Sarah Polack

London School of Hygiene and Tropical Medicine | LSHTM · International Centre for Evidence in Disability

The purpose of this study was to systematically map and synthesise literature on interventions that promote the involvement of parents of school-aged children with disabilities in education. The study focused on peer-reviewed, primary intervention studies published in English between 2000 and 2021. Nine databases were searched, and 21 articles were...

Deaf and hard of hearing children are at risk of exclusion from community life and education, which may increase their risk of mental health conditions. This study explores the experience of deaf and hard of hearing children in the Gaza Strip, with particular focus on the factors that contribute to psychological wellbeing and distress. In-depth int...

Purpose: The purpose of this study was to estimate the prevalence of cognitive impairment and explore its association with hearing loss and other sociodemographic and clinical risk factors, using an objective measurement of hearing levels, in adults over 50 years of age. Method: A population-based survey was completed in Santiago, Chile between...

Objective To assess access to general and disability-related health care among people with disabilities in the Maldives. Methods This study uses data from a case-control study (n = 711) nested within a population-based, nationally representative survey to compare health status and access to general healthcare amongst people with and without disabi...

Epidemiological data on depression and anxiety in Guatemala is lacking. Using 2016 National Disability Survey data, we explored the sociodemographics of people with anxiety and/or depression and its heightened burden on access to key services. The survey (n = 13,073) used the Washington Group Extended Set to estimate disability prevalence, includin...

Objective: This study aimed to determine the implications of including tympanometry in the Rapid Assessment of Hearing Loss survey protocol. A comparative study design was employed, with findings from otoscopy compared with the results of tympanometry. Method: A population-based survey of the prevalence and causes of hearing loss among adults ag...

Introduction To improve access to assistive products (APs) globally, data must be available to inform evidence-based decision-making, policy development and evaluation, and market-shaping interventions. Methods This systematic review was undertaken to identify studies presenting population-based estimates of need and coverage for five APs (hearing...

Objective Among a representative sample of adults aged 50 years and older too (i) determine the prevalence of hearing loss, (ii) evaluate probable causes and risk factors of hearing loss, and (iii) assess the association between hearing loss measured by audiometry and self-report. Design A population-based survey of adults aged 50 and older in San...

Background Musculoskeletal impairment (MSI) in children is an under-recognised public health challenge. Although preventable, road injuries and other traumas continue to cause significant impairments to children worldwide. The study aimed to use the Key Informant Method (KIM) to assess prevalence and causes of MSI in children in two districts in Ma...

Background Children with hearing loss are at increased risk of mental health conditions, including behavioural problems, but there is limited evidence about available mental health support. Aims We aimed to map the evidence on mental health support for children and adolescents with hearing loss. Method Medline, Embase, PsycINFO and grey literatur...

The supply of and market demand for assistive products (APs) are complex and influenced by diverse stakeholders. The methods used to collect AP population-level market data are similarly varied. In this paper, we review current population-level AP supply and demand estimation methods for five priority APs and provide recommendations for improving n...

Objectives To estimate the prevalence of disability among Syrian refugees living in Sultanbeyli district, Istanbul and compare people with and without disabilities in terms of demographic and socio-economic characteristics. Methods Using the municipality refugee database as the sampling frame, 80 clusters of 50 people (aged 2+ years) were selected...

The Washington Group (WG) tools capture self-reported functional limitations, ranging from 6 domains in the Short Set (SS) to 11 in the Extended Set (ESF). Prevalence estimates can vary considerably on account of differences between modules and the different applications of them. We compare prevalence estimates by WG module, threshold, application...

This analysis of surveys from six low- and middle-income countries (LMICs) aimed to (i) estimate the prevalence of disability among older adults and (ii) compare experiences and participation in key life areas among older people with and without disabilities which may show vulnerability during the COVID-19 pandemic. Data were analysed from district...

Few estimates are available of the need for assistive devices (ADs) in African settings. This study aimed to estimate population-level need for glasses and hearing aids in The Gambia based on (1) clinical impairment assessment, and (2) self-reported AD awareness, and explore the relationship between the two methods. The Gambia 2019 National Eye Hea...

If Sustainable Developmental Goal 3 and Universal Health Coverage are to be achieved, functioning is a third health indicator which must be assessed and integrated into global health population-based metrics alongside mortality and morbidity. In this paper, we define functioning according to the International Classification of Functioning, Disabili...

Background Epidemiological data on musculoskeletal impairment (MSI) and related service and assistive product (AP) needs for displaced populations are lacking. This study aimed to estimate the prevalence, aetiology, and specific MSI diagnosis and the need for related services and APs among Syrian refugees living in Sultanbeyli, a district in Istanb...

Aims. Research demonstrates elevated levels of common mental disorders among Syrian refu- gees, but the majority of studies have, to date, focused on adult populations. This study aims to estimate the prevalence of depression, anxiety and post-traumatic stress disorder (PTSD) among Syrian children and adolescents living in Sultanbeyli district of I...

