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Research

Research at LSHTM covers a vast number of diverse subjects in international health, with projects in every corner of the world.

You can read research reports below. You can also sample peer-reviewed publications from members of ICED.

The Missing Billion

Access to health services for 1 billion people with disabilities

One billion people around the world live with disabilities. This report makes the case that they are being 'left behind' in the global community’s work on health.

This lack of access not only violates the rights of people with disabilities under international law, but UHC and SDG 3 cannot be attained without better health services for the one billion people with disabilities

The Missing Billions - PENDA report

Research reports

International Centre for Evidence in Disability - ICED
Disability-inclusive social protection research in Nepal and Vietnam

Social protection programmes are increasingly being adopted in low- and middle-income countries as a set of strategies for poverty reduction, improving livelihoods and decreasing inequality. Due to high levels of poverty and social exclusion, people with disabilities – who comprise upwards of 15% of the global population – have been identified as a key target group for inclusion in social protection, in both international guidelines and in national strategies. However, there is currently a lack of evidence on whether these programmes are adequately reaching and meeting the needs of people with disabilities.

The aim of this research was to assess the extent to which social protection systems in Nepal and Vietnam address the needs of people with disabilities. This research uses a mixed methods approach, combining a national policy analysis with district-level qualitative and quantitative studies in each country.

Nepal reports

Vietnam reports

Missing millions: how older people with disabilities are excluded
from humanitarian response

Up to 14 million older people with disabilities may be affected by humanitarian disasters. These people
are among those most at risk, yet little is known about their particular experiences. Their rights and needs are widely overlooked in humanitarian response.

The aim of this study was to explore the experiences of older people with disabilities across a range of humanitarian settings.

Authors: Phillip Sheppard and Sarah Polack, International Centre for Evidence in Disability at London School of Hygiene & Tropical Medicine and Madeleine McGivern, HelpAge International.

Strengthening the voices of adolescents with disabilities in Nepal

We wanted to understand what were the most important issues which make a difference to the lives of adolescents with disabilities (AWD) in Nepal. We wanted to talk to AWD about their wellbeing, what they needed for ‘good life’, and where the gaps were, so that this can feed into policies and programmes.

Chet Raj Bhatta, Samjhana Bhujel, Sunil Dhakal, Navina Gyawali, Muniya K Shah, Shisam Shrestha, Anita Sigdel, Momsara Sunar, Sarah Bernays, Shaffa Hameed, Shubha Kayastha, Pragya Lamsal, Meenraj Panthee, and Maria Zuurmond

Disabling menstrual barriers: identifying and addressing the barriers to menstrual hygiene that adolescents and young people with disabilities face in Nepal
The Impact of Physical Rehabilitation in Myanmar Report

This research report tracks persons with lower limb amputations in Myanmar before and after they interacted with physical rehabilitation services. The study provides much needed evidence on the impact of these important services on people’s lives.

Database of social protection and disability in Asia-Pacific and Africa

In 2015, a review was undertaken of social protection programmes to identify those that were either disability targeted or had some element of disability inclusion within their design. The review covered social assistance, social insurance and labour market programmes in Asia-Pacific and in Africa, and used a two-stage process:

countries were screened for inclusion, using set criteria (e.g. population size, social protection coverage, presence of formal social security disability benefits).  programmes in countries selected were identified using regional and global social protection databases and other key sources, such as State Party Reports to the Committee on the Rights of Persons with Disabilities. 

 

This work was funded by DFAT.

Data was extracted based upon a standardised set of themes and sub-themes, including both general programme information and disabilty specific data (name and type of programme, benefits provided, number of beneficiaries with disabilities etc). 

Guatemala national disability study 2016

Disability disaggregated population data and understanding the lived situation for people with disabilities is important for informing and motivating evidence based advocacy, policy and service planning. The Guatemala National Disability Study (ENDIS 2016) was undertaken to address a need for up to date reliable data on disability in Guatemala.

Through a population based survey:

  • to estimate the national disability prevalence among adults and children in Guatemala, and to provide regional estimates for 5 broad regions
  • to disaggregate the prevalence of disability in Guatemala by age, sex, type of functional limitation and socio-economic status
  • to explore the impact of disability on: poverty, quality of life, participation, health and opportunities to go to school and to work amongst children and adults respectively

Through a qualitative study:

  • to explore cultural, ideological, and social interpretations and responses to disability; provide insight into the disability and poverty relationship; and examine social, political, and economic dimensions operating within this relationship.

