Fostering inclusion through evidence and empowerment
Research // Health
Health
The areas of health research at AIDD are:
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Translational multidisciplinary operational research as well as health services research constitute the core research activities of AIDD. Translational research is concerned with combination of various disciplines and resources, expertise and techniques for the promotion of enhanced prevention, diagnosis and therapy. Health services research is concerned with delivery and access to healthcare through identification of effective methods or organization, management, financing and delivery of quality healthcare services.
Researchers from a wide variety of disciplines including epidemiology, public health, medicine, nursing, psychology, physiotherapy pharmacy, economics, political science, engineering, and management are encouraged to collaborate with AIDD in health research.
AIDD conducts research in many different settings (community, academia, local and national government, clinical health care and other settings). The purposes of our research are diverse, from collecting empirical data and developing research instruments and methodologies, to policy and operational decision making. Our focus is on broad populations as well as specific population subgroups on different geographical levels (international, national, state/province/division, and district).
Burden of Diseases
AIDD conducts research to investigate the burden of diseases in low and middle-income countries. The purpose of this is to better understand the prevalence, incidence, aetiology, risk factors behind diseases that result in disabilities. The availability of information regarding diseases serves to help guide service delivery and program planning efforts. Here at AIDD, community-based approaches such as the Key Informant Method (KIM) are used to investigate the burden of diseases in various settings. The community-based early intervention and rehabilitation centres in rural Bangladesh also serve as point of identifying and assessing children with disabilities. To address the lack of data on the prevalence and causes of blindness in Bangladesh, the Rapid Assessment of Avoidable Blindness (RAAB) was conducted in 8 districts It involved screening of over 21,000 people and found cataract to be the major cause of blindness. The BCPR study is an ongoing project at AIDD for establishing a national Cerebral Palsy (CP) register in Bangladesh. Apart from its intended purposes, it is also serves as a key source of recruitment of participants for a number of current projects.
Prevention and Early Diagnosis
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Prevention and early diagnosis are fundamental to prevent individuals from developing disabilities and impairments through worsening of physical conditions, and to prevent avoidable disabilities. Early diagnosis is essential for accessing the early stage and timely treatment, rehabilitation and therapy services that are vital to avoiding development of or further deterioration of disabilities and impairments. The Bangladesh Childhood Cataract Campaign was launched to identify 40,000 blind children, carry out 20,000 cataract surgeries, and treat 10,000 blind children. The campaign also aimed to raise awareness nationwide, develop paediatric ophthalmic centres, develop and maintain a database of blind children, and to document and disseminate program learning.
Clinical Care
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Specialist medical camps are conducted in collaboration with partners for medical assessment for inclusion into the Bangladesh Cerebral Palsy Register (BCPR), epilepsy management in the community, oral health assessment and treatment, eye surgery and treatment, assessment for distribution of assistive devices etc. Presence of medical teams consisting of doctors and nurses with necessary medical supplies is ensured for provision of primary on ethical grounds to allow marginalized people from remote rural areas to access medical care. Prescriptions are issued and basic medicines and vitamin supplements are given free of cost. Community management of epilepsy serves to provide training , but also to assess the state of children with disabilities who have epilepsy. Treatment is prescribed and a mechanism is in place for compliance of follow-up and referrals.
Rehabilitiation
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A number of disability centres are operated by CSF Global with research initiatives from AIDD. Children with CP who have been included into the Bangladesh Cerebral Palsy Register (BCPR) are enrolled into rehabilitation programs at the Shishu Shorgo Early Intervention and Rehabilitation Centres. Evaluation mechanisms are implemented for assessment of the effectiveness of therapy services throughout the duration of the program period and the follow-up period afterwards on children’s participation in family, school, and the community. As of 2017, there are four such centres in operation. To find out more about AIDD rehabilitation and research, visit Community Based Rehabilitation. Ophthalmic rehabilitation services consisting of squint correction, cataract surgery, refractive-error correction, and other medical operations are carried out following eye camps conducted with partners throughout Bangladesh by CSF Global as part of the Childhood Blindness Program (CBP) under USAID (United States Agency for International Development). Ophthalmic rehabilitation programs aid in generating data on the prevalence and causes of childhood blindness in Bangladesh.
Assistive devices such as spectacles, low-vision devices (i.e. magnifying screens), and white-canes are provided after assessment to those who need them. Other assistive devices like hearing aids, special shoes, custom-built wheelchairs, crutches, etc. are also provide at camps for rehabilitation and referrals are made for therapy care and other treatment. To find out more, please visit our page on the work of AIDD on assistive devices and technologies.
Nutrition
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Here at AIDD, there is greater emphasis on inclusion of persons with disabilities in accessing health services at facilities as well as empowerment of people with disabilities and their families/households. The institute intends to investigate the relationship between disabilities and nutrition and disseminate the findings to address needs strategically. Currently focus is on early screening and diagnosis with an emphasis on nutritional assessment and dietary intake of children with cerebral palsy, which is being carried out at the affiliated facilities. Existing infrastructure such as that of the Bangladesh Cerebral Palsy Register (BCPR) has been used, future investigation on disabilities and nutrition and related phenomenon will be conducted using this and other available networks and resources.
A major threat towards human health is posed by all forms of malnutrition. According to the World Health Organization (WHO), around 30% of all child deaths are caused by under-nutrition. Therefore, prevention of malnutrition has been a primary focus for designing interventions to reduce childhood morbidity and mortality worldwide. Due to its complex nature in both developing and developed country contexts, multi-sectoral approach has been proven to be effective.
A Comprehensive Implementation Plan has been adopted by the World Health Assembly (WHA) to achieve six (06) global nutrition targets through direct nutrition interventions and multi-sectoral actions in the food system, education and social protection: reducing low birth weight; stunting, wasting and overweight in children; and anaemia in women by 2025. The key actors around the world are now taking steps to meet these targets. Major focus has been given on addressing the underlying issues leading to malnutrition, especially among vulnerable groups of people.
Children with disability are at high risk of malnutrition due to their associated impairments and need for assistance in daily life. Data suggests there is a high burden of undernutrition among children with disability compared to those with no physical or psychological impairments; and cerebral palsy has been well recognized as one of the major causes of these childhood disabilities worldwide. Several studies conducted in both developed and developing countries have repeatedly reported the poor nutritional status with an increase in the severity of CP status. However, this status can be improved with an intensive and comprehensive multidimensional approach. This would in turn decrease the risk of high morbidity and mortality.
The United Nations Convention on the Rights of the Child (UNCRC) clearly states that all children, including children with disabilities, have the right to adequate nutrition. Additionally, the duty of states and governments for preventing or denying health services and food on the basis of disabilities is highlighted in the United Nations Convention of the Rights of Persons with Disabilities (UNCRPD).
The United Nations International Children's Emergency Fund (UNICEF) mentions that disability and nutrition are closely related. Both are global development priorities now and they can only be addressed by also tackling the issues of poverty, ensuring equity and guaranteeing human rights. Inaccessible premises, gaps in communication between professionals and persons with disabilities, as well as various other reasons prevent people with disabilities (both children and adults) from accessing the same level of services as non-disabled individuals. Prevailing conditions of scarcity in some communities might have led to the notion that the health, welfare and life of a non-disabled child has greater priority over a child with disabilities.
Another matter of concern for households/families with disabled member(s) is the state of poverty and unequal distribution of resources serving as obstacles in accessing adequate nutritious food. Also, in the nutrition and disability sectors, access to proper nutritious food for women with disabilities and their children is frequently neglected, thus putting these women and children at greater risk.
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