Families of children with disabilities experience stigma by association with their child. This article examines social and internalised stigma experienced in the family by caregivers who participated in a caregiver programme in Ghana. Stigma is pervasive, and gendered, with most mothers blamed for bringing disability into the home. Emotional distre...

OBJECTIVES: To estimate population need and coverage for distance glasses, hearing aids and wheelchairs in India and Cameroon, and to explore the relationship between assistive product (AP) need measured through self-report and clinical impairment assessment. METHODS: Population-based surveys of approximately 4000 people each were conducted in Mah...

Background The aim of this study was to assess the association between anxiety and depression with physical and sensory functional difficulties, among adults living in five low and middle-income countries (LMICs). Methods and findings A secondary data analysis was undertaken using population-based disability survey data from five LMICs, including...

Although the association between disability and multidimensional poverty has been consistently found in several studies in Low- and Middle-Income Countries. None of these studies so far has used an extended and internationally comparable questionnaire (extended Washington Group Questionnaire) and a clinical screening of disability. The purpose of t...

Objective: (1) To test the feasibility of the Rapid Assessment of Hearing Loss (RAHL) survey protocol in Malawi (Ntcheu); (2) To estimate the prevalence and probable causes of hearing loss (adults 50+). Design: Cross-sectional population-based survey. Study sample: Clusters (n = 38) were selected using probability-proportionate-to-size-sampling. Wi...

Objective: To investigate the validity of hearing screening with hearTest smartphone-based audiometry and to specify test duration addressing the two response modes and hearing loss criteria. Design: A diagnostic accuracy study comparing hearing screening with conventional audiometry. Study sample: Three hundred and forty individuals, aged between...

Background: The Rapid Assessment of Hearing Loss (RAHL) survey protocol aims to measure the prevalence and causes of hearing loss in a low cost and rapid manner, to inform planning of ear and hearing services. This paper reports on the first field-test of the RAHL in Gao'an County, Jiangxi Province, China. This study aimed to 1) To report on the f...

Objectives: To identify and assess the evidence for interventions to reduce stigma experienced by children with disabilities and their families in low and middle-income settings. Methods: Systematic review of seven databases (MEDLINE, EMBASE, Global Health, PsycINFO, Social Policy and Practice, CINAHL, IBSS) for studies of interventions that aim...

PurposeThis study has two main objectives: 1) to assess the value of combining the rapid assessment of avoidable blindness (RAAB) and the recently developed rapid assessment of hearing loss (RAHL) based on existing population-based data from Cameroon andIndia; 2) to test the feasibility of a combined RAAB-RAHL protocol.MethodsA secondary data analy...

Objective: To assess the outcomes of children diagnosed with hearing impairment 3 years earlier in terms of referral uptake, treatment received and satisfaction with this treatment, and social participation. Methods: We conducted a population-based longitudinal analysis of children with a hearing impairment in two rural districts of Malawi. Key...

Data on the prevalence and causes of hearing loss is lacking from many low and middle-income countries, in part, because all-age population-based surveys of hearing loss can be expensive and time consuming. Restricting samples to older adults would reduce the sample size required, as hearing loss is more prevalent in this group. Population-based su...

Background: One way to achieve universal health coverage (UHC) in low- and middle-income countries (LMIC) is the implementation of health insurance schemes. A robust and up to date overview of empirical evidence assessing and substantiating health equity impact of health insurance schemes among specific vulnerable populations in LMICs beyond the m...

(1) Introduction: Poor uptake of referral for ear and hearing services in Malawi has been demonstrated in previous research. A multi-component educational intervention was developed to address poor uptake. The aim of this study was to explore the feasibility and acceptability of the intervention. In addition, we aimed to provide a case study of an...

Objective To determine whether a non‐specialist health worker can accurately undertake audiometry and otoscopy, the essential clinical examinations in a survey of hearing loss, instead of a highly skilled specialist (i.e. ENT or audiologist). Methods Clinic‐based diagnostic accuracy study in Malawi. Consecutively sampled participants ≥18 years had...

Background: Article 25 of the UNCRPD stipulates the right of people with disabilities to the highest attainable standard of health, and the timely uptake of appropriate health and rehabilitation services. This study seeks to explore the factors which influence access to health care among adults with disabilities in Cameroon and India. Methods: A to...

Objective: To compare access to healthcare services for people with disabilities to those without disabilities, within a national case-control study in Guatemala. Methods: We undertook a population-based case-control study, nested within a national survey in Guatemala. Cases with disabilities were people with self-reported difficulties in functi...

Limited evidence exists about how to design interventions to improve access to health care for people with disabilities in low and middle-income countries (LMICs). This paper documents the development of two behaviour change interventions. Case study one outlines the design of an intervention to improve uptake of referral for ear and hearing servic...

Background Cerebral palsy (CP) is the most common childhood disability worldwide, and evidence shows that children with CP are at an increased risk of malnutrition due to feeding difficulties. This qualitative study explores caregiver experiences of feeding before and after a community‐based training program in Ghana. Methods Thirteen caregivers o...

