Health status and disability in persons with spinal cord injuries in South Africa and Kenya

Abstract

Background: There is a lack of understanding regarding the nature of disabilities and functioning limitations associated with spinal cord injuries (SCI) in developing economies given limited healthcare resources.

Aim: Our purpose was to assess and compare SCI-related disability among individuals with SCI in South Africa and Kenya to inform rehabilitation service planning.

Settings: Two hundred individuals from South Africa and 90 from Kenya with SCI took part in this cross-sectional survey study, examining the comprehensive functioning of individuals with long-term SCI.

Methods: This study utilised the International SCI (InSCI) Community Survey questionnaire. Subsections of the questionnaire were used to investigate the differences in the period-prevalence of secondary medical conditions, activity limitations and participation restrictions in persons with SCI.

Results: In both countries, sexual dysfunction (55% – 57%), pain (48% – 49%), spasticity (41% – 42%) and bladder dysfunction (27% – 60%) emerged as the predominant secondary medical complications, with sexual dysfunction and pain showing overlap. There was no notable superiority in terms of treatment rates for secondary medical conditions between countries; however, exceptions were found. Both countries experienced similar overlaps in prevalent activity limitations and participation restrictions, including standing unsupported, using the toilet, bladder and bowel impairments, using public transport and reaching destinations. However, the Kenyan cohort showed significantly higher prevalence rates compared to the South African cohort for challenges related to carrying out daily routines, getting to destinations and using public transportation, while maintaining intimate relationships was more prevalent in South Africa.

Conclusion: This study provides insight into the similarities and differences in both the nature and prevalence of disability in two developing economies. It appears that universal functioning patterns after SCI exist in the two countries, and a further need emerged to examine these functioning problems on other major life areas.

Contribution: While some functioning problems could be addressed through healthcare and rehabilitation alone, others will require improved coordination and a whole-of-government approach, namely issues related to participation, community integration and inclusion.