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Disabil Rehabil. 2012;34(20):1736-46. doi: 10.3109/09638288.2012.662260. Epub 2012 Mar 12.

Indignity, exclusion, pain and hunger: the impact of musculoskeletal impairments in the lives of children in Malawi.

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London School of Hygiene & Tropical Medicine, Faculty of Infectious & Tropical Diseases, London, UK.



To develop a conceptual model representing the impact of musculoskeletal impairments (MSIs) in the lives of children in Malawi.


A total of 169 children with MSIs (CMSIs), family and other community members participated in 57 interviews, focus groups and observations. An inductive approach to data analysis was used to conceptualise the impact of MSIs in children's day-to-day lives.


The main themes that emerged were Indignity, Exclusion, Pain and Hunger. Indignity represents various affronts to children's sense of inherent equal worth as human beings, for example when bullied by peers. Exclusion refers to CMSIs being excluded from three core daily activities: school, play and household chores. Some CMSIs experienced Pain, for example as an outcome of striving to participate. Children with severe mobility impairments were at increased risk of Hunger, having less access to food outside the home and placing a burden of care on the family that could restrict household productivity. Household Poverty was therefore included in the model, as this household impact was inseparable from the impact on CMSIs.


It is recommended that rehabilitation interventions are planned and evaluated with consideration to their impact on Exclusion, Indignity, Pain, Hunger and Household Poverty using multi-faceted partnerships.

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