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

Primary stroke prevention worldwide : translating evidence into action

Funding Information: The stroke services survey reported in this publication was partly supported by World Stroke Organization and Auckland University of Technology. VLF was partly supported by the grants received from the Health Research Council of New Zealand. MOO was supported by the US National Institutes of Health (SIREN U54 HG007479) under the H3Africa initiative and SIBS Genomics (R01NS107900, R01NS107900-02S1, R01NS115944-01, 3U24HG009780-03S5, and 1R01NS114045-01), Sub-Saharan Africa Conference on Stroke Conference (1R13NS115395-01A1), and Training Africans to Lead and Execute Neurological Trials & Studies (D43TW012030). AGT was supported by the Australian National Health and Medical Research Council. SLG was supported by a National Heart Foundation of Australia Future Leader Fellowship and an Australian National Health and Medical Research Council synergy grant. We thank Anita Arsovska (University Clinic of Neurology, Skopje, North Macedonia), Manoj Bohara (HAMS Hospital, Kathmandu, Nepal), Denis ?erimagi? (Poliklinika Glavi?, Dubrovnik, Croatia), Manuel Correia (Hospital de Santo Ant?nio, Porto, Portugal), Daissy Liliana Mora Cuervo (Hospital Moinhos de Vento, Porto Alegre, Brazil), Anna Cz?onkowska (Institute of Psychiatry and Neurology, Warsaw, Poland), Gloria Ekeng (Stroke Care International, Dartford, UK), Jo?o Sargento-Freitas (Centro Hospitalar e Universit?rio de Coimbra, Coimbra, Portugal), Yuriy Flomin (MC Universal Clinic Oberig, Kyiv, Ukraine), Mehari Gebreyohanns (UT Southwestern Medical Centre, Dallas, TX, USA), Ivete Pillo Gon?alves (Hospital S?o Jos? do Avai, Itaperuna, Brazil), Claiborne Johnston (Dell Medical School, University of Texas, Austin, TX, USA), Kristaps Jurj?ns (P Stradins Clinical University Hospital, Riga, Latvia), Rizwan Kalani (University of Washington, Seattle, WA, USA), Grzegorz Kozera (Medical University of Gda?sk, Gda?sk, Poland), Kursad Kutluk (Dokuz Eylul University, ?zmir, Turkey), Branko Malojcic (University Hospital Centre Zagreb, Zagreb, Croatia), Micha? Maluchnik (Ministry of Health, Warsaw, Poland), Evija Migl?ne (P Stradins Clinical University Hospital, Riga, Latvia), Cassandra Ocampo (University of Botswana, Princess Marina Hospital, Botswana), Louise Shaw (Royal United Hospitals Bath NHS Foundation Trust, Bath, UK), Lekhjung Thapa (Upendra Devkota Memorial-National Institute of Neurological and Allied Sciences, Kathmandu, Nepal), Bogdan Wojtyniak (National Institute of Public Health, Warsaw, Poland), Jie Yang (First Affiliated Hospital of Chengdu Medical College, Chengdu, China), and Tomasz Zdrojewski (Medical University of Gda?sk, Gda?sk, Poland) for their comments on early draft of the manuscript. The views expressed in this article are solely the responsibility of the authors and they do not necessarily reflect the views, decisions, or policies of the institution with which they are affiliated. We thank WSO for funding. The funder had no role in the design, data collection, analysis and interpretation of the study results, writing of the report, or the decision to submit the study results for publication. Funding Information: The stroke services survey reported in this publication was partly supported by World Stroke Organization and Auckland University of Technology. VLF was partly supported by the grants received from the Health Research Council of New Zealand. MOO was supported by the US National Institutes of Health (SIREN U54 HG007479) under the H3Africa initiative and SIBS Genomics (R01NS107900, R01NS107900-02S1, R01NS115944-01, 3U24HG009780-03S5, and 1R01NS114045-01), Sub-Saharan Africa Conference on Stroke Conference (1R13NS115395-01A1), and Training Africans to Lead and Execute Neurological Trials & Studies (D43TW012030). AGT was supported by the Australian National Health and Medical Research Council. SLG was supported by a National