Case Study

Integrated home-based screening for people living with disabilities: A case study from rural Malawi

Elizabeth M. Petersen, Emily B. Wroe, Kondwani Nyangulu, Chisomo Kanyenda, Sam Njolomole, Elizabeth L. Dunbar, Chiyembekezo Kachimanga
African Journal of Disability | Vol 8 | a582 | DOI: https://doi.org/10.4102/ajod.v8i0.582 | © 2019 Elizabeth M. Petersen, Emily B. Wroe, Kondwani Nyangulu, Chisomo Kanyenda, Sam Njolomole, Elizabeth L. Dunbar, Chiyembekezo Z. Kachimanga | This work is licensed under CC Attribution 4.0
Submitted: 15 October 2018 | Published: 22 November 2019

About the author(s)

Elizabeth M. Petersen, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, United States
Emily B. Wroe, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, United States; and, Partners In Health, Neno, Malawi
Kondwani Nyangulu, Partners In Health, Neno, Malawi
Chisomo Kanyenda, Partners In Health, Neno, Malawi
Sam Njolomole, Partners In Health, Neno, Malawi
Elizabeth L. Dunbar, Partners In Health, Harper, Liberia
Chiyembekezo Kachimanga, Partners In Health, Neno, Malawi


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Abstract

People living with disabilities (PLWDs) have poor access to health services compared to people without disabilities. As a result, PLWDs do not benefit from some of the services provided at health facilities; therefore, new methods need to be developed to deliver these services where PLWDs reside. This case study reports a household-based screening programme targeting PLWDs in a rural district in Malawi. Between March and November 2016, a household-based and integrated screening programme was conducted by community health workers, HIV testing counsellors and a clinic clerk. The programme provided integrated home-based screening for HIV, tuberculosis, hypertension and malnutrition for PLWDs. The programme was designed and implemented for a population of 37 000 people. A total of 449 PLWDs, with a median age of 26 years and about half of them women, were screened. Among the 404 PLWDs eligible for HIV testing, 399 (99%) agreed for HIV testing. Sixty-nine per cent of PLWDs tested for HIV had never previously been tested for HIV. Additionally, 14 patients self-reported to be HIV-positive and all but one were verified to be active in HIV care. A total of 192 of all eligible PLWDs above 18 years old were screened for hypertension, with 9% (n = 17) referred for further follow-up at the nearest facility. In addition, 274 and 371 PLWDs were screened for malnutrition and tuberculosis, respectively, with 6% (n = 18) of PLWDs referred for malnutrition, and 2% (n = 10) of PLWDs referred for tuberculosis testing. We successfully implemented an integrated home-based screening programme in rural Malawi.


Keywords

Malawi; disability; screening; task shifting; primary healthcare

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