Transcript Document

Poverty and Intellectual
Disabilities:
A View from Africa
Colleen M. Adnams
University of Cape Town
The African Continent
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53 countries
Over 920 million
people
14% of worlds
population
Over 1000
languages
Poverty and intellectual
disabilities in Africa
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Examine the relationship between poverty and
intellectual disabilities in the context of the African
continent
Discuss selected factors that mediate the povertydisability relationship in those at risk for, and with
established intellectual disabilities
Comment on salient issues and implications for the
way forward
Poverty and disability in Africa
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Paucity of evidence-based knowledge
on disability
Scarce information on how poverty
and disability affect each other in
developing countries
People with disabilities are at risk for
being amongst the poorest
The poverty-disability cycle in Africa
poverty
limited
resources
exclusion
disability
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How does this relationship manifest in
terms of prevalence of intellectual
disabilities and poverty in Africa?
Intellectual disabilities in Africa
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Prevalence of disabilities
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Africa: > 80 million (WHO)
South Africa: children under 10yrs 8.3% (Couper, 2002)
population 12.4% (Nat. Dept of Health, 1994)
Prevalence of intellectual disabilities in South
Africa:
 Children: 3.6% (Christianson, 2002).
Poverty in Africa
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Most countries low in income
World Bank category
(<$765/ yr)
Many “absolute” poverty
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South Africa (2005):
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Income poverty (<R1,200p.m)
11,971,741 children (66.2%)
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Inadequate household water:
7,762,007 children (43%)
(Statistics South Africa, 2005)
water
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Poverty and intellectual
disability in Africa
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How does this relationship manifest
in the lives of those with intellectual
disabilities?
The final common pathway
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Largely unmet basic, social, health, educational
or human rights needs
The greater the degree of poverty, the greater
the range of unmet needs
Those in rural areas are most negatively affected
Even when household financial resources
improved by social assistance (disability grant) ,
other measure of poverty (education,
employment) remain divisive (Loeb, 2008)
Poverty and intellectual
disability in Africa
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How does this relationship manifest
for those with intellectual disabilities?
What are the resources?
Resources
Policy or programmes addressing
intellectual disabilities in Africa
60
59.2
54.3
National
policy on
ID
Percentage
50
40
30
20
31.4
22.4
18.4
14.3
10
0
World
ID in other
policies
No
National
policy on
ID
Africa
(WHO Atlas of global resources for persons with intellectual
disabilities, 2007)
(194 countries, representing 95% of world’s population)
Government benefits to adults or children
with intellectual disabilities
World
Africa
(194 countries)
No benefits
22.6%
52.9%
Disability pension
56.2%
29.4%
Health security
43.2%
23.5%
Social security
44.5%
20.6%
Subsidies for food,
housing, medicine,
transport
48.6%
26.5%
Direct payment of
money
34.9%
17.6%
Fiscal or tax benefits
30.8%
14.7%
(WHO Atlas of global resources for persons with intellectual disabilities, 2007)
Percentage
Intellectual disabilities services for
children and adults in Africa
90
80
70
60
50
40
30
20
10
0
Screening
 Children
and adolescents
 Adults
Early
interv.
Indiv.
support
Psych.
Interv.
Psychosoc.
Rehab.
Day
centre/
hosp
(WHO Atlas of global resources for persons with intellectual disabilities, 2007)
National strategies to prevent
intellectual disabilities
70
Percentage
60
67.1
61.6
61.0
Diet supplementation
61.8
57.5
50
44.1
Programmes on
drugs/alcohol
in pregnancy
40
30
23.5
17.6
20
10
0
World
Africa
(WHO Atlas of global resources for persons with
intellectual disabilities, 2007)
Genetic
counselling/
prenatal testing
Test for PKU,
lead or
hypothyroidism
Policies and Resources
The case of South Africa
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Policies
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Constitution – rights based
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UN Convention on Rights of Persons with Disabilities
Realities
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Marked inequity of income distribution (Gini coeff. 0.72)
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2-Tiered system for health and education
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Poverty and inequality have racial, gender, age and
spatial dimensions
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Poor and rural remain marginalised
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Concentration of poverty lies predominantly with black
Africans, women, rural areas and black youth – hidden
disabilities.
