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Research reports

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.

Disability-Inclusive Education and Employment

Background

This project explores Disability-Inclusive Education and Employment for young people in seven countries in Africa; Ethiopia, Ghana, Kenya, Nigeria, Rwanda, Senegal and Uganda.  

This was a disability-inclusive research partnership. The research was guided by Advisory Groups, comprising youth with disabilities in Uganda and Ghana. Researchers with disabilities were part of each country team.

Photo credit: MasterCard Foundation

mastercard disabiity-inclusive logo. Animated image of people with disabilities

Disability-Inclusive Education and Employment: Study details and reports

Background

The research was conducted in partnership with ICED, Mastercard Foundation, the University of Abuja, the University of Ghana, Lifetime Consulting Ltd, Addis Ababa University, University of Nairobi, Global Advocacy and Research Group and MRC/UVRI & LSHTM Uganda Research Group. It was funded by Mastercard Foundation.

Resources available: Reports and Film

Phase 1 explored the policy landscape, through interviews with key stakeholders and document review. Reports are available here:

In phase 2, we conducted interviews with young people with disabilities to explore their experiences, challenges, opportunities and aspirations. Reports are available here:

Summary reports are also available here.

A film was created with young people with disabilities who participated in the study. The film showcases the research findings and is available here.

Watch our end-of-project webinar!

We held a webinar on the 5th March 2024 to present key learnings from research exploring access to education and employment for youth with disabilities in seven African countries: Kenya, Rwanda, Ethiopia, Senegal, Nigeria, Uganda, Ghana. 

Speakers included:

  • John Ganle, University of Ghana 
  • Femke Banink Mbazzi, Twalib Ayub and Charles Okello MRC/UVRI & LSHTM Uganda Research Unit
  • Rasak Adekoyo, University of Abuja
  • Emily Nyariki, University of Nairobi
  • Sarah Polack, ICED LSHTM

Please click here to watch the recording.

For more information, please contact Sarah Polack (Sarah.Polack@lshtm.ac.uk) and Shaffa Hameed (Shaffa.Hameed@lshtm.ac.uk).

Research reports

International Centre for Evidence in Disability - ICED
Translating disability-inclusive WASH policies into practice: lessons from Cambodia and Bangladesh: Study details and reports

Background

One in seven people around the world has disabilities, and the majority live in low- and middle-income countries. Many lack access to water, sanitation and hygiene (WASH) services or have poor-quality access. Countries have progressed in tackling discriminatory WASH legal frameworks, but implementing policy commitments to inclusive WASH remains challenging.

There have been few efforts to evaluate or document national policies on disability-inclusive WASH and none directed toward systematic learning to draw together experiences from different countries, derive elements of best practices and identify gaps in service provision.

The study

This is a collaborative study between the LSHTM and WaterAid, funded by the Australian Government’s Water for Women Fund. It aims to improve disability-inclusive WASH policymaking in low and middle-income countries through policy and practice guidance for governments wishing to mainstream disability-inclusive WASH at scale. Using Cambodia and Bangladesh as case studies, we answered these research questions:

  1. How do Cambodia and Bangladesh’s national WASH policy and guidance incorporate disability?
  2. To what extent do sub-national government officials and service providers implement these commitments to disability inclusion?
  3. How does this implementation impact the WASH experiences of people with disabilities and their caregivers?

Resources available

This poster gives an overview of the study.

We conducted a policy analysis of Cambodia and Bangladesh’s WASH policies and guidance documents to explore the inclusion of disability. We published a journal article and an accessible briefing note that summarised the article.

We carried out qualitative research in Cambodia and Bangladesh that explored the implementation of commitments to disability inclusion in national policies at the sub-national level. This journal article captures our research in Cambodia, which is summarised in this briefing note. We worked with Epic Arts (an inclusive arts organisation based in Cambodia that uses art to empower and bring people with disabilities together) to develop a performance and two short films about the findings related to 'independence' and 'caregivers'.

We wrote a research report capturing findings from Bangladesh, which is supplemented by this poster.     

