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Maseko LJ, Adams F, Myezwa H. Perceptions of integrated rehabilitation service delivery in a metropolitan district. Afr J Prim Health Care Fam Med 2024; 16:e1-e10. [PMID: 38299544 PMCID: PMC10839198 DOI: 10.4102/phcfm.v16i1.4069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND There is a recognised need for rehabilitation services at primary health care (PHC) level. In addition, there are clear policies (international and national) and guidelines for use by healthcare planners in South Africa to implement rehabilitation services. Although rehabilitation services are provided on the primary platform, its operationalisation has not been in an integrated manner. Clarity on the level of integration within existing PHC rehabilitation service delivery is required for its inclusion in a reengineered PHC. AIM The study explored the extent to which rehabilitation services are integrated into PHC service delivery based on the expressed reality of rehabilitation professionals. SETTING The Johannesburg Metropolitan District of Gauteng, South Africa. METHODS In-depth interviews with 12 PHC rehabilitation professionals were completed to elicit their experiences with PHC rehabilitation services. RESULTS The theme the current state of rehabilitation services - 'this is the reality; you need to do what you need to do' along with its two subcategories, was generated from this study. The theme describes the expressed reality of suboptimal, underdeveloped and poorly integrated rehabilitation services within the Johannesburg Metropolitan District. Rehabilitation service providers have adapted service delivery by including isolated components of rehabilitation integration models, but this has not yielded an integrated service. CONCLUSION Rehabilitation services although recognised as a crucial service in PHC must be critically analysed and adapted to develop integrated service delivery models. There should be a shift from selected coping mechanisms to targeted, integrated services.Contribution: The study describes PHC rehabilitation services and explores best practice models for integrated service planning and delivery.
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Affiliation(s)
- Lebogang J Maseko
- Department of Occupational Therapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
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Trafford Z, Swartz L. The Care Dependency Grant for children with disabilities in South Africa: perspectives from implementation officials. DEVELOPMENT SOUTHERN AFRICA 2023; 40:259-272. [PMID: 36937539 PMCID: PMC7614334 DOI: 10.1080/0376835x.2021.1981250] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
For people with disabilities, appropriate social protection interventions can contribute to breaking the cyclical relationship between poverty and disability and may improve social inclusion. In South Africa, a national social assistance programme provides 'social grants' to individuals on the basis of poverty, age, or disability. These grants have been extensively studied but there has been little investigation into the Care Dependency Grant, designed to support the care of children with disabilities. These children consistently have far poorer outcomes on key metrics for wellbeing, health, and education than their non-disabled peers. More attention ought to be focused on uplifting this profoundly marginalised population. We present initial findings from interviews with officials at the South African Social Security Agency, the country's grants implementation agency. These narratives add weight to the growing local and international consensus that complementary interventions and effective intersectoral collaboration may greatly enhance the impact of cash transfers.
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Affiliation(s)
- Zara Trafford
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Louw QA, Conradie T, Xuma-Soyizwapi N, Davis-Ferguson M, White J, Stols M, Masipa A, Mhlabane P, Mdaka L, Manzini C, Kekana I, Schutte M, Rabothata S, Kleinitz P. Rehabilitation Capacity in South Africa-A Situational Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3579. [PMID: 36834271 PMCID: PMC9961618 DOI: 10.3390/ijerph20043579] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Rehabilitation in South Africa (SA) operates independently of major health services and reforms, despite the increasing rehabilitation need. With the introduction of National Health Insurance (NHI), SA is facing another major health reform. Evidence is needed on the current SA rehabilitation situation, regarding shortcomings, opportunities, and priority strategic strengthening actions. We aimed to describe the current rehabilitation capacity in the SA public health sector, which serves the majority and most vulnerable South Africans. A cross-sectional survey was conducted in five provinces, using the World Health Organisation's Template for Rehabilitation Information Collection (TRIC). Participants were purposively selected for their insights and experiences of rehabilitation in specific government departments, health sectors, organisations, and/or services. TRIC responses were analysed descriptively. Participants explained how timely and effective rehabilitation produced long-term health, social, and economic benefits. Positive initiatives were reported for rehabilitation data collection, service design, and innovation. Challenges included inadequacies in human resources, the integration of rehabilitation at primary care, guidelines, and specialised long-term care facilities. The continuity of care across levels of care was sub-optimal due to inefficient referral systems. Promoting and improving rehabilitation nationally requires concerted, innovative, collaborative, and integrated efforts from multiple stakeholders within, and outside, the health system.
