Disability in childhood and the equity of health services: a cross-sectional comparison of mass drug administration strategies for soil-transmitted helminths in southern Malawi
Background School-based approaches are an efficient mechanism for the delivery of basic health services, but may result in the exclusion of children with disabilities if they are less likely to participate in schooling. Community-based ‘door to door’ approaches may provide a more equitable strategy...
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BMJ Publishing Group
2024-09-01
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| author | Hannah Kuper Calum Davey Judd Walson Robin L Bailey Sean Galagan Khumbo Kalua James Simwanza Rachel Pullan Lazarus Juziwelo Hugo Legge Stefan Witek-McManus Rejoice Msiska Hastings Mangawah William Oswald Joseph Timothy Emily Pearman Mariyam Shaikh |
| author_facet | Hannah Kuper Calum Davey Judd Walson Robin L Bailey Sean Galagan Khumbo Kalua James Simwanza Rachel Pullan Lazarus Juziwelo Hugo Legge Stefan Witek-McManus Rejoice Msiska Hastings Mangawah William Oswald Joseph Timothy Emily Pearman Mariyam Shaikh |
| author_sort | Hannah Kuper |
| collection | DOAJ |
| description | Background School-based approaches are an efficient mechanism for the delivery of basic health services, but may result in the exclusion of children with disabilities if they are less likely to participate in schooling. Community-based ‘door to door’ approaches may provide a more equitable strategy to ensure that children with disabilities are reached, but disability is rarely assessed rigorously in the evaluation of health interventions.Objectives To describe the prevalence and factors associated with disability among children aged 5–17 years and to assess the relative effectiveness of routine school-based deworming (SBD) compared with a novel intervention of community-based deworming (CBD) in treating children with disabilities for soil-transmitted helminths.Setting DeWorm3 Malawi Site (DMS), Mangochi district, Malawi.Participants All 44 574 children aged 5–17 years residing within the DMS.Primary and secondary outcome measures Disability was defined as a functional limitation in one or more domains of the Washington Group/UNICEF Child Functioning Module administered as part of a community-based census. Treatment of all children during SBD and CBD was independently observed and recorded. For both intervention types, we performed bivariate analyses (z-score) of the absolute proportion of children with and without disabilities treated (absolute differences (ADs) in receipt of treatment), and logistic regression to examine whether disability status was associated with the likelihood of treatment (relative differences in receipt of treatment).Results The overall prevalence of disability was 3.3% (n=1467), and the most common domains of disability were hearing, remembering and communication. Boys were consistently more likely to have a disability compared with girls at all age groups, and disability was strongly associated with lower school attendance and worse levels of education. There was no significant difference in the proportion of children with disabilities treated during SBD when assessed by direct observation (−1% AD, p=0.41) or likelihood of treatment (adjusted risk ratio (aRR)=1.07, 95% CI 0.89 to 1.28). Treatment of all children during CBD was substantially higher than SBD, but again showed no significant difference in the proportions treated (−0.5% AD, p=0.59) or likelihood of treatment (aRR=1.04, 95% CI 0.99 to 1.10).Conclusion SBD does not appear to exclude children with disabilities, but the effect of consistently lower levels of educational participation of children with disabilities should be actively considered in the design and monitoring of school health interventions.Trial registration number NCT03014167. |
| format | Article |
| id | doaj-art-e80915e2cbdb430786b1c5cb09581acb |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-e80915e2cbdb430786b1c5cb09581acb2025-08-20T02:40:29ZengBMJ Publishing GroupBMJ Open2044-60552024-09-0114910.1136/bmjopen-2023-083321Disability in childhood and the equity of health services: a cross-sectional comparison of mass drug administration strategies for soil-transmitted helminths in southern MalawiHannah Kuper0Calum Davey1Judd Walson2Robin L Bailey3Sean Galagan4Khumbo Kalua5James Simwanza6Rachel Pullan7Lazarus Juziwelo8Hugo Legge9Stefan Witek-McManus10Rejoice Msiska11Hastings Mangawah12William Oswald13Joseph Timothy14Emily Pearman15Mariyam Shaikh16Department of Population Health, London School of Hygiene and Tropical Medicine, London, UKDepartment of Population Health, London School of Hygiene and Tropical Medicine, London, UKGlobal Health, University of Washington, Seattle, Washington, USADepartment of Clinical Research, London School of Hygiene and Tropical Medicine, London, UKDepartment of Global Health, University of Washington, Seattle, Washington, USABlantyre Institute for Community Outreach, Blantyre, MalawiBlantyre Institute for Community Outreach, Blantyre, MalawiDepartment of Disease Control, London School of Hygiene and Tropical Medicine, London, UKNational