Socio-Demographic Factors Influencing the Use of Assistive Technology among Children with Disabilities in Malawi

Abstract: This paper aims to address the information gap on the influence of socio-demographic factors on access and utilization of Assistive Technology (AT) among children with disabilities in Malawi. Thus, it contributes towards the realization of the recommendations of the UN Convention on the Rights of Persons with disabilities and the development of a framework for creating an effective national AT policy. The paper used two statistically matched datasets, namely, the 2017 survey on Living conditions among persons with disabilities in Malawi and the 2015-16 Malawi Demographic and Health survey. Logistic regression and structural equation modeling techniques were utilized to assess the influence of socio-demographic factors on the use of AT among children with disabilities. The results indicate that there is a high level of unmet need for AT among young children aged 2 to 9 and those living in urban areas. The results further indicate that children with multiple disabilities have lower odds (OR = 0.924) of using AT for personal mobility compared to children with a single functional difficulty. These results entail that AT needs for children with multiple disabilities are not adequately addressed. Therefore, when developing policies on AT, younger children and those with multiple disabilities need to be specifically targete

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Disability measurement and uptake of sexual and reproductive health services in Malawi

Addressing the sexual and reproductive health needs of persons with disabilities has been one of the development challenges confronting the global community since the 1994 International Conference on Population and Development (ICPD). This challenge has been more critical in sub-Saharan Africa due to limited availability of disability data, poor-socio-economic status of persons with disabilities and the lack of a universally agreed upon conceptual understanding of disability. Researchers have attempted to address data limitation problems by developing impairment and functional screens that have been used to estimate the proportion of persons with disabilities. However, little has been done in the sub-Saharan African region to examine the various approaches used to measure disability and their relationship with the uptake of sexual and reproductive health services among persons with disabilities.Using anchoring vignettes techniques and Compound Hierarchical Ordered Probit Modelling, this study has examined the self-reported measurement of disability in Malawi. The study has also examined the relationship between impairment and functional limitation as measures of disability with uptake of sexual and reproductive health services using logistic regression models. Among the sexual and reproductive health services used in the analysis are use of modern contraceptive methods, HIV counselling services, place of delivery and professional assistance during childbirth.Controlling for demographic variables such as age and place of resident, this study has found that there are significant variations in use of HIV counselling services by severity of functional disabilities, where women with severe functional disabilities are less likely to use HIV counselling services compared to those with no functional disabilities. This study has also found that there are measurement problems related to the self-reported disabilities. For instance, the study has found that survey respondents use their health expectations and conceptual understanding of disability to respond to questions on functional disabilities. The use of individual understanding of disabilities is likely to affect the accuracy of disability estimates since there is no standardised definition of disability in the country. The low use of HIV counselling service among women with severe functional disabilities implies that most women with functional disabilities are not aware of their HIV status. This necessitates the need for intensifying the provision of HIV counselling information to women with functional disabilities

Zimbabwe's exodus to Australia

Abstract: Zimbabwe’s Exodus to Australia According to Crush and Tevera (2010:3), in their edited book Zimbabwe’s Exodus, ’Estimates of the number of Zimbabweans who have left the country in recent years vary widely-from the barely plausible to the totally outlandish. ’ The estimated numbers have been increasing markedly since 2000, when Mugabe’s government authorised seizure of white-owned land through a loosely organised group of war veterans. At first it was mostly white Zimbabwean farmers who were permanently leaving the country, but with the worsening of economic and human rights conditions in 2002, black Zimbabweans left the country for South Africa and other countries. However, not much has been written about the increasing number of Zimbabweans who have migrated to Australia, a country with good migration data. This profile discusses the migration patterns of Zimbabweans to Australia, by undertaking primary analysis of the 2006 Australian Census using TableBuilder software, together with the settlement reporting facility of the Department of Immigration and Citizenship (DIAC). In addition to looking at the basic characteristics of the Zimbabwe-born, date of arrival in Australia will b

Implementation of the Assistive Product List (APL) in Malawi through development of appropriate policy and systems: an action research protocol

Introduction: Assistive technology (AT) is important for the achievement of the sustainable development goals (SDGs) for persons with disabilities (PWD). Increasingly, studies suggest a significant gap between the need for and demand for and provisions of AT for PWD in low-income and middle-income settings. Evidence from high income countries highlights the importance of robust AT policies to the achievement of the recommendations of the World Health Assembly on AT. In Malawi, there is no standalone AT policy. The objectives of the Assistive Product List Implementation Creating Enablement of inclusive SDGs (APPLICABLE) project, are to propose and facilitate the development of a framework for creating effective national AT policy and specify a system capable of implementing such policies in low-income countries such as Malawi. Ethics and dissemination: The study protocol was approved by Maynooth University Research Ethics Committee (SRESC-2019-2378566) and University of Malawi Research Ethics Committee (P.01/20/10). Findings from the study will be disseminated by publication in peer-reviewed journals, presentations to stakeholders in Malawi, Ireland and international audiences at international conferences. Method and analysis: We propose an action research process with stakeholders in AT in Malawi. APPLICABLE will adopt an action research paradigm, through developing a shared research agenda with stakeholders and including users of AT. This involves the formation of an Action Research Group that will specify the priorities for practice—and policy-based evidence, in order to facilitate the development of contextually realistic and achievable policy aspirations on AT in Malawi and provide system strengthening recommendations that will ensure that the policy is implementable for their realisation. We will undertake an evaluation of this policy by measuring supply and support for specific AT prior to, and following the implementation of the policy recommendations