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Moshi H.1,2, Sundelin G.1, Sahlen K.-G.3, Sörlin A.1
1Umea University, Department of Community Medicine and Rehabilitation, Physiotherapy, UMEA, Sweden, 2Kilimanjaro Christian Medical University College, Physiotherapy, Moshi, Tanzania, 3Umea University, Department of Public Health and Clinical Medicine, Epidemiology and Global Health, UMEA, Sweden
Background: Etiology and rehabilitation for persons with traumatic spinal cord injury (TSCI) in rural settings of Africa are rarely reported. The infrastructural, environmental, economic and cultural features of rural Africa provides unique etiological and rehabilitation features worth reporting. Quantitative and qualitative approaches were employed to assess the causes of TSCI in typical African rural setting and challenges associated to rehabilitation strategies in the community.
Purpose: This study aimed at informing rehabilitation professionals of the major causes of TSCI in the rural settings and challenges to be considered for a successful prevention and rehabilitation.
Methods: In a cross sectional retrospective study a total of 213 hospital records for persons with TSCI for five years (2010 - 2014) were obtained from the biggest consultant hospital in the north-east Tanzania. Sociodemographic, cause, complications and mortality information was captured based on the international spinal cord injury data set.
Semi-structured interviews were conducted in the community involving 18 persons with SCI on challenges of living with SCI in the rural area. The interviews were voice recorded, transcribed and translated from Kiswahili to English followed by Content analysis from which physical health, socioeconomic and environmental challenges were constructed.
Results: Most TSCI involved young male subjects between 15 and 45 years mainly from falls (48.8%) and road traffic accidents (34.3%). Of the 48.8% of falls, 29.3% were from height (especially trees) and 19.5% were other falls. The main categories (challenges) identified from the qualitative analysis were; recurrent complications especially pressure ulcers, inaccessible environment, lack of or inappropriate wheelchairs and inaccessible health and rehabilitation services. These challenges were interconnected to form a disability-poverty vicious cycle around persons with traumatic SCI in a Tanzanian rural setting.
Conclusion(s): Falls (particularly from height) is the leading cause of TSCI and mostly involve male teenagers and younger adults. Poverty is a key factor that leads to occurrence of TCI, recurrent complications and inaccessibility of both the environment, self-care equipment and mobility aids.
Implications: Rehabilitation professionals planning to prevent TSCI in Tanzania rural area ought to target fall from height, focusing mainly on the male teenagers and young adults. Rehabilitation in the community for persons with TSCI should address physical health, accessibility of the environment and the economy of the individual for achievement of function, participation and quality of life.
Funding acknowledgements: This project was funded by grants from the Medical Education Partnership Initiative (MEPI) at Kilimanjaro Christian Medical University College, Tanzania.
Topic: Neurology: spinal cord injury
Ethics approval: This project was approved by the Research Ethics and review Committee (CREC) of the Kilimanjaro Christian Medical University College.
All authors, affiliations and abstracts have been published as submitted.