The results

See the results of the Guatemala National Disability Study (ENDIS 2016), funded by CBM Latin America, UNICEF Guatemala and the Guatemala National Council on Disability (CONADI).

Read the Spanish language qualitative report. To request the full Spanish language report, please email disabilitycentre@lshtm.ac.uk

Project investigators

  • Sarah Polack, Islay Mactaggart and Jonathan Naber – International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine
  • Dr. Carlos Dionicio, Conadi
  • Dr. Shaun Grech ,Director, The Critical Institute
  • Dr. Ana Rafaela Salazar de Barrios, University of San Carlos, Guatemala
  • Gonna Rota, CBM

For further information related to this study, please contact the study’s coordinator, Islay Mactaggart (islay.mactaggart@lshtm.ac.uk)

For press inquiries, please contact the London School of Hygiene & Tropical Medicine press office: +44 (0) 207 927 2802 or press@lshtm.ac.uk

Uptake of health and rehabilitation referrals for children in Malawi 

 For many children with disabilities, being able to access health and rehabilitation interventions is important to maximise functioning and improve quality of life. However, even when services are available, evidence suggests that uptake of referrals to these services in low and middle income countries may remain low.

In this study we i) explored uptake of and barriers to attending health and rehabilitation referrals among children in Malawi and ii) conducted a systematic review of interventions which aim to increase access to health services for children in low and middle income countries.

Do hearing aids improve lives? An impact study among a low-income population in Guatemala

This study aims to assess the impact of hearing impairment and the provision of hearing aids on socio-economic status (poverty), mental health, quality of life and activity participation in Guatemala.

Evaluating the impact of a community-based parent training programme for children with cerebral palsy in Ghana

Cerebral palsy is the most common cause of physical disability in children worldwide, and yet in most low resource settings there are few services available to support children with cerebral palsy or their families. Research is required to understand the effectiveness of community and/or home based programmes to address this gap. This 2-year study aimed to evaluate a participatory caregiver training programme called ‘Getting to know cerebral palsy’ in Ghana. 

Guidelines for consulting with children and young people with disabilities

This document provides a guidance on the importance of consulting with children with disabilities. It provides practical suggestions for consulting
with children and young people with disabilities in a variety of situations. It aims to equip individuals working on child rights with the knowledge and skills  necessary to communicate with children with a variety of disabilities.

This document sets out tips and suggestions for the entire consultation process including: planning for the consultation, general considerations for consulting with children with disabilities, specific tips for communicating with children with different types of impairments, and some case study  examples.

Protect us! Research on child protection and disability

Violence against children, at home, at school and in the community, is extremely common. Every year, approximately one billion children around the world experience some form of violence (Hillis, 2016), and this often has a long-lasting negative impact on their lives.

Children with disabilities make up at least 93 million children worldwide and they are even more vulnerable to violence than their peers without disabilities (WHO, 2011). It is therefore important to make sure that child protection, the measures taken to prevent and respond to all forms of violence, is inclusive of children with disabilities.

Plan International is fully committed to promoting the realisation of children’s rights including their right to protection from violence and abuse, and supports a wide range of child protection programmes around the world.

Please contact Hannah.Kuper@lshtm.ac.uk or Morgon.Banks@lshtm.ac.uk with any queries.

Community-based rehabilitation for people with disabilities in low- and middle-income countries

A systematic review was conducted to assess the evidence for the effectiveness of Community Based Rehabilitation (CBR) for people with disabilities in low and middle income countries. This report details the findings from the systematic review, and discusses implications for policy, practice and research.

Community-based Rehabilitation for People With Disabilities in Low- and Middle-income Countries: A Systematic Review

This review identified 15 studies that assessed the impact of community-based rehabilitation on the lives of people with disabilities and their carers in low- and middle-income countries. The studies included in the review used different types of community-based rehabilitation interventions and targeted different types of physical and mental disabilities.

This review, funded by 3ie and published by the Campbell Collaboration Library of Systematic Reviews in September 2105, reviewed the evidence on the impact of community-based rehabiliation (CBR) on the lives of people with disabilities and their carers in low- and middle-income countries.