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Affiliation(s)
- Quinette A. Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7500, Western Cape, South Africa
| | - Thandi Conradie
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7500, Western Cape, South Africa
| | | | - Megan Davis-Ferguson
- Disabilities and Rehabilitation, Western Cape Department of Health, Cape Town 8000, Western Cape, South Africa
| | - Janine White
- Western Cape Rehabilitation Centre, Western Cape Department of Health, Cape Town 7789, Western Cape, South Africa
| | - Marie Stols
- Therapeutic and Rehabilitation Services, Limpopo Department of Health, Polokwane 0700, Limpopo, South Africa
| | - Andronica Masipa
- Therapeutic and Rehabilitation Services, Limpopo Department of Health, Polokwane 0700, Limpopo, South Africa
| | - Pringle Mhlabane
- Rehabilitation and Disability Services, Mpumalanga Department of Health, Nelspruit 1200, Mpumalanga, South Africa
| | - Lungisile Mdaka
- Rehabilitation and Disability Services, Mpumalanga Department of Health, Nelspruit 1200, Mpumalanga, South Africa
| | - Claudina Manzini
- Rehabilitation and Disability Services, Mpumalanga Department of Health, Nelspruit 1200, Mpumalanga, South Africa
| | - Ivy Kekana
- Rehabilitation and Disability Services, Mpumalanga Department of Health, Nelspruit 1200, Mpumalanga, South Africa
| | - Marike Schutte
- Rehabilitation and Disability Services, Mpumalanga Department of Health, Nelspruit 1200, Mpumalanga, South Africa
| | - Simon Rabothata
- Rehabilitation Service, Gauteng Department of Health, Pretoria 2001, Gauteng, South Africa
| | - Pauline Kleinitz
- Sensory Functions, Disability and Rehabilitation Unit, Department for Noncommunicable Diseases, World Health Organization, 1211 Geneva 27, Switzerland
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Tshaka B, Visagie S, Ned LY. Non-use of healthcare services among persons with mobility impairments in Cofimvaba, South Africa. Afr J Disabil 2023; 12:1112. [PMID: 36756459 PMCID: PMC9900281 DOI: 10.4102/ajod.v12i0.1112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/29/2022] [Indexed: 02/05/2023] Open
Abstract
Background Access to primary health care is a fundamental right for all. However, persons with disabilities are experiencing difficulties when accessing healthcare because of various environmental and personal barriers which may lead to nonuse of such services. Objectives This study aimed to identify the challenges leading to non-use of healthcare services among persons with mobility impairments in Cofimvaba. Method A descriptive qualitative design using snowball sampling was implemented. Semistructured interviews were conducted in isiXhosa with five participants who stopped accessing healthcare, using a self-developed interview guide. Inductive thematic analysis was used to develop codes and themes from the data. Results Study findings revealed major challenges experienced by persons with mobility impairments in accessing healthcare. These included inaccessible roads, geographic inaccessibility, financial accessibility and indirect cost of care, having little or not many health problems, physical infrastructure difficulties within facilities, and attitudinal barriers. Conclusion The findings indicated that persons with disabilities are experiencing a combination of structural and environmental challenges which make them stop accessing healthcare. Contribution The article shares insights on access challenges that influence non-use of the often-needed healthcare services within the context of rural areas.
