Joseph C.1,2, Nilsson-Wikmar L.1
1Karolinska Institutet, Division of Physiotherapy, Stockholm, Sweden, 2University of the Western Cape, Physiotherapy, Cape Town, South Africa
Background: In high-income countries, survivors of traumatic spinal cord injury (TSCI) almost live as long as the general population, mainly due to the establishment of specialised systems of care. However, the situation is not the same in low-to middle-income countries, such as those in Sub-Saharan Africa. What is further plaguing the course is the lack of epidemiological data necessary for evaluating the resources needed to ensure survival and ultimately addressing functioning needs of survivors by establishing a care pathway that is systematic and comprehensive in nature.
Purpose: The aim of this position paper is to provide evidence highlighting the need for further strengthening systems of care for persons with TSCI. A secondary aim is to urge health care professionals and researchers to conduct research on the lived experiences of persons with TSCI in Africa in order to further advance the agenda.
Methods: We conducted a review of the literature pertaining to research that has been primarily conducted in Sub-Saharan Africa, focusing on TSCI epidemiology and functioning. We further reviewed the International Perspectives on Spinal Cord Injury a WHO endorsed project that investigated the lived experiences of SCI and health care systems around the world in order to identify the gaps in knowledge specifically related to Africa.
Results: Very few studies, related to epidemiology and functioning, have been published over the last 10 years. The epidemiological studies from South Africa and Botswana found contrasting incidence figures, with an alarmingly high rate of 76 per million in South Africa and 13 per million in Botswana, despite being neighboring countries. Further, the leading causes of injury were different, with assault, i.e. gun-shots and stab wounds responsible for 60% of cases in South Africa and mainly road-traffic accidents in Botswana. Concerning mortality, studies have found that in-hospital death rate, during acute care, was up to 20%, and plateaus during rehabilitation at least in Botswana where a specialised rehabilitation centre had been established in 2010. However, more research is required in other parts of Sub-Saharan Africa in order to fully establish the burden of disease. Furthermore, studies indicate a high prevalence of secondary preventable complications such as pressure ulcers, urinary tract infections and atelectasis. A number of studies originating from South Africa and Bostwana highlighted the considerable environmental challenges that longer-term survivors face when they enter their homes and communities, while access to rehabilitation, and specifically follow-up, services remained a scarcity.
Conclusion(s): This position paper highlights the urgent need for re-engineering of health care services in order to respond to the needs of survivors by learning from health systems of other countries which have gone through this process before.
Implications: Building trusted systems of care for persons with TSCI in Sub-Saharan Africa will facilitate the attainment of important human rights objectives.
Funding acknowledgements: This study has not received any funding.
Topic: Globalisation: health systems, policies & strategies
Ethics approval: No ethical clearance was required for this position paper.
All authors, affiliations and abstracts have been published as submitted.
