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Special Issue "Disability and Global Health"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (21 December 2018)

Special Issue Editors

Guest Editor
Prof. Hannah Kuper

International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
Website | E-Mail
Interests: disability; health; rehabilitation; low and middle income settings
Guest Editor
Dr. Sarah Polack

International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
Website | E-Mail
Interests: disability; health; rehabilitation; surveys; low and middle income settings

Special Issue Information

Dear Colleagues,

There are an estimated one billion people with disabilities, 80% of whom live in low- and middle-income settings. People with disabilities are more likely to be poor, and are also vulnerable to exclusion from education, employment and social participation more generally. Health is also a common concern among people with disabilities, and the relationship between disability and health is complex.

People with disabilities on average are more likely to experience poor health, and so will have higher needs for accessing health care services. These services may be for general healthcare (e.g., vaccination, sexual and reproductive healthcare, or cancer services) or those specifically related to their impairment (e.g., ophthalmology, assistive devices, physiotherapy). Yet, people with disabilities often report experiencing difficulties accessing services, receiving lower-quality services and paying more for healthcare services. Together, this means that people with disabilities are being left behind in terms of improving access to health, which will make achievement of Universal Health Coverage difficult.

This Special Issue is open to any investigation of global health and disability. It will cover a range of different topics, such as inclusive health; access to rehabilitation; universal health coverage and disability; health insurance and disability; equitable quality of care; and preventive care and health promotion for people with disabilities.

We look forward to reading your submissions, and putting together an exciting and impactful Special Issue.

Yours sincerely,

Prof. Hannah Kuper
Dr. Sarah Polack
Dr. Carla Sabariego
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • disability
  • global health
  • SDGs
  • universal health coverage
  • access
  • health services

Published Papers (11 papers)