Heart Foundation of Australia Future Leader Fellowship and an Australian National Health and Medical Research Council synergy grant. We thank Anita Arsovska (University Clinic of Neurology, Skopje, North Macedonia), Manoj Bohara (HAMS Hospital, Kathmandu, Nepal), Denis Čerimagić (Poliklinika Glavić, Dubrovnik, Croatia), Manuel Correia (Hospital de Santo António, Porto, Portugal), Daissy Liliana Mora Cuervo (Hospital Moinhos de Vento, Porto Alegre, Brazil), Anna Członkowska (Institute of Psychiatry and Neurology, Warsaw, Poland), Gloria Ekeng (Stroke Care International, Dartford, UK), João Sargento-Freitas (Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal), Yuriy Flomin (MC Universal Clinic Oberig, Kyiv, Ukraine), Mehari Gebreyohanns (UT Southwestern Medical Centre, Dallas, TX, USA), Ivete Pillo Gonçalves (Hospital São José do Avai, Itaperuna, Brazil), Claiborne Johnston (Dell Medical School, University of Texas, Austin, TX, USA), Kristaps Jurjāns (P Stradins Clinical University Hospital, Riga, Latvia), Rizwan Kalani (University of Washington, Seattle, WA, USA), Grzegorz Kozera (Medical University of Gdańsk, Gdańsk, Poland), Kursad Kutluk (Dokuz Eylul University, İzmir, Turkey), Branko Malojcic (University Hospital Centre Zagreb, Zagreb, Croatia), Michał Maluchnik (Ministry of Health, Warsaw, Poland), Evija Miglāne (P Stradins Clinical University Hospital, Riga, Latvia), Cassandra Ocampo (University of Botswana, Princess Marina Hospital, Botswana), Louise Shaw (Royal United Hospitals Bath NHS Foundation Trust, Bath, UK), Lekhjung Thapa (Upendra Devkota Memorial-National Institute of Neurological and Allied Sciences, Kathmandu, Nepal), Bogdan Wojtyniak (National Institute of Public Health, Warsaw, Poland), Jie Yang (First Affiliated Hospital of Chengdu Medical College, Chengdu, China), and Tomasz Zdrojewski (Medical University of Gdańsk, Gdańsk, Poland) for their comments on early draft of the manuscript. The views expressed in this article are solely the responsibility of the authors and they do not necessarily reflect the views, decisions, or policies of the institution with which they are affiliated. We thank WSO for funding. The funder had no role in the design, data collection, analysis and interpretation of the study results, writing of the report, or the decision to submit the study results for publication. Funding Information: VLF declares that the PreventS web app and Stroke Riskometer app are owned and copyrighted by Auckland University of Technology; has received grants from the Brain Research New Zealand Centre of Research Excellence (16/STH/36), Australian National Health and Medical Research Council (NHMRC; APP1182071), and World Stroke Organization (WSO); is an executive committee member of WSO, honorary medical director of Stroke Central New Zealand, and CEO of New Zealand Stroke Education charitable Trust. AGT declares funding from NHMRC (GNT1042600, GNT1122455, GNT1171966, GNT1143155, and GNT1182017), Stroke Foundation Australia (SG1807), and Heart Foundation Australia (VG102282); and board membership of the Stroke Foundation (Australia). SLG is funded by the National Health Foundation of Australia (Future Leader Fellowship 102061) and NHMRC (GNT1182071, GNT1143155, and GNT1128373). RM is supported by the Implementation Research Network in Stroke Care Quality of the European Cooperation in Science and Technology (project CA18118) and by the IRIS-TEPUS project from the inter-excellence inter-cost programme of the Ministry of Education, Youth and Sports of the Czech Republic (project LTC20051). BN declares receiving fees for data management committee work for SOCRATES and THALES trials for AstraZeneca and fees for data management committee work for NAVIGATE-ESUS trial from Bayer. All other authors declare no competing interests. Publisher Copyright: © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseStroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course.publishersversionPeer reviewe

