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    ABSTRACT: Severe acute malnutrition (SAM) in infants aged <6 months is a major global health problem. Supplementary suckling (SS) is widely recommended as an inpatient treatment technique for infant <6 months SAM. Its aim is to re-establish effective exclusive breastfeeding. Despite widespread support in guidelines, research suggests that field use of SS is limited in many settings. In this study, we aimed therefore to describe and understand the barriers and facilitating factors to SS as a treatment technique for infant SAM. We conducted qualitative interviews and focus group discussions in a hospital setting in Blantyre, Malawi, with ward staff and caregivers of infants <2 years. We created a conceptual framework based on five major themes identified from the data: (1) motivation; (2) breastfeeding views; (3) practicalities; (4) understanding; and (5) perceptions of hospital-based medicine. Within each major theme, more setting-specific subthemes can also be developed. Other health facilities considering SS roll-out could consider their own barriers and facilitators using our framework; this will facilitate the implementation of SS, improve staff confidence and therefore give SS a better chance of success. Used to shape and guide discussions and inform action plans for implementing SS, the framework has the potential to facilitate SS roll-out in settings other than Malawi, where this study was conducted. We hope that it will help pave the way to more widespread SS, more research into its use and effectiveness, and a stronger evidence-base on malnutrition in infants aged <6 months.
    Maternal and Child Nutrition 06/2013; 10(4). DOI:10.1111/mcn.12064
  • Evidence-based medicine 05/2013; DOI:10.1136/eb-2013-101312
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    ABSTRACT: The recent AIDS and Disability Partners Forum at the UN General Assembly High Level Meetings on AIDS in New York in June 2011 and the International AIDS Conference in Washington, DC in July 2012 underscores the growing attention to the impact of HIV and AIDS on persons with disabilities. However, research on AIDS and disability, particularly a solid evidence base upon which to build policy and programming remains thin, scattered and difficult to access. In this review paper, we summarise what is currently known about the intersection between HIV and AIDS and disability, paying particular attention to the small but emerging body of epidemiology data on the prevalence of HIV for people with disabilities, as well as the increasing understanding of HIV risk factors for people with disabilities. We find that the number of papers in the peer-reviewed literature remains distressingly small. Over the past 20 years an average of 5 articles on some aspect of disability and HIV and AIDS were published annually in the peer-reviewed literature from 1990 to 2000, increasing slightly to an average of 6 per year from 2000 to 2010. Given the vast amount of research around HIV and AIDS and the thousands of articles on the subject published in the peer-reviewed literature annually, the continuing lack of attention to HIV and AIDS among this at risk population, now estimated to make up 15% of the world's population, is striking. However, the statistics, while too limited at this point to make definitive conclusions, increasingly suggest at least an equal HIV prevalence rate for people with disabilities as for their non-disabled peers.
    Social Science [?] Medicine 11/2012; 77. DOI:10.1016/j.socscimed.2012.10.024
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    ABSTRACT: The critical importance of unrestricted access to clean drinking water and basic sanitation for all is highlighted in Millennium Development Goal 7, which calls for the reduction by half of the proportion of people without such access by 2015. Unfortunately, little attention has been paid to the needs of such access for the one billion people living with a disability worldwide, despite the fact that the right to equal access for all international development initiatives is guaranteed in the new United Nations Convention on the Rights of Persons with Disabilities. In this paper, we review what is currently known about access to water and sanitation for persons with disabilities in low- and middle-income countries from the perspective of both international development and global health, and identify existing gaps in research, practice and policy that are of pressing concern if the water and sanitation needs of this large - and largely overlooked - population are to be addressed.
    Journal of Water and Health 12/2011; 9(4):617-27. DOI:10.2166/wh.2011.198
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    ABSTRACT: The present paper examines the theories and principles upon which the Convention of the rights of people with disabilities (CRPD) are premised. It therefore demonstrates the potential value and utility that these have in extending the inherent human rights that people with disabilities, are endowed. The implementation of the CRPD is a challenge considering the complex ‘rights based’ issues involved and because disabled people have to generate the commitment from civil society and government. It is argued that there is a need to move from policy to implementation, and that this needs to be adequately monitored and evaluated. Sustainable and effective interventions will benefit by being informed, monitored and evaluated based upon the broader human rights paradigm and the capabilities approach.
    Alter - European Journal of Disability Research/Revue Européenne de Recherche sur le Handicap 07/2011; 5(3). DOI:10.1016/j.alter.2011.02.004
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    ABSTRACT: This article examines the politically-charged and hotly contested issue of the role of professionals can and should play in the provision of disability services in both the global North and South, with specific reference to Community-Based Rehabilitation (CBR). A discursive theoretical discussion of the issues regarding the current and normative power relations that exist between disabled people and professionals working in the health sector is undertaken, by drawing upon contemporary debates in disability studies, rehabilitation, development studies and political science. This article provides an historical analysis of the development and subsequent critique of the underlying principles of CBR. Reference is then to the social model of disability and how it relates to client-professional relationships and subsequently analyses what impact and implications this has for professional practice. The normative relationships that exist between disabled people and health professionals remains a contested area. Political imperatives for increased user involvement and public sector reform necessitate the reconfiguration of client-professional relationships. However, there is scant agreement on precisely how this should take place. The article concludes by suggesting practical strategies on how health and care services can be provided in a manner that embraces the positive characteristics of the social model of disability, and which enables professionals, such as occupational therapists, rehabilitation professionals and physicians to act as facilitators in extending the human rights and responsibilities of disabled people.
    Disability and Rehabilitation 01/2011; 33(2):165-73. DOI:10.3109/09638288.2010.487923
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    ABSTRACT: This paper presents findings on conditions of healthcare delivery in Afghanistan. There is an ongoing debate about barriers to healthcare in low-income as well as fragile states. In 2002, the Government of Afghanistan established a Basic Package of Health Services (BPHS), contracting primary healthcare delivery to non-state providers. The priority was to give access to the most vulnerable groups: women, children, disabled persons, and the poorest households. In 2005, we conducted a nationwide survey, and using a logistic regression model, investigated provider choice. We also measured associations between perceived availability and usefulness of healthcare providers. Our results indicate that the implementation of the package has partially reached its goal: to target the most vulnerable. The pattern of use of healthcare provider suggests that disabled people, female-headed households, and poorest households visited health centres more often (during the year preceding the survey interview). But these vulnerable groups faced more difficulties while using health centres, hospitals as well as private providers and their out-of-pocket expenditure was higher than other groups. In the model of provider choice, time to travel reduces the likelihood for all Afghans of choosing health centres and hospitals. We situate these findings in the larger context of current debates regarding healthcare delivery for vulnerable populations in fragile state environments. The 'scaling-up process' is faced with several issues that jeopardize the objective of equitable access: cost of care, coverage of remote areas, and competition from profit-orientated providers. To overcome these structural barriers, we suggest reinforcing processes of transparency, accountability and participation.
    Social Science [?] Medicine 03/2010; 70(11):1745-55. DOI:10.1016/j.socscimed.2010.02.007
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    The Lancet 11/2009; 374(9704):1800-1. DOI:10.1016/S0140-6736(09)61909-7
  • The Lancet 11/2009; 374(9704):1801-3. DOI:10.1016/S0140-6736(09)62024-9
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    The Lancet 11/2009; 374(9704):1806-7. DOI:10.1016/S0140-6736(09)61996-6
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