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Research

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Open AccessArticle Factors Influencing Disability Inclusion in General Eye Health Services in Bandung, Indonesia: A Qualitative Study
Int. J. Environ. Res. Public Health 2019, 16(1), 23; https://doi.org/10.3390/ijerph16010023
Received: 15 November 2018 / Revised: 11 December 2018 / Accepted: 11 December 2018 / Published: 21 December 2018
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Abstract
The Inclusive System for Effective Eye-care (I-SEE) is a pilot project for disability inclusion in eye health in Bandung district of Indonesia. The aim of this research was to investigate factors influencing the introduction, i.e., adoption, implementation and continuation of I-SEE. A qualitative
[...] Read more.
The Inclusive System for Effective Eye-care (I-SEE) is a pilot project for disability inclusion in eye health in Bandung district of Indonesia. The aim of this research was to investigate factors influencing the introduction, i.e., adoption, implementation and continuation of I-SEE. A qualitative exploratory study was conducted by interviewing relevant stakeholders (n = 27) and users with disabilities (n = 12). A theoretical framework on the introduction of innovations in health care was used to guide data collection and thematic analysis. Factors related to the characteristics of the innovation (I-SEE) (e.g., infrastructure, equipment, engagement of people with disabilities, inclusive communication), service provider characteristics (e.g., motivation, attitudes, training), organizational characteristics (e.g., supervision, indicators, data), and the socio-political context of I-SEE (policy, motivation of users, family support, costs, transport) were essential for supporting the introduction process. Additionally, stakeholders proposed strategies for enhancing the introduction of I-SEE (e.g., awareness, collaborations). While there are specific disability related factors, most factors influencing the introduction of disability inclusive eye health were similar to introducing any innovation in general health care. Strategies for disability inclusion should be included from the planning phase of an eye health program and are reasonably simple to adapt. Full article
(This article belongs to the Special Issue Disability and Global Health)
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Open AccessArticle Unmet Needs and Use of Assistive Products in Two Districts of Bangladesh: Findings from a Household Survey
Int. J. Environ. Res. Public Health 2018, 15(12), 2901; https://doi.org/10.3390/ijerph15122901
Received: 21 September 2018 / Revised: 13 December 2018 / Accepted: 14 December 2018 / Published: 18 December 2018
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Abstract
Access to assistive products (AP) is an under-researched public health issue. Using an adaptation of a draft World Health Organization tool—the ‘Assistive Technology Assessment—Needs (ATA-N)’ for measuring unmet needs and use of AP, we aimed to understand characteristics of AP users, self-reported needs
[...] Read more.
Access to assistive products (AP) is an under-researched public health issue. Using an adaptation of a draft World Health Organization tool—the ‘Assistive Technology Assessment—Needs (ATA-N)’ for measuring unmet needs and use of AP, we aimed to understand characteristics of AP users, self-reported needs and unmet needs for AP, and current access patterns in Bangladesh. The ATA-N was incorporated in a Rapid Assessment of Disability (RAD), a population-based survey to estimate prevalence and correlates of disability. In each of two unions of Kurigram and Narsingdi districts, 60 clusters of 50 people each aged two years and older were selected using a two-staged cluster random sampling process, of whom, 4250 (59% Female; 41% Male) were adults, including 333 using AP. We estimate 7.1% of the studied population used any AP. AP use is positively associated with age and self-reported functional difficulty. The proportion of people using AP is higher for mobility than for sensory and cognitive difficulties. Of all people with any functional difficulty, 71% self-reported an unmet need for AP. Most products were home or self-made, at low cost, but provided benefits. Needs and unmet needs for AP are high, especially for people with greater functional difficulties. Assessing unmet needs for AP revealed important barriers to scale that can inform policy and practice. Full article
(This article belongs to the Special Issue Disability and Global Health)
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Open AccessArticle Analysis of Social Determinants of Health and Disability Scores in Leprosy-Affected Persons in Salem, Tamil Nadu, India
Int. J. Environ. Res. Public Health 2018, 15(12), 2769; https://doi.org/10.3390/ijerph15122769
Received: 4 October 2018 / Revised: 21 November 2018 / Accepted: 3 December 2018 / Published: 6 December 2018
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Abstract
A consistent relationship has been found between leprosy and inequities in social determinants of health. It, however, remains unclear which aspect of these social determinants contributes most to the risk of infection, and even less clear are the risk factors for the development
[...] Read more.
A consistent relationship has been found between leprosy and inequities in social determinants of health. It, however, remains unclear which aspect of these social determinants contributes most to the risk of infection, and even less clear are the risk factors for the development of leprosy-related disabilities. The objective of this study was to elicit the differential impact of social determinants of health in leprosy-affected persons, and determine whether structural inequities in accessibility to societal resources and lower socioeconomic parameters correlated with higher severity of disabilities. This analysis was based on a sampled population affected by leprosy in Salem, Tamil Nadu, India. Persons enrolled in the study were covered by a nongovernmental lifelong care program, had completed a multidrug therapy for leprosy and/or were slit-skin-smear negative, and showed Grade 1 or higher disabilities due to leprosy. Multiple stepwise linear regression analysis was performed. The Eyes-Hands-Feet (EHF) score was the outcome variable, and gender, age, time after release from treatment, monthly income, and living space were explanatory