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Affiliation(s)
- Babalwa Tshaka
- Centre for Disability and Rehabilitation Studies, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Surona Visagie
- Centre for Disability and Rehabilitation Studies, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lieketseng Y. Ned
- Centre for Disability and Rehabilitation Studies, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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5
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Trafford Z, Swartz L. 'Five minutes earlier, you were giving hope': Reflections from interviews with doctors conducting assessments for South Africa's childhood disability Care Dependency Grant. Wellcome Open Res 2022; 7:263. [PMID: 36777883 PMCID: PMC7614167.2 DOI: 10.12688/wellcomeopenres.18424.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 11/27/2022] Open
Abstract
Background: In South Africa, medical doctors functionally decide whether a primary caregiver can access state-funded social assistance cash transfers ('social grants') for the care of their disabled child. In this paper, we unpack the subjective experiences of one group of doctors in the country's Western Cape province who are involved in conducting assessments for the care dependency grant, designed to support the cost of disabled children's specific needs. Methods: Individual in-depth interviews were conducted with five paediatric doctors who practice at three Cape Town public sector hospitals and regularly conduct assessments for the care dependency grant. Analysis was thematic and used deductive coding. Results: The doctors we interviewed were aware that care dependency grants were probably shared among household members but felt this was acceptable, as it contributed to the child's wellbeing. Doctors seemed to be applying nuanced, individualised assessments but often felt the need to simplify the documentation of these assessments, sometimes even bending the rules, to ensure access. Doctors' primary allegiance in these processes appeared to be to their patients. They identified more with their care responsibilities than their bureaucratic gate-keeping role but nonetheless felt the weight of their responsibility for decision-making, in the context of extremely strained public resources and a lack of guidance from the government's social assistance implementation agency. Conclusions: The hyperlocal practices and approaches that doctors described allows for perception of the messier - but also more accurate - details of the system that is actually in place. Doctors' narratives also reflect long-standing inattention to the 'trickle down' of guidelines to frontline implementers of disability-related grants. This cadre is a valuable but under-utilised source of evidence and information about the real-world functioning of disability-related grants administration and they should be actively included in implementation planning.
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Affiliation(s)
- Zara Trafford
- Psychology Department, Stellenbosch University, Stellenbosch, Western Cape, 7600, South Africa,
| | - Leslie Swartz
- Psychology Department, Stellenbosch University, Stellenbosch, Western Cape, 7600, South Africa
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6
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Trafford Z, Swartz L. ‘Five minutes earlier, you were giving hope’: Reflections from interviews with doctors conducting assessments for South Africa’s childhood disability Care Dependency Grant. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18424.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: In South Africa, medical doctors functionally decide whether a primary caregiver can access state-funded social assistance cash transfers (‘social grants’) for the care of their disabled child. In this paper, we unpack the subjective experiences of doctors involved in conducting assessments for the care dependency grant, designed to support the cost of disabled children’s specific needs. Methods: Individual in-depth interviews were conducted with five paediatric doctors who practice and regularly conduct assessments for the care dependency grant at three Cape Town public sector hospitals. Analysis was thematic and used deductive coding. Results: The doctors we interviewed were aware that these grants were probably shared among household members but felt this was acceptable, as it contributed to the child’s wellbeing. Doctors seemed to be applying nuanced, individualised assessments but often felt the need to simplify the documentation of these assessments, sometimes even bending the rules, to ensure access for their patients. Doctors’ primary allegiance in these processes appeared to be to their patients. They identified more with their caring responsibilities than their bureaucratic gate-keeping role but nonetheless felt a heavy responsibility for decision-making, in the context of extremely strained public resources and a lack of guidance from the government’s social assistance implementation agency. Conclusions: The hyperlocal practices and approaches that doctors described allows for perception of the messier – but also more accurate – details of the system that is actually in place. Doctors’ narratives also reflect long-standing inattention to the ‘trickle down’ of guidelines to frontline implementers of disability-related grants. This cadre is a valuable but under-utilised source of evidence and information about the real-world functioning of disability-related grants administration and they should be actively included in implementation planning.
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7
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Adeleke A, Franzsen D, de Witt P, Smith R. Validity and reliability of the HIV Disability Questionnaire for people living with HIV in South Africa. AFRICAN JOURNAL OF AIDS RESEARCH 2022; 21:364-372. [DOI: 10.2989/16085906.2022.2142141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Adetunji Adeleke
- Department of Occupational Therapy, University of Witwatersrand, Johannesburg, South Africa
| | - Denise Franzsen
- Department of Occupational Therapy, University of Witwatersrand, Johannesburg, South Africa
| | - Patricia de Witt
- Department of Occupational Therapy, University of Witwatersrand, Johannesburg, South Africa
| | - Rulaine Smith
- Department of Occupational Therapy, University of Witwatersrand, Johannesburg, South Africa
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Moreno JD, Bennett LHV, Ferrite S. The use of the Washington Group on Disability Statistics questionnaires to identify hearing disability: a systematic review. Codas 2022; 34:e20200328. [PMID: 35043863 PMCID: PMC9769417 DOI: 10.1590/2317-1782/20212020328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 07/14/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To investigate the use of instruments from the Washington Group on Disability Statistics (WG) to obtain data on hearing disability (HD). RESEARCH STRATEGIES We conducted searches in the PubMed, Scopus, Science Direct, Web of Science, Lilacs databases and the grey literature. The software "The State of the Art through Systematic Review" and "Mendeley" were used to assist in the bibliographic reference organization, selection, and storage. SELECTION CRITERIA we followed the guidelines proposed by the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis" and we selected studies that met the following inclusion criteria: written in English or Portuguese, within the period of 2001 to 2017 and have used the WG hearing disability question. DATA ANALYSIS The variables analyzed into the studies were: WG module, country and year of data collection, sample size and composition, objective of the study, publication journal, HD estimate of prevalence and accuracy measures. RESULTS Sixty-five studies are included in the review, conducted with data from 30 countries. The WG Short Set of question was the most often used. Hearing disability prevalence ranged from 0.2 to 2.3% and only three studies estimated the accuracy of the instrument to identify HD. CONCLUSION The hearing disability question of WG has been used worldwide and mainly in developing countries. The short variation in the estimated prevalence measurements within studies seems favorable to the WG's goal of generate estimates that allow international comparison. However, the shortage of validity studies indicates the need for further investigations with this purpose.
