Ensuring holistic development of disabled children in developing countries

Abstract

A disability is a sort of disadvantage that either restricts or prevents the given person in the discharge of the roles/duties that are considered normal for that person. Disabled children belong to one of the most vulnerable and marginalised sections of society and have to deal with multiple challenges in their day-to-day life, especially in developing countries. Owing to the enormous magnitude and global distribution, it is of foremost importance to plan and implement cost-effective strategies to reduce the magnitude of the problem. In fact, a major proportion of etiological factors can be neutralised, if policy-makers can ensure universal implementation of primary prevention strategies well supported with the strengthening of existing infrastructure and a comprehensive welfare policy. In conclusion, programme managers, health care professionals, and society should recognise disabled children’s special needs and hence assist them in all possible ways to facilitate their adaptation to the neighbouring environment.

Keywords:

• children
• developing countries
• disabled
• health

Children with disabilities: challenges and consequences

A disability is a sort of disadvantage that either restricts or prevents the given person in the discharge of the roles/duties that are considered normal for that person.¹ A disabled child belongs to one of the most vulnerable and marginalised sections of society and has to deal with multiple challenges in day-to-day life. These include accessibility of welfare centres and health care establishments; minimal infrastructure support; negative attitudes of health care professionals or employers; limited educational and vocational opportunities; social stigma; negligible psychological and social support to them as well as their families; monetary constraints; and poor quality of life, especially in developing countries.² Disabled children are also susceptible to a wide range of violence (verbal, physical, sexual) as well as poor personal hygiene and co-morbidities (dental caries, malnutrition, dermatological infections).^1,3,4

Types and potential risk factors

Broadly, disabled children have been categorised into three major categories, namely ^{1, 5, 6}

1. Physically disabled — resulting from birth defects (e.g. congenital heart disease), infections (e.g. polio), or accidents (e.g. burns, road traffic accidents);

2. Mentally disabled — owing to genetic conditions (like Down’s syndrome), antenatal factors (like drugs or TORCH infections or radiation exposure during pregnancy), peri-natal factors (such as cerebral palsy or birth injuries), postnatal factors (like head injuries or encephalitis), or factors such as consanguineous marriage, late pregnancy, and iodine deficiency disorders; and

3. Socially disabled — usually attributed to familial conditions like problem families, broken family, and emotional disturbances.^1,5,6

In fact, most of the physical and mental disability can be averted provided quality-assured maternal and child health care services (adequate antenatal, natal, and postnatal services) are made available to the members of the community.⁷

Suggested measures to ensure development of disabled children

Owing to the enormous magnitude, global distribution, and long-term impact on multiple dimensions of life, it is of foremost importance to plan and implement cost-effective strategies to reduce the incidence of disabilities.² A major proportion of etiological factors can be neutralised, if policy-makers in co-ordination with the multiple stakeholders can ensure universal implementation of primary prevention strategies. These strategies can be implemented in different stages, namely^{1, 5, 6}

1. Pre-conception period: Employment of genetic counselling services, decreasing the practice of consanguineous marriages and conceptions at an advanced age, and discouraging further reproduction if congenital anomalies have been reported in a previous offspring;

2. Antenatal period: Ensuring no exposure to drugs, radiation, and environmental chemicals, promoting immunisation, improving the nutritional status of women during pregnancy, opting for abortion for a seriously disabled child, and promoting adherence to the risk approach by health care professionals;

3. Intra-natal period: Promotion of hospital delivery and ensuring availability of trained health care professionals and resuscitation equipment 24 × 7 in health institutes; and

4. Infancy, childhood, and adolescence: Immunisation against poliomyelitis, compliance with traffic safety regulations, and establishing an adequate number of child guidance clinics or other special homes for the welfare of children from broken or problem families.^1,5,6

However, in spite of all the above measures, if a child is diagnosed with any kind of disability, the health and allied welfare systems should be strengthened to such an extent as to allow the children to lead a normal life.¹ All steps should be taken to facilitate early diagnosis of a disability — sensitising parents or school teachers to bring any abnormal behaviour to the notice of a doctor; motivating the doctors to have a high index of suspicion if developmental milestones are delayed; and encouraging the use of appropriate investigations to facilitate early detection.^1,2 Once a disability is diagnosed, depending upon the type of disability and its severity, appropriate and adequate interventions like physiotherapy, occupational therapy, and speech therapy should be put in place to prevent the further progression of diseases or to give supportive care for the disability.^1,2 In addition, suitable rehabilitation in the form of provision of prosthetics, psychosocial support, desired training, and health education, plus sensitisation of different stakeholders about the special needs of disabled children is the need of the hour.^1,6,8 All the above-mentioned interventions emphasise the need for secondary and tertiary prevention strategies.¹ Almost all of the therapeutic care can be delivered through a regional/national institute that offers integrated care under the same roof.²

Furthermore, the program managers can even assist the disabled children by ^{1, 7, 8}

1. formulating comprehensive policies that address all their needs;

2. providing assistance to voluntary organisations for provision of the aids and appliances at minimal cost;

3. facilitating appropriate rehabilitation of disabled persons by establishment of special schools;

4. advocating the practice of integrated education;

5. offering adequate opportunities to the children in their field of interest to excel in their talent;

6. implementing reservation provisions in different educational/vocational establishments;

7. extending benefits to disabled children in different aspects of day-to-day life (travel, medical care, etc.);

8. strengthening the existing infrastructure; and

9. encouraging community-based research work to explore their needs and identify the hurdles which are preventing disabled children from leading a quality life.^1,7,8

Conclusion

Disabled children are being exposed to numerous challenges and adverse events in their life which can have serious impact on their quality of life, especially in developing countries. Programme managers, health care professionals, and society should recognise their special needs and hence assist them in all possible ways to facilitate their adaptation to the neighbouring environment.