variables. There were 123 participants, comprised of 41 (33.33%) women and 82 (66.67%) men. All study participants belonged to India’s Backward classes; 81.30% were illiterate and the average monthly income was 1252 Indian rupee (INR) (US$19.08 or €17.16). The average EHF score was 7.016 (95% CI, 6.595 to 7.437). Stepwise multiple linear regression analysis built a significant model, where F(2, 120) = 13.960, p ≤ 0.001, effect size (Cohen’s f2) = 0.81, explaining 18.9% of the variance in EHF scores (R2 = 0.189). Significant predictors of a higher EHF score in persons affected by leprosy were found to be higher age (beta = 0.340, 95% CI, 0.039 to 0.111, p < 0.001), as well as less living space (beta = −0.276, 95% CI, −0.041 to −0.011, p = 0.001). Our results suggest that inequalities in social determinants of health correspond to higher disability scores, which indicates that poor living standards are a common phenomenon in those living with leprosy-related disabilities. Further research is needed to dissect the exact development of impairments after release from treatment (RFT) in order to take targeted actions against disability deterioration. Full article
(This article belongs to the Special Issue Disability and Global Health)
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Open AccessArticle Developing Behaviour Change Interventions for Improving Access to Health and Hygiene for People with Disabilities: Two Case Studies from Nepal and Malawi
Int. J. Environ. Res. Public Health 2018, 15(12), 2746; https://doi.org/10.3390/ijerph15122746
Received: 27 September 2018 / Revised: 22 November 2018 / Accepted: 24 November 2018 / Published: 5 December 2018
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Abstract
Limited evidence exists about how to design interventions to improve access to health care for people with disabilities in low and middle-income countries (LMICs). This paper documents the development of two behaviour change interventions. Case study one outlines the design of an intervention
[...] Read more.
Limited evidence exists about how to design interventions to improve access to health care for people with disabilities in low and middle-income countries (LMICs). This paper documents the development of two behaviour change interventions. Case study one outlines the design of an intervention to improve uptake of referral for ear and hearing services for children in Malawi. Case study two describes the design of an intervention to improve menstrual hygiene management for people with intellectual impairments in Nepal. Both followed existing approaches—Medical Research Council Guidance for developing and evaluating complex interventions and Behaviour Centred Design. The purpose is to demonstrate how these frameworks can be applied, to document the interventions developed, and encourage further initiatives to advance health services targeting people with disabilities. Important components of the intervention design process were: (1) systematic reviews and formative research ensure that interventions designed are relevant to current discourse, practice and context; (2) people with disabilities and their family/carers must be at the heart of the process; (3) applying the theory of change approach and testing it helps understand links between inputs and required behaviour change, as well as ensuring that the interventions are relevant to local contexts; (4) involving creative experts may lead to the development of more engaging and appealing interventions. Further evidence is needed on the effectiveness of these types of interventions for people with disabilities to ensure that no one is left behind. Full article
(This article belongs to the Special Issue Disability and Global Health)
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Open AccessArticle Intersections Between Systems Thinking and Market Shaping for Assistive Technology: The SMART (Systems-Market for Assistive and Related Technologies) Thinking Matrix
Int. J. Environ. Res. Public Health 2018, 15(12), 2627; https://doi.org/10.3390/ijerph15122627
Received: 17 August 2018 / Revised: 19 October 2018 / Accepted: 6 November 2018 / Published: 23 November 2018
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Abstract
The Sustainable Development Goals (SDGs) aspire to “leave no-one behind”. Universal access to assistive products is a critical link between the realization of the SDGs and those most likely to be left behind. However, assistive technology provision in many countries, particularly low- and
[...] Read more.
The Sustainable Development Goals (SDGs) aspire to “leave no-one behind”. Universal access to assistive products is a critical link between the realization of the SDGs and those most likely to be left behind. However, assistive technology provision in many countries, particularly low- and middle-income countries, has traditionally been conducted through small-scale local providers, manufacturing products of varying degrees of quality at a limited price range. An effective way to scale these production and provision enterprises to the required level is needed to close the gap between available and required assistive technology. We argue that better access to assistive technology will only be realized through the adoption of a far stronger systems thinking and market shaping approach. We undertook a rapid literature review to explore the relationship between market shaping and assistive technology. Based on our review, we present an emergent framework for conceptualizing intersections between systems thinking and market shaping for assistive technology—the SMART (Systems-Market for Assistive and Related Technologies) Thinking Matrix. Full article
(This article belongs to the Special Issue Disability and Global Health)
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Open AccessArticle Adverse Childhood Experiences in Children with Intellectual Disabilities: An Exploratory Case-File Study in Dutch Residential Care
Int. J. Environ. Res. Public Health 2018, 15(10), 2136; https://doi.org/10.3390/ijerph15102136
Received: 5 August 2018 / Revised: 11 September 2018 / Accepted: 26 September 2018 / Published: 28 September 2018
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Abstract
Adverse Childhood Experiences (ACEs) are negative childhood events occurring in a child’s family or social environment, that may cause harm or distress. Children with intellectual disabilities (ID) and their families are underrepresented in international ACEs research, while current insights can also contribute to
