HEALTH STATUS AND DISABILITY IN PERSONS WITH SPINAL CORD INJURY: COMPARISON BETWEEN SOUTH AFRICA AND KENYA

C. Joseph¹, B. Lijodi¹, A. Titus¹

¹Stellenbosch University, Department of Health and Rehabilitation Sciences, Cape Town, South Africa

Background: Spinal cord injuries (SCI) typically result in long-term disability. Therefore, secondary and tertiary prevention remains important targets for healthcare systems, including rehabilitation services. Quantifying the nature and prevalence of health status (secondary medical conditions) and disability (activity limitation and participation restrictions) provides useful information on societal response towards the needs of persons with SCI, and findings from such inquiries could provide essential starting points to improve the lived experiences of those affected.

Purpose: To determine health status and disability (activity limitations and participation restrictions) in persons with SCI in two low resource settings, i.e., South Africa and Kenya.

Methods: A quantitative, cross-sectional study design was used in both settings to describe the nature and period-prevalence of functioning problems in community-dwelling persons with SCI. The following modules of the International Spinal Cord Injury Community Survey were used: 1) secondary health conditions scale for SCI; and 2) activity and participation. Both descriptive and inferential statistics were used to identify the most prevalence problems as well as whether significant differences existed between countries.

Results: The sample consisted of 200 and 90 individuals with SCI from South Africa and Kenya, respectively. The mean (SD) age was 38.4 (12.6) in the South African, and 37.10 (9.7) in the Kenyan cohort. No differences were found in the age and gender between countries, but differences were observed for cause of injury and level of injury (tetraplegia vs. paraplegia). Concerning health status, two of the three most prevalent secondary complications, namely sexual dysfunction (56% vs. 56%) and pain (50% and 48%) were similar between countries. Significant differences in prevalence were found for bladder dysfunction (p <0.01), bowel dysfunction (p <0.01), and urinary tract infections (p <0.05) between countries, with persons from Kenya being more affected. With respect to self-care independence, a significant difference (p <0.01) in self-care scores, according to the Spinal Cord Independence Measure – Self Report version, were found between countries, with individuals from South Africa demonstrating greater independence. The most prevalent participation problems between countries were “using public transportation” (63% vs 90%) and “standing unsupported” (54% vs 83%), with those from Kenya demonstrating greater difficulty.

Conclusions: Secondary medical conditions and physical disability are prevalent in community-dwelling persons living with SCI in South Africa and Kenya. Overall, there is a need to strengthen health systems, including rehabilitation and primary health care, in both countries, to help address the myriad of consequences after SCI with the aim of facilitating improved participation and quality of life.

Implications: This study highlights the need to systemically improve all-of-society’s response to SCI in Africa, which will require improved implementation, monitoring and evaluation of disability policies and health system’s strengthening efforts.

Funding acknowledgements: The South African Medical Research Council, via Research Capacity Development Initiative

Keywords:
Spinal cord injuries
Health status
Disability

Topics:
Neurology: spinal cord injury
Disability & rehabilitation
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes

Institution: University of the Western Cape and The Kijabi Hospital

Committee: Biomedical Research Ethics Committee AND The Kijabi Hospital Review Committee

Ethics number: BM 16/3/24 AND KH/IERC/02178/0098/2021