Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
Blantyre Institute for Community Outreach, Blantyre, Malawi.
BMJ Open. 2024 Sep 5;14(9):e083321. doi: 10.1136/bmjopen-2023-083321.
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.
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.
DeWorm3 Malawi Site (DMS), Mangochi district, Malawi.
All 44 574 children aged 5-17 years residing within the DMS.
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).
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).
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.
NCT03014167.
以学校为基础的方法是提供基本卫生服务的有效机制，但如果残疾儿童参与学校教育的可能性较低，他们可能会被排除在外。以社区为基础的“逐户”方法可能提供更公平的策略，以确保残疾儿童能够获得服务，但在评估卫生干预措施时，残疾情况很少得到严格评估。
描述 5-17 岁儿童残疾的流行情况和相关因素，并评估常规学校驱虫（SBD）与以社区为基础的驱虫（CBD）治疗土壤传播性蠕虫的新干预措施相比，治疗残疾儿童的相对效果。
马拉维德worm3 网站（DMS），曼戈奇区。
所有居住在 DMS 内的 44574 名 5-17 岁儿童。
残疾定义为在华盛顿小组/儿基会儿童功能模块中管理的一个或多个领域的功能受限，该模块作为社区普查的一部分。在 SBD 和 CBD 治疗期间，所有儿童的治疗均独立观察和记录。对于两种干预类型，我们对接受治疗的残疾儿童和无残疾儿童的绝对比例（治疗的绝对差异（AD））进行了双变量分析，并进行了逻辑回归以检验残疾状况是否与治疗的可能性相关（治疗的相对差异）。
残疾的总体患病率为 3.3%（n=1467），最常见的残疾领域是听力、记忆和沟通。与所有年龄组的女孩相比，男孩患残疾的可能性始终更高，残疾与较低的入学率和较差的教育程度密切相关。直接观察评估的 SBD 治疗残疾儿童的比例（-1% AD，p=0.41）或治疗可能性（调整风险比（aRR）=1.07，95%置信区间 0.89 至 1.28）均无显著差异。与 SBD 相比，CBD 期间所有儿童的治疗率均大幅提高，但治疗比例（-0.5% AD，p=0.59）或治疗可能性（aRR=1.04，95%置信区间 0.99 至 1.10）均无显著差异。
SBD 似乎不会排斥残疾儿童，但应积极考虑残疾儿童教育参与率持续较低的情况，在学校卫生干预措施的设计和监测中加以考虑。
NCT03014167。