[...] Read more.
Adverse Childhood Experiences (ACEs) are negative childhood events occurring in a child’s family or social environment, that may cause harm or distress. Children with intellectual disabilities (ID) and their families are underrepresented in international ACEs research, while current insights can also contribute to the improvement of their health and well-being. Deficiencies in intellectual and adaptive functioning and living circumstances can increase their vulnerability to adversities. In the present exploratory study 69 case-files of children referred to a Dutch national center for residential youth care for children with ID were analyzed to assess the prevalence and associations of ACEs. It was found that almost half (49.3%) of the children experienced 2 ACEs from the original ACEs framework or more (M (mean) = 2.1; SD (standard deviation) = 1.8) and that the number of ACEs in children was related to the presence of ACEs in parents. Both child and parental ACEs were also related to attachment- and trauma- and stressor-related disorders. Finally, living circumstances and multiple ACEs from the expanded ACEs framework, especially related to parental characteristics, were found to be related to ACEs in children with ID. This implicates the importance of a transgenerational approach when further investigating the impact of ACEs on mental and physical health in children with ID (intellectual disabilities). Full article
(This article belongs to the Special Issue Disability and Global Health)
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Open AccessArticle Risk of Exclusion in People with Disabilities in Spain: Determinants of Health and Poverty
Int. J. Environ. Res. Public Health 2018, 15(10), 2129; https://doi.org/10.3390/ijerph15102129
Received: 30 July 2018 / Revised: 23 September 2018 / Accepted: 25 September 2018 / Published: 27 September 2018
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Abstract
In this paper, we analyze data from the 2012 Encuesta de Integración Social y Salud (Social Integration and Health Survey) of the Instituto Nacional de Estadística (Spanish National Institute of Statistics) to obtain profiles created by combining disability, poverty and social exclusion. We
[...] Read more.
In this paper, we analyze data from the 2012 Encuesta de Integración Social y Salud (Social Integration and Health Survey) of the Instituto Nacional de Estadística (Spanish National Institute of Statistics) to obtain profiles created by combining disability, poverty and social exclusion. We hypothesize that the probability that people will experience social exclusion increases if they have a disability, chronic illness or limitation in conducting everyday activities, and that this probability is greater for women than for men. To conduct our analysis, we constructed a social exclusion model based on a series of social determinants that acts as a dependent variable. In this context, social exclusion is understood to go beyond the concept of financial poverty. We performed bivariate analyses, in which we calculated the Odds Ratios (OR) for certain variables considered to be predictors of social exclusion. We also performed a means comparison test and an ANOVA test to observe differences between individuals with recognized disability and those without. Finally, we conducted logistic regression analysis to determine which vulnerability profiles are most likely to experience a situation of social exclusion. We also discuss the limitations of our study, and suggest areas in, which the relationships between health, social exclusion and disability can be further investigated. Full article
(This article belongs to the Special Issue Disability and Global Health)
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Open AccessArticle Implementation of the International Classification of Functioning, Disability, and Health (ICF) Core Sets for Children and Youth with Cerebral Palsy: Global Initiatives Promoting Optimal Functioning
Int. J. Environ. Res. Public Health 2018, 15(9), 1899; https://doi.org/10.3390/ijerph15091899
Received: 24 July 2018 / Revised: 11 August 2018 / Accepted: 16 August 2018 / Published: 1 September 2018
Cited by 1 | PDF Full-text (2683 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Background: The International Classification of Functioning, Disability, and Health (ICF) Core Sets for children and youth with cerebral palsy (CP) offer service providers and stakeholders a specific framework to explore functioning and disability for assessment, treatment, evaluation, and policy purposes in a global
[...] Read more.
Background: The International Classification of Functioning, Disability, and Health (ICF) Core Sets for children and youth with cerebral palsy (CP) offer service providers and stakeholders a specific framework to explore functioning and disability for assessment, treatment, evaluation, and policy purposes in a global context. Objective: Describe global initiatives applying the ICF Core Sets for children and youth with CP, with a focus on contributions to clinical practice and challenges in their implementation. Methods: This is a descriptive cross-sectional study. Ongoing initiatives applying the ICF Core Sets for CP in Russia, Poland, Malawi, and Brazil are included. Results: The main contributions of applying the ICF Core Sets for children and youth with CP include: (1) an objective description of abilities and limitations in everyday activities; (2) a consistent identification of facilitators and barriers influencing functioning; (3) a practical communication tool promoting client-centered care and multidisciplinary teamwork; and, (4) a useful guideline for measurement selection. The main challenges of adopting the ICF Core Sets are related to lack of ICF knowledge requiring intense training and translating results from standardized measures into the ICF qualifiers in a consistent way. Conclusions: Global initiatives include research and clinical applications at the program, service and system levels. The ICF Core Sets for CP are useful tools to guide service provision and build profiles of functioning and disability. Global interprofessional collaboration, capacity training, and informatics (e-records) will maximize their applications and accelerate adoption. Full article
(This article belongs to the Special Issue Disability and Global Health)
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Review