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In low and middle-income settings, where access to support and rehabilitation services for children with disabilities are often lacking, the evidence base for community initiatives is limited. This study aimed to explore the impact of a community-based training programme for caregivers of children with cerebral palsy in Ghana.A pre and post evaluat...

Objective To assess the Water, Sanitation and Hygiene (WASH) access and appropriateness of people with disabilities compared to those without, in Guatemala. Methods A case-control study was conducted, nested within a national survey. The study included 707 people with disabilities, and 465 age- and sex-matched controls without disabilities. Partic...

Objectives To assess access to adequate water, sanitation and hygiene (WASH) among people with disabilities at the household and individual level. Design Cross-sectional surveys. Setting Data were included from five district-level or regional-level surveys: two in Bangladesh (Bangladesh-1, Bangladesh-2), and one each in Cameroon, Malawi and India...

Age and sex distribution of the national population and study sample. (DOCX)

Items contributing towards the water, sanitation and hygiene scores. (DOCX)

Aim To assess feeding difficulties and nutritional status among children with cerebral palsy (CP) in Ghana, and whether severity of feeding difficulties and malnutrition are independently associated with caregiver quality of life (QoL). Method This cross‐sectional survey included 76 children with CP (18mo–12y) from four regions of Ghana. Severity...

Objectives: To estimate the prevalence of hearing impairment in Mahabubnagar district, Telangana state, India. Methods: A population-based prevalence survey of hearing impairment was undertaken in 2014. Fifty-one clusters of 80 people aged 6 months and older were selected using probability-proportionate-to-size sampling. A two-stage hearing scre...

Proven links between disability and poverty suggest that development programmes and policies that are not disability-inclusive will leave persons with disabilities behind. Despite this, there is limited quantitative evidence on livelihood opportunities amongst adults with disabilities in Low and Middle Income Countries. This study adds to the limit...

Final Questionnaire case control study, Telegu. (PDF)

Final Questionnaire case control study, English. (PDF)

Following the publication of this article [1] it was brought to our attention that inadvertently the COSECSA Oxford Orthopaedic Link (COOL) programme was not acknowledged for funding this study.

Background: The populations of many low and middle-income countries (LMIC) are young. Despite progress made towards achieving Universal Health Coverage and remarkable health gains, evidence suggests that many children in LMIC are still not accessing needed health care services. Delayed or lack of access to health services can lead to a worsening o...

Background Musculoskeletal impairments (MSI) are the leading contributor to global years lived with disability. Comparable epidemiological data on MSI is lacking, and are needed to inform health and rehabilitative services. This study aimed to estimate the prevalence and causes of MSI in Telangana State, India. Method A population-based survey u...

Purpose: To estimate the prevalence and correlates of visual impairment in Mahabubnagar district, Telangana, India. Methods: Fifty-one clusters of 80 people (all ages) were sampled with probability proportionate to size. Households within clusters were selected through the compact segment sampling. Visual acuity (VA) was measured with a tumbling “E...

Introduction Disability and poverty are believed to operate in a cycle, with each reinforcing the other. While agreement on the existence of a link is strong, robust empirical evidence substantiating and describing this potential association is lacking. Consequently, a systematic review was undertaken to explore the relationship between disability...

Summarised extraction table. (DOCX)

Sample search string. (DOCX)

References of included studies. (DOCX)

Background Early detection and appropriate intervention for children with hearing impairment is important for maximizing functioning and quality of life. The lack of ear and hearing services in low income countries is a significant challenge, however, evidence suggests that even where such services are available, and children are referred to them,...

Topic guides for caregivers. (DOCX)

Topic guides for stakeholders. (DOCX)

Data collection form for quantitative survey. (DOCX)

Background: Trachomatous trichiasis (TT) may lead to disability, impeding productive activities, resulting in loss of income. This study was conducted to determine if trichiasis surgery improves participation in productive and leisure activities, and ability to perform activities without difficulty or assistance. Methods: We recruited 1000 adults w...

Background Epidemiological data on childhood disability are lacking in Low and Middle Income countries (LMICs) such as Malawi, hampering effective service planning and advocacy. The Key Informant Method (KIM) is an innovative, cost-effective method for generating population data on the prevalence and causes of impairment in children. The aim of thi...

Objectives: Epidemiological data on musculoskeletal conditions such as degenerative joint diseases and bone fractures are lacking in low- and middle-income countries. This survey aimed to estimate the prevalence and causes of musculoskeletal impairment in Fundong Health District, North-West Cameroon. Methods: Fifty-one clusters of 80 people (all...

Purpose: To estimate the prevalence and causes of visual impairment in Fundong Health District, North West Cameroon. Methods: A total of 51 clusters of 80 people (all ages) were sampled with probability proportionate to size and compact segment sampling. Visual acuity (VA) was measured with a tumbling "E" chart. An ophthalmic nurse examined peop...