We produced the Disability-Inclusive WASH Checklist for government officials and service providers to support the meaningful inclusion of people with disabilities and caregivers in national policies, guidance documents, and interventions. The Disability-Inclusive WASH Checklist is based on our study findings and co-developed recommendations. Three films introduce the checklist, give an overview of it and show how to complete it. Each film has transcripts (film 1, film 2, film 3).    

Finally, we wrote a Learning Brief, Foundations of success: driving change through successful research collaborations. This brief documents the process the Principal Investigator followed to support and mentor the research team in Cambodia remotely. The Brief captures the strengths and limitations of approaches and learning gained. It includes recommendations for organisations that remotely support non-academics to conduct ethical research in low-and middle-income countries.

For more information, please contact Jane Wilbur (Jane.Wilbur@lshtm.ac.uk).

Mental health and psychosocial support guidelines for deaf and hard of hearing children in the Gaza Strip

Starting in 2020, ICED partnered with Atfaluna Society for Deaf Children and CBM to develop guidelines on supporting the mental health and wellbeing of deaf and hard of hearing children in the Gaza Strip. Designed to be used by teachers in special and mainstream schools, these evidence-based guidelines were informed by a systematic scoping review, qualitative research and pilot study. The research was guided by a steering committee in the Gaza Strip, comprised of Deaf leaders, parents of deaf and hard of hearing children, teachers, mental health specialists, and experts in education policy and practice. The guidelines are being rolled-out across schools in the Gaza Strip, and Atfaluna Society for Deaf Children are initiating a number of psychosocial support programmes for deaf and hard of hearing children in the region.

The guidelines are available in Arabic and English below.

For further information, please contact Nathaniel Scherer (nathaniel.scherer@lshtm.ac.uk)

Arabic version

English version

Universal Health coverage for people with stroke in South Africa

This research was commissioned by the National Institute for Health Research (NIHR) Global Health Policy and Systems Research Development Award using UK Aid from the UK government and was titled:

Strengthening health systems in South Africa to achieve universal health coverage for people with stroke through research, partnership, capability building and stakeholder engagement.

The study involved:

  1. Conducting a policy and systems analysis on the provision of healthcare, including rehabilitation, for people with stroke
  2. Using participatory methods to map components of the health system, and identified data and appropriate tools to estimate costs and outcomes for a cost-effectiveness analysis to compare different models of stroke care
  3. Conducting a network analysis of the provision of healthcare for people with stroke, and
  4. Undertaking qualitative data collection with people with stroke and carers.

Read the reports and training materials developed here:

For more information, please contact Tracey Smythe (Tracey.Smythe@lshtm.ac.uk) or Quinette Louw (qalouw@sun.ac.za)

Access to rehabilitation and specialised health services for Syrian refugee children with disabilities in Türkiye

In this secondary qualitative data analysis, authors explore the experiences of Syrian refugee children with disabilities in Türkiye (Istanbul, Adana, Antakya) when accessing to rehabilitation and specialised health services. Barriers and facilitators to access are explored with aid of the Levesque Framework on healthcare access. Findings have been used by INGO Relief International to inform upcoming programme and service delivery.

Authors: Anna Paula Preciado Jiménez and Nathaniel Scherer

Read the report: Access to rehabilitation and specialised health services for Syrian refugee children with disabilities in Türkiye

The Water, Women and Disability study in Vanuatu

Water, sanitation and hygiene (WASH) are essential to human health and well-being. People with disabilities commonly have less adequate access to WASH services than people without disabilities. Women (with and without disabilities):

  • Often bear the socially prescribed responsibility for household water provision and WASH-related activities
  • Have additional WASH requirements related to menstrual hygiene management
  • May be more at risk of incontinence, which leads to additional WASH requirements and can be extremely stigmatising

This Water, Women and Disability study, the baseline study for the Laetem Dak Kona (LDK) Project, aimed to complete a comprehensive mixed method (qualitative and quantitative) population-based study of disability in TORBA and SANMA Provinces, to measure how common disability is, and understand access to, and experience of WASH, menstrual hygiene management and incontinence amongst persons with and without disabilities with a gender lens.