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Affiliation(s)
- Jennifer Dantas Moreno
- Departamento de Fonoaudiologia, Universidade Federal da Bahia – UFBA - Salvador (BA), Brasil.
| | | | - Silvia Ferrite
- Departamento de Fonoaudiologia, Universidade Federal da Bahia – UFBA - Salvador (BA), Brasil.
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9
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Cote A. Social protection and access to assistive technology in low- and middle-income countries. Assist Technol 2021; 33:102-108. [PMID: 34951824 DOI: 10.1080/10400435.2021.1994052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
To overcome widespread barriers and lack of support, persons with disabilities face significant disability-related costs, including assistive technology (AT), that drive them to or maintain them in poverty and undermine their socio-economic participation. In many countries, social protection systems are a gateway to accessing assistive devices either through health insurance, integration in Universal Health Coverage (UHC) packages, subsidies, cash transfers or direct provision. However, the broader issues of access to AT (lack of awareness, information, availability, human resources, etc.) are compounded by barriers to social protection. In low- and middle-income countries globally, less than 20% of persons with significant disabilities, who are likely to need AT, receive disability benefits. This paper reflects on the relation of AT and disability-related costs, the evolution of the role of social protection in line with the CRPD, and the different social protection mechanisms used at the national level to provide access to AT. It further highlights some of the key issues to be tackled by social protection systems to enhance access to AT, with a focus on low- and middle-income countries.
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10
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Wentzel A, Mchiza ZJR. Exploring Factors Associated with Diabetic Retinopathy Treatment Compliance Behaviour in Cape Town, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212209. [PMID: 34831965 PMCID: PMC8617604 DOI: 10.3390/ijerph182212209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Abstract
Complete patient adherence to treatment for diabetic retinopathy (DR) is critical to limit vision loss. There is a dearth of evidence regarding the reasons why South African patients referred for suspected vision-threatening DR stay compliant to or default their treatment. The current study sought to explore factors associated with treatment compliance among patients living with diabetes who have been referred for suspected vision-threatening DR in the Northern/Tygerberg sub-Structure (NTSS) public health care system of Cape Town, South Africa. A qualitative research approach was used where semi-structured in-depth interviews were conducted with 13 adult patients living with DR, and 2 key informants who are primary eye care providers. Thematic data analysis was conducted using taguette.org. Fear of going blind was the most notable patient-related factor associated with compliance. Notable patient-related barriers reported were forgetfulness and a poor state of health. Notable institution-related barriers included suboptimal information received from health care service providers, poor referral management by the organisation delivering retinal screening services, as well as the inaccessibility of the main NTSS hospital via telephone calls. All these factors were confirmed by the key informants of the current study. Finally, all patients and key informants agreed that SARS-CoV-2 negatively affected patients’ adherence to their DR treatment. Hence, scaling up of health care, referral, and appointment setting services could increase the uptake of treatment and retinal screenings among patients attending the Cape Town, NTSS public health care system.
