This preprint is under consideration at Conflict and Health. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research
Jean-Francois Trani
Washington University in Saint Louis
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9187-0946
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background. The 2006 United Nations Convention on the Rights of Persons with Disabilities states that the achievement of equal rights, empowerment and social inclusion of people with disabilities requires comprehensive rehabilitation services encompassing all components of the World Health Organization Community based rehabilitation (CBR) matrix: health, education, livelihood, social and empowerment. CBR programs specifically aim to deliver such comprehensive interventions. In the present study, we investigate the impact of a CBR program in Afghanistan on all these components.
Methods. We enrolled 1861 newly recruited CBR participants with disabilities in the study, from 169 villages between July 2012 and December 2013 as well as 1132 controls with disabilities randomly selected through a two-stage process within 6000 households from 100 villages in the same provinces but outside the catchment area of the CBR program. We interviewed them again after one (midline) and two (end-line) years in the study. Using propensity score matching and difference in difference analysis, we estimated the impact of the CBR on outcomes of interest, namely mobility, activities of daily living, communication, participation in social and community life, emotional well-being and employment.
Results. There were statistically significant differences between participants and controls on all outcomes between baseline and end-line, with impacts ranging from the highest on emotional wellbeing (1.02, 95%CI 0.04-2.00) and the lowest on activities of daily living (0.08, CI 0.03-0.13).
Conclusion. Our study indicates that a CBR program may provide positive rehabilitation outcomes for persons with disabilities even in a conflict context, and improve overall well-being of all participants with disabilities, whatever their impairment, individual characteristics and the CBR matrix components considered.
Trial registration. ISRCTN, ISRCTN50214054. Registered August 5th 2020 - retrospectively registered, http://www.isrctn.com/ISRCTN50214054
Keywords
Afghanistan, Community Based Rehabilitation, Difference in difference, Disability, Impact evaluation, Low Middle Income Countries, Propensity score matching
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CURRENT STATUS: Under Revision
Version 1
Posted 10 Aug, 2020
No community comments so far
Review #2 received
Received 14 Mar, 2021
Editorial decision: Minor revision
On 14 Mar, 2021
Review #1 received
Received 21 Jan, 2021
Reviewer #2 agreed
On 07 Jan, 2021
Reviewer #1 agreed
On 14 Dec, 2020
Reviewers invited
Invitations sent on 24 Aug, 2020
Editor assigned
On 07 Aug, 2020
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On 06 Aug, 2020
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On 06 Aug, 2020
Editor invited
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This preprint is under consideration at Conflict and Health. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Jean-Francois Trani
Washington University in Saint Louis
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9187-0946
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 10 Aug, 2020
No community comments so far
Review #2 received
Received 14 Mar, 2021
Editorial decision: Minor revision
On 14 Mar, 2021
Review #1 received
Received 21 Jan, 2021
Reviewer #2 agreed
On 07 Jan, 2021
Reviewer #1 agreed
On 14 Dec, 2020
Reviewers invited
Invitations sent on 24 Aug, 2020
Editor assigned
On 07 Aug, 2020
First submitted
On 06 Aug, 2020
Submission checks complete
On 06 Aug, 2020
Editor invited
On 06 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background. The 2006 United Nations Convention on the Rights of Persons with Disabilities states that the achievement of equal rights, empowerment and social inclusion of people with disabilities requires comprehensive rehabilitation services encompassing all components of the World Health Organization Community based rehabilitation (CBR) matrix: health, education, livelihood, social and empowerment. CBR programs specifically aim to deliver such comprehensive interventions. In the present study, we investigate the impact of a CBR program in Afghanistan on all these components.
Methods. We enrolled 1861 newly recruited CBR participants with disabilities in the study, from 169 villages between July 2012 and December 2013 as well as 1132 controls with disabilities randomly selected through a two-stage process within 6000 households from 100 villages in the same provinces but outside the catchment area of the CBR program. We interviewed them again after one (midline) and two (end-line) years in the study. Using propensity score matching and difference in difference analysis, we estimated the impact of the CBR on outcomes of interest, namely mobility, activities of daily living, communication, participation in social and community life, emotional well-being and employment.
Results. There were statistically significant differences between participants and controls on all outcomes between baseline and end-line, with impacts ranging from the highest on emotional wellbeing (1.02, 95%CI 0.04-2.00) and the lowest on activities of daily living (0.08, CI 0.03-0.13).
Conclusion. Our study indicates that a CBR program may provide positive rehabilitation outcomes for persons with disabilities even in a conflict context, and improve overall well-being of all participants with disabilities, whatever their impairment, individual characteristics and the CBR matrix components considered.
Trial registration. ISRCTN, ISRCTN50214054. Registered August 5th 2020 - retrospectively registered, http://www.isrctn.com/ISRCTN50214054
Figure 1
Figure 2
Figure 3
This preprint is available for download as a PDF.
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