What are the most effective strategies for preventing visual impairment among older people in Africa?
Globally, the World Health Organization estimates that 2.2 billion people have a near or distance vision impairment and that 50% of these cases could have been prevented through multiple strategies and measures. According to WHO Afro, visual impairment is a major public health problem in African countries affecting about 26.3 million people and the principal causes are trachoma, cataracts, age-related macular degeneration, glaucoma, diabetic retinopathy, corneal opacity and uncorrected refractive error. The 2019 Global burden of disease report supported by studies showed that visual impairment is higher among adults especially older women and 90% of cases are centered in LMICs (Bourne et al., 2021). Visual impairment affects people’s quality of life, exacerbates poverty, increases risk of mortality, and negatively impacts on individuals’ independence and mental health (Banks & Polack, 2014; Kuper et al., 2019). If no steps are taken, this will derail African countries progress towards the Sustainable Development Goals, especially Goal 3 ‘Good Health and Well-Being’ (as vision has a significant impact on both) as well as the Africa Agenda 2063 which aims to address the continent’s specific development challenges. This evidence brief aims to bring out effective strategies informed by research that can prevent visual impairment among older people in Africa.
- Countries to conduct in-depth, population -based surveys and dialogues to understand the context specific barriers, challenges, and inform plans
- Early targeting of girls and young women addressing gender specific factors contributing to visual impairment
- African countries to carry out mass media and community level awareness campaigns targeting mainly rural communities about visual impairment.
- Integration of eye health services in primary health care, for increasing access, affordability, and availability of services
- Human resources for health – training, deployment and equipping of eye specialists and support especially rural communities.
How can we improve the oral health of people with intellectual disabilities in low-resource settings?
People with Intellectual Disabilities have a worse oral health status than the general population, with caries and periodontal disease being the most prevalent disorders. Moreover, the poor oral health status of people with Intellectual Disabilities tends to be more severe in Low- and Middle-income countries (LMICs) since, in this setting, the situation of systemic inequity experienced by people with disabilities tends to be deeper. For this reason, a comprehensive understanding of the oral health of people with Intellectual Disabilities is a crucial factor in informing the development of strategies and interventions that address the specific dental care needs of this group, thus promoting their quality of life and overall health. The brief explores the critical challenges of providing oral health care for people with intellectual disabilities and evidence-based recommendations for overcoming these challenges.
- Improve the training of health professionals about the needs of people with Intellectual Disabilities regarding their oral care specificities
- Involvement of people with Intellectual Disabilities and caregivers in the oral care delivery process
- Promote, where possible, the independence of people with Intellectual Disabilities in performing their oral hygiene
- Development of tailor-made dental care accommodations that meet the needs of this population
How can we address intersectional stigma for people living with disability and chronic infectious diseases?
People living with disability are at a higher risk of contracting chronic infectious diseases such as human immunodeficiency virus (HIV) compared to those without disabilities. Furthermore, those with HIV are at higher risk of developing a disability as a result of their condition. Infectious diseases such as HIV, tuberculosis (TB), neglected tropical diseases (NTDs), etc can, like disability, be very stigmatising. Stigma is founded in inequality, power, and systems of domination. It can be intra-personal, such as self-stigmatisation, interpersonal, such as social stigma, and structural, such as institutional stigma. Intersectionality looks at the way different forms of discrimination combine in the experiences of marginalised groups, such as people with disabilities living with chronic infectious diseases. Consequently, this group can face additional societal barriers in their day-to-day lives compared to people with disabilities that don’t have chronic infectious diseases or those that have a chronic infectious disease without a disability. This evidence brief summarises how intersectional stigma for this particularly vulnerable group can be addressed.
- Inclusion and participation of people with disabilities in the development and implementation of national strategies for infectious diseases.
- Establish peer-led or peer-supported outreach for people with disabilities focused on chronic infectious diseases.
- Provide health workers in infectious disease control services with disability training.
- Offer nutritional and social grant support to people with disabilities and/or chronic infectious diseases.
How to eliminate stigma as a barrier to accessing mental health services for people with mental illness in LMICs
People with mental illness have higher disability and mortality rates globally as a result of access gaps between available mental health providers and potential users (WHO, 2013). Between 76% and 85% of people with severe mental illness in low- and middle-income countries (LMICs) do not have access to mental health care services (WHO, 2013). Stigma is a major barrier to mental health service delivery and can impact care-seeking behaviours. Stigma refers to a set of beliefs and attitudes about people with mental disorders which can create an environment of discrimination on a public, personal and institutional level (e.g. healthcare systems). The fear of discrimination can delay access to care as well as influence poor adherence to treatment and follow-up. This brief highlights effective strategies for eliminating stigma as a barrier to accessing health services for people with mental illness in LMICs.
- Develop mental health stigma reduction strategies for primary healthcare settings and providers.
- Involve people with mental health conditions and family members in mental illness stigma reduction programs.
- Develop and enforce laws and policies that promote and protect the rights of people with mental illness.
- Mental health stigma reduction strategies should be culturally appropriate and contextually feasible.
- Generate more research on short- and long-term interventions that target mental health stigma at multiple levels
WaterAid. Putting equality, inclusion and rights at the centre of a COVID-19 water, sanitation and hygiene response (2020)
WaterAid. Guidance: Rapid assessment of equality, inclusion and rights impacts to inform Covid-19 and WASH programs (2020)