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Affiliation(s)
- Annalie Wentzel
- School of Public Health, University of the Western Cape, Bellville, Cape Town 7535, South Africa;
- Correspondence:
| | - Zandile June-Rose Mchiza
- School of Public Health, University of the Western Cape, Bellville, Cape Town 7535, South Africa;
- Non-Communicable Disease Research Unit, South African Medical Research Council, Parow Valley, Cape Town 7501, South Africa
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11
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Banks LM, Kuper H, Shakespeare T. Social health protection to improve access to health care for people with disabilities. Bull World Health Organ 2021; 99:543-543A. [PMID: 34354306 PMCID: PMC8319859 DOI: 10.2471/blt.21.286685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Lena Morgon Banks
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, England
| | - Hannah Kuper
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, England
| | - Tom Shakespeare
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, England
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12
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Louw Q, Grimmer K, Berner K, Conradie T, Bedada DT, Jesus TS. Towards a needs-based design of the physical rehabilitation workforce in South Africa: trend analysis [1990-2017] and a 5-year forecasting for the most impactful health conditions based on global burden of disease estimates. BMC Public Health 2021; 21:913. [PMID: 33985469 PMCID: PMC8116643 DOI: 10.1186/s12889-021-10962-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/27/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Rehabilitation can improve function in many people with chronic health conditions. It is important to consider priority conditions requiring rehabilitation, so it can be realistically positioned and costed in national health financing systems like South Africa (SA)'s proposed National Health Insurance (NHI). This paper describes temporal trends of top-ranked conditions on years lived with disability (YLDs) rates in SA, for which physical rehabilitation can ameliorate associated disability. METHODS This study is a systematic synthesis of publicly available Global Burden of Disease (GBD) 2017 estimates. The top 11 conditions contributing most to YLDs and for which evidence-based rehabilitation interventions exist were identified. Age-standardized rates per 100,000 and YLDs counts were extracted from 1990 to 2017. Significance of changes in temporal trends was determined using Mann-Kendall trend tests. Best-fit rates of yearly changes were calculated per condition, using GBD estimates (2012-2017), and extrapolated (by imposing the best-fit regression line onto results for each subsequent predicted year) as forecasts (2018-2022). RESULTS Trends for YLDs counts per condition year (1990-2017) and forecasted values (2018-2022) showed an overall steady increase for all conditions, except HIV and respiratory conditions. YLDs counts almost doubled from 1990 to 2017, with a 17% predicted increase from 2017 to 2022. The proportionate contribution to YLDs counts reduced over time for all conditions, except HIV. Although age-standardized YLDs rates appear relatively stable over the analyzed periods for all conditions (except HIV, respiratory conditions and type 2 diabetes), trend changes in YLDs rates over 28 years were significant for all conditions, except neonatal (p = 0.855), hearing loss (p = 0.100) and musculoskeletal conditions (p = 0.300). Significant trend decreases were apparent for 4/9 conditions, implying that another 5/9 conditions showed trend increases over 28 years. Predicted all-age prevalence in 2022 suggests relatively large increases for cardiovascular disease and heart failure, and burns, while relative decreases are predicted for fractures and dislocations, stroke, and musculoskeletal conditions. CONCLUSION Rehabilitation needs in SA are potentially massive and unmet, highlighting the need for innovative and context-specific rehabilitation that considers current local needs and projected changes. These findings should be considered when designing the NHI and other schemes in SA to ensure human and financial resources are deployed efficiently.
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Affiliation(s)
- Q Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
| | - K Grimmer
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - K Berner
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - T Conradie
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - D T Bedada
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - T S Jesus
- Global Health and Tropical Medicine (GHTM) & WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine - NOVA University of Lisbon (IHMT-UNL), Rua da Junqueira 100, 1349-008, Lisbon, Portugal
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Pilusa SI, Myezwa H, Potterton J. Experiences of secondary health conditions amongst people with spinal cord injury in South Africa: A qualitative study. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1530. [PMID: 33937547 PMCID: PMC8063775 DOI: 10.4102/sajp.v77i1.1530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/26/2021] [Indexed: 01/04/2023] Open
Abstract
Background Secondary health conditions (SHCs) such as pain, pressure sores, sexual problems, bowel and bladder problems are prevalent throughout the lifespan of people with spinal cord injury (SCI). Studies have reported that SHCs decrease life expectancy and increase health care costs. Studies on the lived experience of SHCs are, however, limited. Objectives To explore the experiences of SHCs amongst people with SCI in a public rehabilitation hospital in South Africa. Method Face-to-face semi-structured interviews were conducted with people with SCI from August 2018 to July 2019. All interviews were transcribed verbatim and analysed using a content analysis approach. Results Seventeen people with SCI were interviewed. Participants experienced a range of SHCs. The most common experienced SHC was pain (94%). The main theme that emerged from the analysis was 'the impact of secondary health conditions on health and well-being'. The categories linked to the impact were SHCs co-occurrence and how SHCs limit function, restrict participation, affect mental health and disrupt lives. Conclusion We found that SHCs were enormously impactful on our participants' lives and health, as illustrated by their stories of fear, embarrassment and shame. Understanding people with SCI experiences of SHCs can enhance communication between people with SCI and health professionals and may help develop prevention strategies. Clinical implications To enhance patient-centred care, health professionals are encouraged to actively listen to patients' experiences of illness and the impact on health and wellbeing.