LDK is funded by the Australian Government’s Water for Women Fund and implemented by World Vision Vanuatu with and through its key partners. More information is available on the Water for Women site. 

Resources available

  1. Executive summary
  2. Full report
  3. Infographics
  4. Presentations
  5. Quantitative survey tools:
  6. Qualitative data generation tools:
  7. Journal articles:

For more information please contact Jane Wilbur (jane.wilbur@lshtm.ac.uk) or Islay Mactaggart (islay.mactaggart@lshtm.ac.uk).

Disability and mental health among Syrian refugees in Sultanbeyli, Istanbul: 2019 Survey Report

There are approximately 3.6 million Syrian refugees living in Turkey. As a result of conflict and migration related stressors, poverty and difficulties accessing healthcare, these people are at a greater risk of disability and common mental disorders. This survey aims to provide reliable data on disability and mental health among Syrian refugees in Istanbul, with which to inform service planning, policy and advocacy.

Authors: Sarah Polack, Nathaniel Scherer, Shaffa Hameed and Dorothy Boggs, International Centre for Evidence in Disability at the London School of Hygiene & Tropical Medicine.

Read the reports:

Full Report Executive Summary

For further information related to this study, please contact Nathaniel Scherer (nathaniel.scherer@lshtm.ac.uk) 

Disability Allowance in the Maldives

Evidence is needed to demonstrate whether the Disability Allowance programme in the Maldives has a positive impact on its target population, and if any changes are required to improve its effectiveness. Consequently, a quasi-experimental study design was implemented to evaluate the impact of the Disability Allowance among people with disabilities and their households in the Maldives, with a focus on primary indicators of poverty, quality of life and participation. A population-based survey was conducted to determine the prevalence of disability, marking the first time nationally-representative prevalence figures have been available in the country. These infographs depict key findings from three components of the study:

This study was funded by 3ie, commissioned by the Maldives National Social Protection Authority, and with in-country support from Es-Key.

Authors: Shaffa Hameed, Morgon Banks, Hannah Kuper

For further information about the study, please contact Shaffa Hameed (shaffa.hameed@lshtm.ac.uk)

The Bishesta campaign: menstrual health and hygiene for people with intellectual impairments

The Disabling Menstrual Barriers research is a collaborative study between the LSHTM and WaterAid, with funding from the Bill and Melinda Gates Foundation. The research aimed to understand and address the barriers that adolescents and young people with disabilities in Nepal face to managing menstrual hygiene.

It began with a systematic review of relevant literature, followed by formative research in the Kavre district to understand the barriers faced. That led to the development of the Bishesta campaign, which was delivered, monitored and evaluated in the Kavre district, Nepal.

Read: The Bishesta campaign: menstrual health and hygiene for people with intellectual impairments

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.

Read The Missing Billion

An evaluation of the impact of the online Community of Practice, “Working in the community with children with cerebral palsy”

A mixed methods evaluation of participation and impact of a global, online Community of Practice to support the roll out of a training programme for caregivers for children with cerebral palsy. “The CoP can be used to find ways to bring expertise and resources together, it allows the little man with lots of lived experience to access scientific research, knowledge and to share their own. Its strength is in offering a space to share diverse opinions in a non-confrontational way.”

Authors: Sally Parsley, Kelly James & Maria Zuurmond

An intervention to improve uptake of referrals for children with ear disease or hearing loss in Thyolo District, Malawi: development and feasibility testing

There is evidence that uptake of specialist referral for ear and hearing service in Malawi is low. This study aimed to develop and test an intervention to improve uptake of referral for children with ear and hearing conditions in Thyolo district, Malawi using a structured approach. 

Authors: Tess Bright, Antonia Baum, Wakisa Mulwafu, Mwanaisha Phiri, Richard Thindwa & Sarah Polack

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 Foreign Commonwealth and Development Office (FCDO).

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.

Useful KIM resources

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 here:

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.