Key findings
  • Fifteen studies meeting the search criteria were identified
  • The studies included used different types of community-based rehabilitation interventions and targeted different types of physical and mental disabilities.
  • Randomised controlled trials suggested a beneficial effect of CBR amongst people with physical disabilities
  • Non-randomised studies showed mixed results, with one study on stroke showing CBR less favourable than hospital-based rehabilitation
  • Findings on benefit for people with mental disorders suggest modest benefit
  • Majority of studies’ weak design and need for methodological rigour in future studies to build stronger evidence

Authors: Valentina Iemmi, Lorna Gibson, Karl Blanchet, K Suresh Kumar, Santosh Rath1, Sally Hartley, Gudlavalleti VS Murthy, Vikram Patel, Joerg Weber, Hannah Kuper

For further information on this report, including to request a Word.doc version, please contact Valentina Iemmi or Karl Blanchet.

Barriers and enablers to inclusion
in education for children with
disabilities in Malawi

This report details findings of a qualitative research study commissioned by the Norwegian Association of Disabled (NAD) on barriers and enablers to inclusion in education for children with disabilities in Malawi. Focusing on the perspectives of children with disabilities and their caregivers, the study explored challenges in accessing and progressing through school as well as the quality of the social and learning experiences for children who attended.

Undoing inequity: inclusive water, sanitation and hygiene programmes that deliver to all in Uganda and Zambia

These two mid-term review reports assess the early impacts of the inclusive WASH interventions implemented in Zambia and Uganda. The interventions seek to help build an evidence base on common environmental, attitudinal and institutional barriers to accessing WASH faced by vulnerable individuals. 

The Undoing Inequity Intervention seeks to build an evidence base on common environmental, attitudinal and institutional barriers to accessing water, sanitation and hygiene (WASH) faced by vulnerable individuals in Uganda and Zambia. The intervention comprised three components, namely water technologies involving the construction of new and rehabilitated boreholes in schools and communities, sanitation in the form of latrine promotion, and hygiene approaches.

A mid-term review of the was undertaken in both the Mwanza West Ward, Monze (Southern Province) of Zambia and in the Amuria and Katakwi districts of Uganda in 2014 to assess the early impacts of the intervention and to test and refine the baseline data-collection tools for the project evaluation in 2016.

The review was led by Dr Lisa Danquah, a researcher from the International Centre for Evidence in Disability based at the LSHTM on behalf of WaterAid UK in collaboration with project collaborators including WEDC at Loughborough University, WAZ and DAPP and local government. This research was funded by SHARE through funding received by UK aid from DFID.

For more information on the study and intervention please contact Lisa Danquah at Lisa.Danquah@lshtm.ac.uk.

GIZ / ICED inclusive social protection study reports: Tanzania and Peru

The Inclusive Social Protection Study undertaken by GIZ and ICED in Tanzania and Peru resulted in six reports detailing the findings from the respective research methodologies: Policy Analysis, Qualitative Analysis and Quantitative Analysis. Guidelines and tools on how to design and implement inclusive social protection projects for disabled people have been developed from the findings of the study.

Persons with disabilities have the same rights as everyone else to protection from basic social and economic risks and to access appropriate services, regardless of their disability or gender. For everyone to benefit from social protection systems, the related policies and programmes must be designed in such a way as to include persons with disabilities.

In 2014, members of the ICED research team from the London School of Hygiene and Tropical Medicine conducted a study on inclusive social protection for people with disabilities in Peru and Tanzania. National partners included REPOA in Tanzania and SODIS and CRONICAS in Peru. Overall, the study was led and coordinated by the Deutsche Gesellschaft für Internationale Zusammenarbeit GmbH (GIZ) on behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ). 

The purpose of the study was to establish how to design social protection systems that adequately and systematically include people with disabilities. The aim was to produce a scientifically based analysis and develop a toolbox and set of guidelines for project implementers based on the findings of the study. 

Project reports

Peru
Tanzania

Please contact karl.blanchet@lshtm.ac.uk or islay.mactaggart@lshtm.ac.uk with any queries regarding the Inclusive Social Protection Project.

Using the key informant method to identity children with disabilities: a working guide

The Key Informant Method (KIM) is is an approach to identifying children with disabilities in the community through trained community volunteers, known as Key Informants (KIs). KIM is an evolving method that has been used by ICED in a number of projects, supported by CBM.

We developed a working guide to using the KIM, based on lessons we’ve learnt along the way in our use of the KIM in various settings. It includes tips for the best outcomes.

 Building the evidence in disability

Few robust quantitative data on the magnitude and impact of disability on people’s lives are available globally, and amongst the limited evidence base that exists, different methodologies used in defining disability make comparison between countries and over time extremely difficult.