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Affiliation(s)
- Sonti I Pilusa
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Hellen Myezwa
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Joanne Potterton
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
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14
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Pilusa S, Myezwa H, Potterton J. 'I forget to do pressure relief': Personal factors influencing the prevention of secondary health conditions in people with spinal cord injury, South Africa. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1493. [PMID: 33824916 PMCID: PMC8008043 DOI: 10.4102/sajp.v77i1.1493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/25/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Across the lifespan, people with spinal cord injury (SCI) may experience preventable secondary health conditions (SHCs) such as pressures sores, muscle spasms and urinary tract infections (UTIs). Some factors influencing prevention of SHCs include social support, poor access to care and the prevention style of individuals. There is limited research on these factors. OBJECTIVE To explore personal factors influencing the prevention of SHCs in people with SCI. METHOD An explorative qualitative study included participants recruited in an outpatient department at a rehabilitation hospital. Semi-structured interviews were conducted with patients with SCI. Interviews were transcribed verbatim. Data analysis was conducted using content analysis. RESULTS Seventeen individuals with SCI were interviewed. From the interview analysis, six personal factors were identified, namely, socio-economic status; mental well-being (forgetfulness, beliefs, attitude); lack of knowledge of SHCs and prevention; lifestyle choices and practising prevention care; patient activation (self-management, problem-solving, resilience, self-awareness, help-seeking behaviour) and owning an appropriate assistive device. CONCLUSION Socio-economic status, mental well-being, knowledge of SHCs and prevention care, behaviour patterns, patient activation and owning an appropriate assistive device can influence prevention of SHCs. To enhance patient-oriented care, a model of care for people with SCI should consider these factors when developing prevention strategies. Future research could look into identifying environmental factors that influence the prevention of SHCs in people with SCI. CLINICAL IMPLICATIONS Tailored prevention strategies need to be developed, health professionals must ask patients about individual factors that may be barriers or facilitators to preventing secondary health conditions.
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Affiliation(s)
- Sonti Pilusa
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hellen Myezwa
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joanne Potterton
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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15
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Trafford Z, van der Westhuizen E, McDonald S, Linegar M, Swartz L. More Than Just Assistive Devices: How a South African Social Enterprise Supports an Environment of Inclusion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2655. [PMID: 33800783 PMCID: PMC7967322 DOI: 10.3390/ijerph18052655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 11/21/2022]
Abstract
Appropriate assistive technology has the potential to considerably enhance quality of life, access to health and education, and social and economic participation for people with disabilities. Most disabled people in the world live in low- and middle-income countries where access to assistive devices and other support is severely lacking. There is little evidence that describes contextually relevant approaches to meeting these needs, particularly in African countries. We provide a detailed description of a South African organisation which has manufactured mobility and seating devices for children with disabilities since 1992. The Shonaquip Social Enterprise (SSE) also trains and builds capacity among a wide range of stakeholders (caregivers, health workers, educators, government, and communities) to acknowledge and advocate for the wellbeing of disabled children and adults, and works closely with government to strengthen existing service provisions. Using examples from the SSE, we highlight a number of useful principles to consider when trying to provide for the needs of people with disabilities, particularly in low-resource settings. While access to assistive devices is important, devices have limited capacity to improve participation if the broader environment is overly restrictive and stigmatising. Improved access to devices ought to be situated within a range of broader efforts to increase the inclusion and participation of people with disabilities.