Schistosomiasis and STH Control Programme, Community Health Sciences Unit, Ministry of Health & Population, Lilongwe, MalawiDepartment of Disease Control, London School of Hygiene and Tropical Medicine, London, UKDepartment of Disease Control, London School of Hygiene and Tropical Medicine, London, UKBlantyre Institute for Community Outreach, Blantyre, MalawiBlantyre Institute for Community Outreach, Blantyre, MalawiDepartment of Disease Control, London School of Hygiene and Tropical Medicine, London, UKDepartment of Disease Control, London School of Hygiene and Tropical Medicine, London, UKDepartment of Global Health, University of Washington, Seattle, Washington, USADepartment of Global Health, University of Washington, Seattle, Washington, USABackground School-based approaches are an efficient mechanism for the delivery of basic health services, but may result in the exclusion of children with disabilities if they are less likely to participate in schooling. Community-based ‘door to door’ approaches may provide a more equitable strategy to ensure that children with disabilities are reached, but disability is rarely assessed rigorously in the evaluation of health interventions.Objectives To describe the prevalence and factors associated with disability among children aged 5–17 years and to assess the relative effectiveness of routine school-based deworming (SBD) compared with a novel intervention of community-based deworming (CBD) in treating children with disabilities for soil-transmitted helminths.Setting DeWorm3 Malawi Site (DMS), Mangochi district, Malawi.Participants All 44 574 children aged 5–17 years residing within the DMS.Primary and secondary outcome measures Disability was defined as a functional limitation in one or more domains of the Washington Group/UNICEF Child Functioning Module administered as part of a community-based census. Treatment of all children during SBD and CBD was independently observed and recorded. For both intervention types, we performed bivariate analyses (z-score) of the absolute proportion of children with and without disabilities treated (absolute differences (ADs) in receipt of treatment), and logistic regression to examine whether disability status was associated with the likelihood of treatment (relative differences in receipt of treatment).Results The overall prevalence of disability was 3.3% (n=1467), and the most common domains of disability were hearing, remembering and communication. Boys were consistently more likely to have a disability compared with girls at all age groups, and disability was strongly associated with lower school attendance and worse levels of education. There was no significant difference in the proportion of children with disabilities treated during SBD when assessed by direct observation (−1% AD, p=0.41) or likelihood of treatment (adjusted risk ratio (aRR)=1.07, 95% CI 0.89 to 1.28). Treatment of all children during CBD was substantially higher than SBD, but again showed no significant difference in the proportions treated (−0.5% AD, p=0.59) or likelihood of treatment (aRR=1.04, 95% CI 0.99 to 1.10).Conclusion SBD does not appear to exclude children with disabilities, but the effect of consistently lower levels of educational participation of children with disabilities should be actively considered in the design and monitoring of school health interventions.Trial registration number NCT03014167.https://bmjopen.bmj.com/content/14/9/e083321.full |
| spellingShingle | Hannah Kuper Calum Davey Judd Walson Robin L Bailey Sean Galagan Khumbo Kalua James Simwanza Rachel Pullan Lazarus Juziwelo Hugo Legge Stefan Witek-McManus Rejoice Msiska Hastings Mangawah William Oswald Joseph Timothy Emily Pearman Mariyam Shaikh Disability in childhood and the equity of health services: a cross-sectional comparison of mass drug administration strategies for soil-transmitted helminths in southern Malawi BMJ Open |
| title | Disability in childhood and the equity of health services: a cross-sectional comparison of mass drug administration strategies for soil-transmitted helminths in southern Malawi |
| title_full | Disability in childhood and the equity of health services: a cross-sectional comparison of mass drug administration strategies for soil-transmitted helminths in southern Malawi |
| title_fullStr | Disability in childhood and the equity of health services: a cross-sectional comparison of mass drug administration strategies for soil-transmitted helminths in southern Malawi |
| title_full_unstemmed | Disability in childhood and the equity of health services: a cross-sectional comparison of mass drug administration strategies for soil-transmitted helminths in southern Malawi |
| title_short | Disability in childhood and the equity of health services: a cross-sectional comparison of mass drug administration strategies for soil-transmitted helminths in southern Malawi |
| title_sort | disability in childhood and the equity of health services a cross sectional comparison of mass drug administration strategies for soil transmitted helminths in southern malawi |
| url | https://bmjopen.bmj.com/content/14/9/e083321.full |
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