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Open AccessReview Challenges in Accessing Health Care for People with Disability in the South Asian Context: A Review
Int. J. Environ. Res. Public Health 2018, 15(11), 2366; https://doi.org/10.3390/ijerph15112366
Received: 7 September 2018 / Revised: 4 October 2018 / Accepted: 16 October 2018 / Published: 26 October 2018
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Abstract
South Asia is a unique geopolitical region covering 3.4% of the world’s surface area and supporting 25% of the world’s population (1.75 billion). Available evidence from South Asia shows variable estimates of the magnitude of disability. The projected magnitude depends on whether an
[...] Read more.
South Asia is a unique geopolitical region covering 3.4% of the world’s surface area and supporting 25% of the world’s population (1.75 billion). Available evidence from South Asia shows variable estimates of the magnitude of disability. The projected magnitude depends on whether an impairment focus is highlighted (approximately 1.6–2.1%) or functionality is given precedence (3.6–15.6%). People with disability (PWD) face significant challenges to accessing health care in the region. Studies show that adults with disability reported a four times higher incidence of a serious health problem in a year’s recall period. Evidence shows a significantly higher rate (17.8%) of hospitalization among PWD compared to others (5%). Chronic conditions like diabetes were also significantly higher. Women with disability had significantly more concerns on reproductive health issues. Studies from the South Asia region reveal that not only did PWD have a higher load of adverse health outcomes but they also faced significantly more barriers in accessing health services. Full article
(This article belongs to the Special Issue Disability and Global Health)
Open AccessReview A Systematic Review of Access to Rehabilitation for People with Disabilities in Low- and Middle-Income Countries
Int. J. Environ. Res. Public Health 2018, 15(10), 2165; https://doi.org/10.3390/ijerph15102165
Received: 10 August 2018 / Revised: 25 September 2018 / Accepted: 27 September 2018 / Published: 2 October 2018
Cited by 2 | PDF Full-text (631 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Rehabilitation seeks to optimize functioning of people with impairments and includes a range of specific health services—diagnosis, treatment, surgery, assistive devices, and therapy. Evidence on access to rehabilitation services for people with disabilities in low- and middle-income countries (LMICs) is limited. A systematic
[...] Read more.
Rehabilitation seeks to optimize functioning of people with impairments and includes a range of specific health services—diagnosis, treatment, surgery, assistive devices, and therapy. Evidence on access to rehabilitation services for people with disabilities in low- and middle-income countries (LMICs) is limited. A systematic review was conducted to examine this in depth. In February 2017, six databases were searched for studies measuring access to rehabilitation among people with disabilities in LMICs. Eligible measures of access to rehabilitation included: use of assistive devices, use of specialist health services, and adherence to treatment. Two reviewers independently screened titles, abstracts, and full texts. Data was extracted by one reviewer and checked by a second. Of 13,048 screened studies, 77 were eligible for inclusion. These covered a broad geographic area. 17% of studies measured access to hearing-specific services; 22% vision-specific; 31% physical impairment-specific; and 44% measured access to mental impairment-specific services. A further 35% measured access to services for any disability. A diverse range of measures of disability and access were used across studies making comparability difficult. However, there was some evidence that access to rehabilitation is low among people with disabilities. No clear patterns were seen in access by equity measures such as age, locality, socioeconomic status, or country income group due to the limited number of studies measuring these indicators, and the range of measures used. Access to rehabilitation services was highly variable and poorly measured within the studies in the review, but generally shown to be low. Far better metrics are needed, including through clinical assessment, before we have a true appreciation of the population level need for and coverage of these services. Full article
(This article belongs to the Special Issue Disability and Global Health)
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Open AccessReview A Systematic Review of Access to General Healthcare Services for People with Disabilities in Low and Middle Income Countries
Int. J. Environ. Res. Public Health 2018, 15(9), 1879; https://doi.org/10.3390/ijerph15091879
Received: 16 July 2018 / Revised: 17 August 2018 / Accepted: 29 August 2018 / Published: 30 August 2018
Cited by 1 | PDF Full-text (727 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Background: A systematic review was undertaken to explore access to general healthcare services for people with disabilities in low and middle-income countries (LMICs). Methods: Six electronic databases were searched in February 2017. Studies comparing access to general healthcare services by people
[...] Read more.
Background: A systematic review was undertaken to explore access to general healthcare services for people with disabilities in low and middle-income countries (LMICs). Methods: Six electronic databases were searched in February 2017. Studies comparing access to general healthcare services by people with disabilities to those without disabilities from LMICs were included. Eligible measures of healthcare access included: utilisation, coverage, adherence, expenditure, and quality. Studies measuring disability using self-reported or clinical assessments were eligible. Title, abstract and full-text screening and data extraction was undertaken by the two authors. Results: Searches returned 13,048 studies, of which 50 studies were eligible. Studies were predominantly conducted in sub-Saharan Africa (30%), Latin America (24%), and East Asia/Pacific (12%). 74% of studies used cross-sectional designs and the remaining used case-control designs. There was evidence that utilisation of healthcare services was higher for people with disabilities, and healthcare expenditure was higher. There were less consistent differences between people with and without disabilities in other access measures. However, the wide variation in type and measurement of disability, and access outcomes, made comparisons across studies difficult. Conclusions: Developing common metrics for measuring disability and healthcare access will improve the availability of high quality, comparable data, so that healthcare access for people with disabilities can be monitored and improved. Full article
(This article belongs to the Special Issue Disability and Global Health)
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