Determinants of intellectual
disability in the context of
poverty in Africa
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Child growth stunting
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Malnutrition
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Ill-health
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Cultural and social factors
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Community factors
Child Development
Growth stunting and poverty
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Indicators of poor development – represent
multiple biological and psychosocial risks
Good predictors of poor school achievement and
cognition in 7 yr old S. African children7 yr olds
(Grantham-McGregor, 2007)
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25% of S. African children under 5 yrs growth
stunted (Labadorius 1999)
Malnutrition
Iodine nutrition
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Reduction in 12 – 13 IQ points in iodine deficient children (Bleichrodt
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Extreme manifestations becoming uncommon due to salt
idiodisation
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1994, Qian 2005)
Some African countries iodine deficient (Ethiopia, Sudan,
Mocambique) – others are iodine over-nourished (DRC, Rwanda,
Uganda, Zimbabwe)
62.4% South African households use iodised salt adequately
(Jooste, 2008)
Iron Deficiency
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10% of S. African children are iron deficient
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64% and 83% of W. Cape black infants are anaemic (Oelofse 2002)
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Increased malnutrition in persons with severe multiple disabilities
and feeding difficulties
Protein Energy Malnutrition
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20 year follow up of 20 South African
children with severe PEM in infancy
showed significant
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reduced head growth, structural brain
changes
lower cognitive performance (mild
intellectual disability) and poorer
scholastic achievement
problems with social adjustment
unemployment in early adulthood
(Stoch, Smythe, Moodie & Bradshaw 1982)
Ill-Health
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Infectious diseases
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HIV/AIDS
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Malaria
HIV: NeuroAIDS in Africa
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HIV-neurocognitive impairment and HIVdementia - major and common
complications of HIV disease (up to 47%)
(Robertson 2008)
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The Sub-Saharan African (SSA) population
accounts for over 64% of 39 million
persons living with HIV worldwide (UNAIDS,
2005)
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In Sub-Saharan Africa this represents up
to 34% of populations, with 28% receiving
treatment.
NeuroAIDS in children
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95% of children infected with HIV in SSA
acquire infection from their mothers
HIV leading cause of death in South
African children under 5 years (2000)
(Bradshaw 2004)
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Those who survive (prevalence 2.1%)
without early treatment have high
prevalence of cognitive disability, visual
spatial and motor deficits (Msellati 1993) as well
as neurological impairment (Wilmshurst 2006).
Malaria
(plasmodium falciparum)
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Over 85% of world’s 500 million cases of
falciparum malaria occur in Sub-Saharan Africa,
mostly in under 5 year olds (WHO 2002).
Neurological deficits following cerebral malaria
and less severe infection have been described
(Carter, Newton, Kenya 2005).
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Significant disabilities of cognition (memory,
attention, language, non-verbal performance)
occur in both short and long term post infection
(Kihara, 2006)
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Complications are related to severity of infection
(Carter, Newton, 2005).
Cultural and psychosocial
factors
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Determine cultural aspects and
status of persons with
intellectual disabilities
Tanzania – bad omen to the clan
and a curse to parents. (WHO
Global Atlas 2007).
Underpins status of women in
Africa, who largely care for
children and adults with
intellectual disability
Cultural and psychosocial
factors
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Resilience and vulnerability
Rural children with intellectual
disabilities have high social maturity
and community participation relative
to their measured IQ (Pillay 2003, Adnams 2001)
Substance Abuse
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Binge drinking pattern of alcohol abuse
characterises many African countries (WHO 1994)
High burden of mental and physical disease
associated with alcohol abuse in South Africa
(Bradshaw 2005) with major implications for intellectual
and cognitive disabilities.
South Africa has one of the world’s highest
prevalence of Fetal Alcohol Spectrum Disorder
(60- 80 /100 school entry level children) in high
risk communities in Western Cape (May, 2003, 2007)
Most with FASD have mild intellectual disability,
behavioural problems
Communities in conflict
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Domestic violence,
conflicts, wars
Exacerbate
circumstances for
those with existing
disabilities
Pose risk factors for
increased incidence of
disabilities, including
mental illness
Women’s Commission for Refugee Women and Children 2008
The way forward
lmplications for governance,
policies
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Country specific
Raise priority of intellectual disabilities
for governments and civil society
Implications for practice and
services
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Identify good, effective evidencebased practices and strategies
Implement prevention strategies
Good practices
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each from the continent has a story
remarkable human spirit of people of
the many countries in Africa
Special Olympics
Remote possibilities…
Tanzania (Yohana Madole)
“Some parents in the remote villages do not like to expose their
children with Intellectual disabilities; this is because of ignorance.
Communication in Tanzania is not reliable; most parts of the country
are not accessible during the rainy season, which makes it difficult to
reach athletes using roads or railways. Not many people in Tanzania
can afford to own or use telephones.
Undaunted, Special Olympics Tanzania held a train-the-trainer
workshop for coaches from 23 sub-Programs, most from rural
areas, who, in turn, trained 10 coaches each for a total of
460 new coaches.
When the Program’s 2006 National Games were held in March,
scores of athletes and coaches who had never competed outside
their villages, came back home as heroes, relating exciting
experiences, helping conquer ignorance and shame along the way”.
Implications for intellectual
disability research in Africa
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Prioritise research set in low resource settings
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Research interventions
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Identify common research priorities across
regions
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IAASID: Africa Research Network meeting
Wednesday 27 August, 18h00–19h15,
CCTIC, Room 1.43