Importance of proximity to resources, social support, transportation and neighborhood security for mobility and social participation in older adults: results from a scoping study

ABSTRACT: Background: Since mobility and social participation are key determinants of health and quality of life, it is important to identify factors associated with them. Although several investigations have been conducted on the neighborhood environment, mobility and social participation, there is no clear integration of the results. This study aimed to provide a comprehensive understanding regarding how the neighborhood environment is associated with mobility and social participation in older adults.Methods: A rigorous methodological scoping study framework was used to search nine databases from different fields with fifty-one keywords. Data were exhaustively analyzed, organized and synthesized according to the International Classification of Functioning, Disability and Health (ICF) by two research assistants following PRISMA guidelines, and results were validated with knowledge users.Results: The majority of the 50 selected articles report results of cross-sectional studies (29; 58 %), mainly conducted in the US (24; 48 %) or Canada (15; 30 %). Studies mostly focused on neighborhood environment associations with mobility (39; 78 %), social participation (19; 38 %), and occasionally both (11; 22 %). Neighborhood attributes considered were mainly 'Pro ducts and technology' (43; 86) and 'Services, systems and policies' (37; 74 %), but also 'Natural and human- made changes' (27; 54 %) and 'Support and relationships' (21; 42 %). Mobility and social participation were both positively associated with Proximity to resources and recreational facilities, Social support, Having a car or driver's license, Public transportation and Neighborhood security, and negatively associated with Poor user-friendliness of the walking environment and Neighborhood insecurity. Attributes of the neighborhood environment not covered by previous research on mobility and social participation mainly concerned 'Attitudes', and 'Services, systems and policies'.Conclusion: Results from this comprehensive synthesis of empirical studies on associations of the neighborhood environment with mobility and social participation will ultimately support best practices, decisions and the development of innovative inclusive public health interventions including clear guidelines for the creation of age-supportive environments. To foster mobility and social participation, these interventions must consider Proximity to resources and to recreational facilities, Social support, Transportation, Neighborhood security and User-friendliness of the walking environment. Future studies should include both mobility and social participation, and investigate how they are associated with 'Attitudes', and 'Services, systems and policies' in older adults, including disadvantaged older adults

Linguistic Diffusion in the Development of Hausa Language

The purpose of this paper is to prove that intercultural relationship and sufficient contact between Hausa and other languages result in linguistic diffusion or borrowing. The study adopts both the historical and descriptive survey research design, predicated on the need for a brief history of Hausa and the donor languages, and descriptive design to facilitate the use of secondary data generated from textbooks, theses, dissertations, seminar and conference papers. The study traces the location of Hausa people in order to vividly comprehend the nature of contact with the donor languages which effectively bears on the objective nature of the borrowed words. It is in this light that three types of language relationship emerged: genetic, typological and cultural. The intercultural relationship can be unidirectional (English and Hausa) or bi-directional (Hausa and Yoruba). The work provides concrete examples from Tuareg, Fulfulde, Kanuri, Yoruba, Nupe, Arabic and English languages to demonstrate the long contact with the Hausa language. The study finally observes suppressive interference on the structures of Hausa especially from Arabic and English, which have attained second language status in Hausa society, which, again, does not make the language lose its originality

Balance Retraining In Post Stroke Patients Using A Simple, Effective And Affordable Technique