Collection of comparable disability data is advocated by WHO World Report on Disability and a key component of ongoing Post 2015 debates. This study set out to develop a comprehensive population-based disability survey methodology that was compatible with the ICF, and to explore the relationship between components of the framework.

This methodology was field-tested in Telangana State, India and North West Region, Cameroon between 2013-2014.

“We always struggle to have reliable data on disability which is very much needed to inform our work. This comprehensive assessment tool helps us and others in gaining such data while also relating to the life realities behind the ‘figures’.” 

Christiane Noe, CBM Research Manager

Country reports and summaries 

Research summaries

Include us in education!

This is a qualitative research study on barriers and enablers to education for children with disabilities in Nepal.

This mixed-methods study, funded by Plan International comprised of quantitative analysis of Plan’s global database; and qualitative data collection and analysis on barriers and enablers to education in Nepal.

For the full quantitative report:

The report has been compiled by Maria Zuurmond and Lena Morgon Banks from the London School of Hygiene and Tropical Medicine, Prem Aryal and Shusil Joshi from Plan Nepal, Jacqueline Gallinetti, Adrienne Monteath-Van Dok, Aidan Leavy and Linda Campbell from Plan International.

Childhood disability and malnutrition in Turkana Kenya

This study was conducted in Turkana, Kenya using qualitative and quantitative methods to explore the relationship between childhood disability and malnutrition.

The study aimed to assess:  a) whether children with disabilities were included within humanitarian aid in Turkana, and b) whether there was an association between disability and malnutrition.

Malawi key informant child disability project

This study used the Key Informant Method (KIM) to estimate the prevalence of moderate/severe physical, sensory and intellectual impairments and epilepsy among children in two districts - Ntcheu and Thyolo - in Malawi.

Community volunteers (Key Informants) were trained to identify children with disabilities, who were then screened by medical professionals and referred for appropriate health and rehabilitation interventions.

Key informant method (KIM)

Door-to-door surveys are often used to identify children with disabilities in developing countries – either as beneficiaries for an intervention, or so as to be able to estimate numbers and plan services. These surveys can be costly and time consuming, and there is often a lack of comparability between studies and methods/definitions used.

The Key Informant Method (KIM) is a method that has previously been validated in the identification of children with severe visual impairment and blindness using trained, community volunteers in the place of a door-to-door survey.

KIM has been developed by a number of organisations working together to enable states and state parties to formulate suitable policies and programs.

ICED is working with a number of partners using KIM in different settings. This KIM resources page will continue to be updated with literature and resources from these various projects.


Malawi key informant child disability project (2013-14)

This study used the KIM to estimate the prevalence of moderate/severe physical, sensory and intellectual impairments and epilepsy among children in two districts (Ntcheu and Thyolo) in Malawi.

The aim was to estimate the prevalence of moderate/severe physical, sensory and intellectual impairments and epilepsy among children in two districts (Ntcheu and Thyolo) in Malawi.

Child disability and malnutrition project – Turkana, Kenya (2013-14)

The study aimed to assess:  a) whether children with disabilities were included within humanitarian aid in Turkana & b) whether there was an association between disability and malnutrition.

A “Mini KIM” was undertaken to identify children with disabilities for inclusion in the study.

Key informant child disability project in Bangladesh and Pakistan (2008 – 2013)

This study set out to test whether voluntary, community-level Key Informants (KIs) could be trained to effectively identify children with moderate or severe physical impairments, sensory impairments (visual and hearing) or epilepsy in Bangladesh and Pakistan, and if so whether this process could be used to assess prevalence and plan appropriate referral services for children meeting these criteria.

The study also undertook a large door-to-door survey in Bangladesh to compare estimates produced using the different methods.

Seminar: community volunteers - an asset for detecting and following up children with disabilities

 

The economic costs of exclusion and gains of inclusion of people with disabilities - evidence from low and middle income countries

The report is formed of two parts:

PART A – Systematic Review on Disability and Economic Poverty
This section presents a systematic review of the literature on the relationship between disability and economic poverty. The majority of studies identified showed a positive, statistically significant association between disability and economic poverty across age groups, location, disability types and study designs.

PART B  Economic Costs of Exclusion and Gains of Inclusion
This section explores the economic consequences of the exclusion and inclusion of people with disabilities in the areas of education, employment and health. The key pathways through which these economic costs may arise are discussed and studies that have attempted to quantify the financial impacts are reviewed.

