Medical publications

Tanya is ten years old and is unable to walk. She was diagnosed with HIV when she was just a few months old. Zimbabwe. Photo by Rachel Corner/De Beeldunie.

Knowledge of HIV-related disabilities and challenges in accessing care: Qualitative research from Zimbabwe (PDF)

Globally, an estimated 35 million people live with HIV today. Many of them are experiencing or will develop a range of disabilities (e.g. musculoskeletal impairment) related to HIV-infection and its treatment, with potential consequences on mobility, social participation as well as access to healthcare.

In this study, the availability and accessibility of services addressing HIV-related disabilities are explored through interviews with stakeholders in the fields of HIV and disability, in Zimbabwe. They find a range of barriers to accessing services, such as unavailability of skilled professionals and equipment, lack of alternative forms of communication (braille, images), centralization of care centers to urban areas and the social marginalization of persons with HIV and/or disabilities.

“As people living with HIV are surviving longer [with the growing availability of antiretroviral treatment], HIV-related disabilities will become a major source of disability globally, particularly in sub-Saharan Africa where infection is endemic. Preventing, treating and managing HIV-related disabilities must become a key component of both HIV response efforts and rehabilitation strategies.”

HIV patients counting and registering the number of pills for antiretroviral treatment. Maputo, Mozambique. Photo by Andre Francois.

The relationship between HIV and prevalence of disabilities in sub-Saharan Africa: systematic review (PDF)

The spread of HIV is pervasive in sub-Saharan Africa. The findings in this study, with the aim to provide a systematic review of evidence on “the prevalence and risk of disabilities among children living with HIV in sub-Saharan Africa”, suggests that HIV is linked to disabilities.

61 papers are included in the study, with or without HIV-non infected comparators to evaluate the link between HIV and disabilities. The authors find that disability is widespread among HIV-positive individuals across age groups, impairment types and study locations. In the majority of studies using an HIV- comparator, they find that people living with HIV have significantly lower levels of functioning.

“More research is needed to better understand the implications of HIV-related disability for individuals, their families as well as those working in the fields of disability and HIV so that appropriate interventions can be developed.”

Ebola survivor Saleh takes an eye test during a MSF outreach mission to treat survivors of Ebola. Many Ebola survivors still suffer from physical, social and psychological problems after beating the virus. Kumrabai, Sierra Leone, 2015. Photo by Tommy Trenchard.

Ebola Virus Disease Complications as Experienced by Survivors in Sierra Leone (PDF)

Approximately 50% of the persons infected by the Ebola virus survive the disease. This article describes the complications experienced by a selection of the thousands of survivors from the epidemic hitting West Africa between the years 2013-2016.

The clinical characteristics of patients in MSF’s Ebola survivor clinic in Sierra Leone are described in this article. The results show that among other complications, such as arthralgia, there is a high (57%) prevalence of vision related conditions among Ebola virus disease survivors. Particularly persons aged 16-30 are found to experience ocular complications. The authors identify risk factors associated with the development of the various conditions, and in conclusion suggest immediate follow-up and treatment in order to prevent long-term disability, such as blindness.

Kamara, 25, used to farm rice and cassava before he caught Ebola but is now too weak. “I got Ebola in October last year. I felt so happy when I survived, but then three months later I stated to feel pain in my chest and my joints. I feel so weak I can’t go to the farm any more”. Sierra Leone. Photo by Tommy Trenchard.

Disability Among Ebola Survivors and Their Close Contacts in Sierra Leone: A Retrospective Case-Controlled Cohort Study (PDF)

In addition to the immediate complications following Ebola virus disease, survivors also experience long-term consequences. By comparing the state of survivors 12 months after their discharge, with those who were close to them during the outbreak - this study provides an assessment of disability among Ebola survivors.

The findings in this study show that “they have higher odds of developing disability in vision, mobility, and cognition 1 year after recovery from acute disease in comparison to their contacts." More specifically, they experience blurred vision, musculoskeletal pain hindering them from walking 500 meters and climbing stairs, depression and concentration difficulties.

The authors highlight the need for further studies of disability following Ebola virus disease, and long-term rehabilitation for survivors.

Mothers and their children at MSF's Ambulant Therapeutic Feeding Center (ATFC) in Mitimiti, Chad. Photo By Florian Lems.

Malnutrition and disability: unexplored opportunities for collaboration (PDF)

Malnutrition and disability are both major global problems, respectively affecting an estimated one billion people, who are often among the most vulnerable individuals. The authors of this article show that the conditions have several interaction points, for which they provide a conceptual framework and explore in this narrative review.

Malnutrition can cause or contribute to a range of disabilities, and persons with disabilities are often at risk of malnutrition. These interactions can occur in all phases of the life course. While the prevention of disabilities often has been addressed through nutrition programs, the risks of malnutrition facing persons with disabilities are less recognized. The increased risk can be due to medical causes, but also importantly due to lack of knowledge, attitudes and social factors. The authors give several examples of how this exclusion takes place in the family, institutions or through non-accessibility to nutrition programs.

They argue that taking this link into consideration in policies and humanitarian action can strengthen the work against both malnutrition and disability.

Consultation in MSF mobile clinic in Forkouloum, Chad. Photo by Sylvain Cherkaoui.

Ending Neglect of Older People in the Response to Humanitarian Emergencies (PDF)

There is a growing group of older people in developing countries, however most data from assessments and evaluations are aggregated and hide the specific needs and vulnerabilities of this group.

This essay, with the “aim to stimulate thinking and action on how older people are treated in humanitarian emergencies” - highlights one exception from an MSF mission.

The results show that people above age 50 have the highest mortality. In addition to being at risk of malnutrition, older people often have chronic diseases that are aggravated in humanitarian crises. The author suggest a line of actions to include the needs of this vulnerable group in emergency response.

Legs of patients injured by gunshot during the March of Return, waiting in front of Gaza clinic. Wheelchair, external fixator and crutches. The average age of the patients is 25 years old and the injuries will leave them with long term consequences. Photo by Laurie Bonnaud.

Disability and Equity in Global Health (PDF)

Taking the momentum created by the Sustainable Development Goals as starting point, the author discusses “the interaction between disability, poverty and equity in health, and a new agenda for practice and research”.

It is argued that equity - "the absence of avoidable or remediable differences among groups of people" - in health cannot be achieved without the needs of persons with disabilities being addressed.

Several concepts that are useful in this effort are introduced using empirical examples from developing countries. One example is the dominant model of understanding disability, in which it is framed as an outcome that is created in a process of interaction between individual physical factors and social context. The author outlines five dimensions that are useful for identifying factors that have a negative impact on access to care and lists some of the main hinders facing persons with disabilities in terms of access to health, while strongly highlighting the need to include this group in analysis.

Father calms his crying son after the child receives treatment for cutaneous leishmaniasis in form of injections directly in the lesion on the face. Pakistan. Photo by Nasir Ghafoor.

People are neglected, not diseases:
the relationship between disability and neglected tropical diseases

The article focuses on the frequently overlooked intersection between disability and neglected tropical diseases (NTDs).
It highlights similarities and intersections between them; summarily presents physical, mental, social and economic consequences of chronic NTD infections; discusses emerging and established practices that make NTD programmes more inclusive of people with disabilities; and points out opportunities for creating synergies between and shared approach to disability and NTDs.

Here, we have collected relevant examples of medical research that shows the links between disabilities and the conditions that MSF treats in the field. Press the article title to access the publication.