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Affiliation(s)
- Zara Trafford
- Psychology Department, Stellenbosch University, Stellenbosch 7602, South Africa;
| | | | - Shona McDonald
- Shonaquip Social Enterprise, Cape Town 7800, South Africa; (E.v.d.W.); (S.M.); (M.L.)
| | - Margi Linegar
- Shonaquip Social Enterprise, Cape Town 7800, South Africa; (E.v.d.W.); (S.M.); (M.L.)
| | - Leslie Swartz
- Psychology Department, Stellenbosch University, Stellenbosch 7602, South Africa;
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16
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Hashemi G, Wickenden M, Bright T, Kuper H. Barriers to accessing primary healthcare services for people with disabilities in low and middle-income countries, a Meta-synthesis of qualitative studies. Disabil Rehabil 2020; 44:1207-1220. [PMID: 32956610 DOI: 10.1080/09638288.2020.1817984] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
METHODS Six electronic databases were searched for relevant studies from 2000 to 2019. Forty-one eligible studies were identified. RESULTS Findings suggest that the people with disabilities' choice to seek healthcare services or not, as well as the quality of intervention provided by primary healthcare providers, are influenced by three types of barriers: cultural beliefs or attitudinal barriers, informational barriers, and practical or logistical barriers. CONCLUSION In order to achieve full health coverage at acceptable quality for people with disabilities, it is necessary not only to consider the different barriers, but also their combined effect on people with disabilities and their households. It is only then that more nuanced and effective interventions to improve access to primary healthcare, systematically addressing barriers, can be designed and implemented.IMPLICATIONS FOR REHABILITATIONPeople with disabilities in both high income and low- and middle-income country settings are more likely to experience poorer general health than people without disabilities.Barriers to accessing primary healthcare services for people with disabilities result from a complex and dynamic interacting system between attitudinal and belief system barriers, informational barriers, and practical and logistical barriers.Given primary healthcare is often the initial point of contact for referral to specialty care and rehabilitation services, it is crucial for people with disabilities to access primary healthcare services in order to get appropriate referrals for such services, specifically rehabilitation as appropriate.To achieve full health coverage at acceptable quality for people with disabilities, starting with primary healthcare, it is necessary for healthcare stakeholders, including rehabilitation professionals, to consider the combined and cumulative effects of the various barriers to healthcare on people with disabilities and their families and develop an understanding of how healthcare decisions are made by people with disabilities at the personal and the household level.
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Affiliation(s)
- Goli Hashemi
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK.,Department of Occupational Therapy, Samuel Merritt University, Oakland, CA, USA
| | - Mary Wickenden
- Institute of Development Studies, University of Sussex, Brighton, UK
| | - Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
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17
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Kietrys D, Myezwa H, Galantino ML, Parrott JS, Davis T, Levin T, O'Brien K, Hanass-Hancock J. Functional Limitations and Disability in Persons Living with HIV in South Africa and United States: Similarities and Differences. J Int Assoc Provid AIDS Care 2020; 18:2325958219850558. [PMID: 31109225 PMCID: PMC6748470 DOI: 10.1177/2325958219850558] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Persons living with HIV (PLHIV) may experience disability. We compared disability among
PLHIV in the United States and South Africa and investigated associations with health and
demographic characteristics. Secondary analysis of cross-sectional data using medical
records and questionnaires including the World Health Organization Disability Assessment
Schedule (WHO-DAS) 2.0 12-item version (range: 0-36, with higher scores indicative of more
severe disability). Between-country differences for the presence of disability were
assessed with logistic regression and differences in severity using multiple regression.
Eighty-six percent of US participants reported disability, compared to 51.3% in South
Africa. The mean WHO-DAS score was higher in the United States (12.09 ± 6.96) compared to
South Africa (8.3 ± 6.27). Participants with muscle pain, depression, or more years since
HIV diagnosis were more likely to report disability. Being female or depressed was
associated with more severity. Being adherent to anti-retroviral therapy (ART) and
employed were associated with less severity. Because muscle pain and depression were
predictive factors for disability, treatment of those problems may help mitigate
disability in PLHIV.