Purpose Balance impairment is important sequel of stroke that is of primary concern in physiotherapy intervention. This quasi-experimental study evaluated the efficacy of stepper in training balance in post stroke patients; and the effects of change in balance performance on motor function. Subjects Eight individuals (6 males and 2 females) presenting with hemiparesis resulting from first incidence hemispheric cerebrovascular disease (age=61.38 ± 6.04 years) who were receiving physiotherapy on out-patient basis at a tertiary health facility in Nigeria participated in this study. All subjects had attained independent walking status without the use of any assistive device. Methods Subjects performed 60 repetitions stepping exercise on a stepper at own self-determined pace, twice a week for 6 consecutive weeks. Progression of the exercise was by increasing the repetition by 10 every week. Baseline and post-training balance and motor function were assessed using Berg Balance Scale (BBS) and Motor Assessment Scale (MAS) respectively. Results Analyses using the Wilcoxon signed rank test showed significant improvement in some of the BBS activities viz. the tandem standing (z = - 2.42; p=0.01); standing on one leg (z=-2.59; p=0.00); turning trunk with feet fixed (z= -2.07; p=0.03); turning 3600 (z = -2.12;p=0.03); stool stepping (z =-1.89; p=0.05) and reaching forward in standing (z= -2.56; p= 0.01). Significant improvement were also recorded in the moving from supine to side lying (z = -2.06; p=0.03); sitting to standing (z = -2.33; p=0.02); walking (z=-2.40; p=0.01); hand movements (z = -2.44; p=0.01); and advanced hand movements (z = -2.00; p=0.04) on the MAS. Conclusion The outcomes suggest that both balance and motor function could be improved in individuals who have suffered a stroke using the stepper as a training tool. Further studies involving large sampling size is however needed to make a conclusive inference Objectifs Les troubles de l\'équilibre sont des séquelles importantes des accidents vasculaires cérébraux (AVC). Cette étude se propose d\'évaluer l\'efficacité de « stepper » dans la rééducation des troubles de l\'équilibre chez des patients après un AVC et les répercussions sur la fonction motrice. Méthodes Huit patients - 6 hommes et 2 femmes - présentant une hémiparésie en rapport avec un AVC ( âge = 61,38+/- 6,04 ans) ont bénéficié d\'une physiothérapie en ambulatoire dans un centre hospitalier tertiaire au Nigéria. Tous les patients ont eu une marche autonome sans l\'aide d\'une quelconque assistance. Les patients ont effectué 60 séances répétitives de stepping sur un mode auto-adapté, deux fois par semaine et ce durant 6 semaines consécutives. La progression des exercices a été augmentée toutes les dix semaines. L\'évaluation a été réalisée a l\'aide de la Berg Balance Scale (BBS) et la Motor Assessment Scale (MAS) Résultats Les analyses utilisant le test de Wilcoxon ont noté une amélioration significative sur les activités BBS vs la station bipodale (z = - 2.42; p=0.01) station unipodale (z=-2.59; p=0.00); rotation du tronc avec un pied fixe (z = -2.12;p=0.03) ; retournement 3600 (z = -2.12;p=0.03); stool stepping (z =-1.89; p=0.05) et reaching forward in standing (z= -2.56; p= 0.01). Une amélioration significative a été relevée lors du passage de la position couchée en décubitus latéral (z = -2.06; p=0.03);de la station assise à la station debout (z = -2.33; p=0.02); à la marche (z=-2.40; p=0.01); la des mains (z = -2.44; p=0.01); et l\'avancée des mains (z = -2.00; p=0.04) sur le MAS Conclusion L\'évolution atteste que l\'équilibre et la fonction motrice pourraient être améliorées chez les patients ayant eu un AVC en utilisant la méthode du stepper. Toutefois des études plus larges sont nécessaires pour valider cette technique. Keywords: Stroke, Balance, Training, Exercise, Stepper.African Journal of Neurological Sciences Vol. 26 (2) 2007: pp. 39-4

Site diversity technique application on rain attenuation for Lagos

This paper studied the impact of site diversity (SD) as a fade mitigation technique on rain attenuation at 12 GHz for Lagos. SD is one of the most effective methods to overcome such large fades due to rain attenuation that takes advantage of the usually localized nature of intense rainfall by receiving the satellite downlink signal at two or more earth stations to minimize the prospect of potential diversity stations being simultaneously subjected to significant rain attenuation. One year (January to December 2011) hourly rain gauge data was sourced from the Nigerian Meteorological Agency (NIMET) for three sites (Ikeja, Ikorodu and Marina) in Lagos, Nigeria. Significant improvement in both performance and availability was observed with the application of SD technique; again, separation distance was seen to be responsible for this observed performance improvements

Site diversity technique application on rain attenuation for Lagos

This paper studied the impact of site diversity (SD) as a fade mitigation technique on rain attenuation at 12 GHz for Lagos. SD is one of the most effective methods to overcome such large fades due to rain attenuation that takes advantage of the usually localized nature of intense rainfall by receiving the satellite downlink signal at two or more earth stations to minimize the prospect of potential diversity stations being simultaneously subjected to significant rain attenuation. One year (January to December 2011) hourly rain gauge data was sourced from the Nigerian Meteorological Agency (NIMET) for three sites (Ikeja, Ikorodu and Marina) in Lagos, Nigeria. Significant improvement in both performance and availability was observed with the application of SD technique; again, separation distance was seen to be responsible for this observed performance improvements