilitation comprised hospital-based occupational therapy, physiotherapy and orthopaedic technology; and seven special education establishments plus an education assessment resource centre. There was one non-government organisation and one community-based organisation relevant to children with disabilities. Activities focused on assessment, diagnosis and raising community awareness. Provision was challenged by inadequate staffing, resources and transport. Government funding was supplemented variously by donations and self-sufficiency initiatives. Rehabilitation approaches appeared to be informed by professional background of practitioner, rather than the needs of child. Service documentation revealed use of inconsistent recording methods. Conclusions: The data highlight the challenges of rehabilitation, demanding greater investment in personnel and their training, more material resources, improved access to the community and better recording mechanisms. Implications for Rehabilitation There needs to be greater investment in rehabilitation provision in developing countries. Consideration of community-based initiatives is required to support better access for all. In order to argue the case for improved resources, better skills and mechanisms for recording, monitoring and evaluating practice are needed

Estimación del carbono orgánico en los suelos de ecosistema de páramo en Colombia

Los ecosistemas montañosos (en los cuales se encuentran los páramos) ocupan una quinta parte de la superficie terrestre, albergan el 25% de la biodiversidad del planeta y suministran agua de consumo para la población mundial. Se consideran estratégicos para el cambio climático por su relación con captura y almacenamiento de carbono. Con el objetivo de estimar el contenido de carbono orgánico en los primeros 30 cm de profundidad en los suelos (COS) de páramos de Colombia, y su relación con los factores ambientales mediante el mapeo digital de suelos; se tomaron 390 perfiles provenientes de los estudios semidetallados de suelos en un área de 1 469 980.1 ha (aproximadamente 1.3% del área nacional). La información de densidad aparente para calcular COS se estimó mediante funciones de pedotransferencia ajustadas con los datos disponibles. La técnica de modelado predictivo fue Random Forest (RF), usando 44 covariables ambientales como posibles predictores con información de clima, vegetación, relieve y ordenes de suelo. Este modelo fue evaluado mediante validación cruzada (R2 = 0.48 – 0.52). El contenido estimado de COS osciló entre 22 y 338 t.ha-1, y sus mejores predictores son la cobertura y uso del suelo y las condiciones climáticas (temperatura y precipitación). El mapa de COS de páramos de Colombia (2013-2016) establece una línea base de este indicador para el ecosistema, brinda un panorama de la susceptibilidad a la degradación de los suelos, y sirve de apoyo para la planificación del territorio.The mountainous ecosystems (in which the paramos are found) occupy a fifth of the earth’s surface, hold 25% of the planet’s biodiversity and supply water to almost half of the world’s population. They are considered strategic for climate change due to their relationship with carbon dioxide capture and storage. With the objective of estimating the organic carbon content in the first 30 cm of depth in the soils (COS) of Colombia páramos, and its relationship with the environmental factors affecting its spatial patterns, by means of digital soil mapping; 390 profiles were taken from the semi-detailed studies of soils in an area of ​​1 469 980.1 ha (approximately 1.3% of the national area). The missing information of bulk density was estimated by means of pedotransference functions adjusted with the available data. The predictive modeling technique was Random Forest (RF), using 44 environmental covariables as possible predictors that included information on climate, vegetation, relief and soil orders. The quality of the model was evaluated by cross validation (R2 = 0.48 – 0.52). The estimated COS content oscillated between 22 and 338 t.ha-1, this is related to the coverage and use of the soil and the climatic conditions (temperature and precipitation). The map of COS of páramos of Colombia establishes a baseline of this indicator for the ecosystem, provides an overview of the susceptibility to soil degradation and serves as support for the planning of the territory.EEA MendozaFil: Guevara, J. Instituto Geográfico Agustín Codazzi. Subdirección de Agrología; ColombiaFil: Ordoñez, N. Instituto Geográfico Agustín Codazzi. Subdirección de Agrología; ColombiaFil: Ordoñez, N. Universidad Nacional de Colombia. Facultad de Ciencias Agrarias; ColombiaFil: Bolivar, A. Instituto Geográfico Agustín Codazzi. Subdirección de Agrología; ColombiaFil: Bolivar A. Universidad Pedagógica y Tecnológica de Colombia; ColombiaFil: Bunning, S. Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO). Oficina Regional para Latinoamérica y el Caribe; ChileFil: Guevara, E. University of Delaware. Department of Plant and Soil Science; Estados UnidosFil: Medina, E. Instituto Geográfico Agustín Codazzi. Subdirección de Agrología; ColombiaFil: Olivera, C. Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO). Oficina Regional para Latinoamérica y el Caribe; ChileFil: Olmedo, Guillermo Federico. Instituto Nacional de Tecnologia Agropecuaria (INTA). Estación Experimental Agropecuaria Mendoza; ArgentinaFil: Rodriguez, L. Instituto Geográfico Agustín Codazzi. Subdirección de Agrología; ColombiaFil: Sevilla, V. Universidad Central de Venezuela. Instituto de Edafología; VenezuelaFil: Vargas, R. Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO); Itali

The perception of disability by community groups: Stories of local understanding, beliefs and challenges in a rural part of Kenya

Cultural narratives on disability have received much attention over the past few decades. In contexts of poverty, limited information and everyday challenges associated with having, or caring for someone with a disability, different understandings have emerged. A project was set up to promote disability awareness in neighborhood communities in a rural part of Kenya, using a process of reflection and education. This paper reports on the first aspect–reflection. The aim was to investigate local understanding of disability as a co-constructed concept. The research questions were: 1. What cultural beliefs shape local understanding of disability? 2. What challenges are perceived to be associated with disability? A phenomenological approach was adopted. Focus group discussions were conducted with twenty-one community groups involving 263 participants and audio-recorded. The data were transcribed and thematic analysis was carried out. Visual maps were created to illustrate any interconnections, before establishing the final conclusions. Local beliefs attributed disability to: human transgression of social conventions, particularly concerning inappropriate family relations, which invoked a curse; supernatural forces affecting the child; the will of God; unexplained events; and biomedical factors. Challenges associated with disability related to the burden of caregiving and perceived barriers to inclusion, with stress as a shared bi-product. Local understanding of disability in this rural part of Kenya demonstrated overlapping explanations and plurality of beliefs. Two possible interpretations are offered. Firstly, oscillation between explanatory lines demonstrated instability, affecting broader acceptance of disability. Secondly, and more positively, in the face of challenges, the desire to make sense of the existing situation, reflected a healthy pluralism

Caregiver perceptions of children who have complex communication needs following a home-based intervention using augmentative and alternative communication in rural Kenya: an intervention note:Home-based intervention using AAC in rural Kenya

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

Soil Change: Impacts and Responses

Peer reviewe