  • Read the full report
Cataract impact study

People with visual impairment are assumed to experience poorer quality of life and restricted engagement in daily activities but there is little evidence for this from low income countries. There is also a widespread assumption that there is a vicious cycle between poverty and blindness, as poor people are more likely to become blind and blind people are more likely to become poor, but there is little research confirming or refuting this theory.

To address these gaps in knowledge we carried out the cataract impact study in 2005-2006 which assessed the impact of cataract surgery on poverty, activities and health related quality of life in Kenya, Bangladesh and the Philippines. The study highlighted some key benefits of cataract surgery to a population of older adults in low-income countries after one year.

As it remained unclear whether the benefits of cataract surgery are sustained over time, in 2012 we undertook a six year follow up study in Bangladesh and the Philippines. This has indicated sustained long term benefits of cataract surgery to a population of older adults in low-income countries in terms of household economics, health related quality of life and activities.

Representation and evaluation of disability in Haiti (Port-au-Prince, 2012)

The three specific objectives of the population-based survey of disability in Haiti were to:

  • provide statistically reliable data on disability and people with disabilities in Port-au-Prince (prevalence, reported causes, profile of people with disabilities identified)
  • provide a snapshot of the situation for people with disabilities and compare it to a control group without disabilities in order to reveal restrictions on participation and barriers that specifically affect the study population (family environment, living standards, education, employment and health)
  • investigate from a qualitative perspective people with disabilities’ difficulties in terms of inclusion, access and social participation. Location The study was carried out in 2012 in 5 districts from the Port-au-Prince metropolitan area: Carrefour, Delmas, Pétionville, Tabarre and Port-au-Prince1.

Read the full report

A journal article was also published following the findings of the study:

Evaluation of post-earthquake physical rehabilitation response in Haiti, 2010

On 12 January 2010, an earthquake of 7.0 on the Richter scale hit Haiti, killing over 222,000, injuring more than 300,000 and displacing 2.3 million people. Mindful of the complex and difficult context, the response to the disaster was rapid and multi-sectoral, bringing together UN agencies, military forces, governments and NGOs.

A new evaluation by the London School of Hygiene & Tropical Medicine of the physical rehabilitation response after the 2010 Haiti earthquake, finds that many hands didn’t always make light work.

Thousands of people became disabled during and after the 2010 earthquake, and physical rehabilitation interventions were crucial to the emergency response. The rehabilitation sector alone involved 125 organisations including UN agencies, government, international and Haitian NGOs.

With a strong focus on relationships between the 125 rehabilitation organisations involved, the study finds that effective coordination was challenged by top-down implementation with little respect for existing national structures or consideration of local practitioners, failure to observe international standards, and the sheer diversity of the collaboration.

The study report is critical of the failure to hold coordination meetings in accessible locations or in local languages, which effectively prevented participation by local government and NGOs. Due to such weak connections, Haitian authorities and civil society felt excluded. The short-term contract bases of international rehabilitation teams and a lack of standardised record keeping compromised the transfer of usable knowledge to Haitian health services, while instability resulted in out-migration of Haitian professionals, as free provision by international volunteer teams usurped demand for local services.

Long-term impact was sometimes sacrificed in favour of short-term headlines and funding concerns, as the cluster mechanism focused on day-to-day activities, neglecting the building of a common vision for the sector. The report suggests that actors should start building the future rehabilitation system as soon as the acute emergency response ends.

The study also recognises positive outcomes. Prior to 2010, prosthetic and orthotic (P&O) and in-patient rehabilitation services were very weak in Haiti, while treatment for spinal cord injured patients was virtually non-existent. Subsequent to the disaster response, the range of rehabilitation services is significantly expanded in Haiti, including the introduction of Haiti’s first spinal cord injury services. Despite slow initial progress, the rehabilitation sector moved much more quickly than the health sector in terms of bringing Haitian actors on board, and handing over lead roles to national authorities, which bodes well for the sustainability of the service going forward.

Evaluating the impact of rehabilitation in the lives of people with disabilities and their families in low and middle income countries

This report has been commissioned by CBM, an international disability organisation working with local partners around the globe to improve the quality of life of the world‟s persons with disabilities who live in the most disadvantaged societies.

CBM is increasingly interested in evidencing and evaluating the extent to which they are achieving this goal, so that they can plan and implement their programmes in the most cost-effective way.

As there are many tools available for evaluating impact in the international literature, CBM commissioned this review in order to obtain clear guidance on how research can be carried across their programmes in order to generate high quality and reliable evidence on the impact of their programmes in the lives of people with disabilities and their families.