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Affiliation(s)
- David Kietrys
- 1 Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers - The State University of New Jersey, Blackwood, NJ, USA
| | - Hellen Myezwa
- 2 Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Lou Galantino
- 2 Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa.,3 Physical Therapy Program, School of Health Sciences, Stockton University, Galloway, NJ, USA.,4 Clinical Center for Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James Scott Parrott
- 1 Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers - The State University of New Jersey, Blackwood, NJ, USA
| | - Tracy Davis
- 1 Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers - The State University of New Jersey, Blackwood, NJ, USA
| | - Todd Levin
- 5 School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
| | - Kelly O'Brien
- 6 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,7 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,8 Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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18
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Thorpe J, Viney K, Hensing G, Lönnroth K. Income security during periods of ill health: a scoping review of policies, practice and coverage in low-income and middle-income countries. BMJ Glob Health 2020; 5:e002425. [PMID: 32540963 PMCID: PMC7299014 DOI: 10.1136/bmjgh-2020-002425] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 01/20/2023] Open
Abstract
The COVID-19 pandemic is a reminder that insufficient income security in periods of ill health leads to economic hardship for individuals and hampers disease control efforts as people struggle to stay home when sick or advised to observe quarantine. Evidence on income security during periods of ill health is growing but has not previously been reviewed as a full body of work concerning low-income and middle-income countries (LMICs). We performed a scoping review to map the range, features, coverage, protective effects and equity of policies that aim to provide income security for adults whose ill health prevents them from participating in gainful work. A total of 134 studies were included, providing data from 95% of LMICs. However, data across the majority of these countries were severely limited. Collectively the included studies demonstrate that coverage of contributory income-security schemes is low, especially for informal and low-income workers. Meanwhile, non-contributory schemes targeting low-income groups are often not explicitly designed to provide income support in periods of ill health, they can be difficult to access and rarely provide sufficient income support to cover the needs of eligible recipients. While identifying an urgent need for more research on illness-related income security in LMICs, this review concludes that scaling up and diversifying the range of income security interventions is crucial for improving coverage and equity. To achieve these outcomes, illness-related income protection must receive greater recognition in health policy and health financing circles, expanding our understanding of financial hardship beyond direct medical costs.
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Affiliation(s)
- Jennifer Thorpe
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Kerri Viney
- National Centre for Epidemiology and Population Health, Australian National University Research Division of Biomedical Science and Biochemistry, Canberra, Australian Capital Territory, Australia
| | - Gunnel Hensing
- Department of Public Health and Community Medicine, University of Gothenburg, Goteborg, Sweden
| | - Knut Lönnroth
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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19
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Maddocks S, Moodley K, Hanass-Hancock J, Cobbing S, Chetty V. Children living with HIV-related disabilities in a resource-poor community in South Africa: caregiver perceptions of caring and rehabilitation. AIDS Care 2019; 32:471-479. [PMID: 31426663 DOI: 10.1080/09540121.2019.1654076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The care offered to children living with HIV (CLHIV) experiencing HIV-related disability is often challenged by caregiver illness, poverty and poor support structures in and around communities. Since caregiver needs directly influences the care offered to CLHIV this paper aimed to explore the experiences of the caregivers of CLHIV in order to inform an appropriate rehabilitation model in South Africa. A qualitative enquiry using in-depth interviews with 14 caregivers (one male and thirteen females) of CLHIV experiencing disability in a peri-urban setting was conducted. Data were analysed using thematic analysis. Four themes emerged from the interviews: understanding of HIV-related disability and rehabilitation, challengers to care and well-being, enablers to care; and perceived needs of caregivers. The study revealed that caregiver burden is influenced by the availability of resources and social support services. Financial constraints, poor access to rehabilitation and reduced support networks challenged the care offered to CLHIV. The perceived needs of the caregivers in this study included appeals for improved social security, housing, accessible rehabilitation and education. Changes in government policy guiding social support, employment, education and rehabilitation interventions are needed to improve the availability of resources, education, health and well-being of CLHIV and their caregiver's in South Africa.
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Affiliation(s)
- Stacy Maddocks
- Department of Physiotherapy, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - Koobeshan Moodley
- Department of Physiotherapy, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - Jill Hanass-Hancock
- Department of Physiotherapy, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - Saul Cobbing
- Department of Physiotherapy, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - Verusia Chetty
- Department of Physiotherapy, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
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20
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Mapatwana D, Tomita A, Burns JK, Robertson LJ. Predictors of quality of life among community psychiatric patients in a peri-urban district of Gauteng Province, South Africa. Int J Soc Psychiatry 2019; 65:322-332. [PMID: 31035835 DOI: 10.1177/0020764019842291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few studies on quality of life (QoL) among people with mental illness have been conducted in South Africa, and none in community dwelling individuals. However, a greater understanding of subjective QoL may inform community-based medical, psychotherapeutic, or social interventions. This study examined the QoL, clinical and sociodemographic characteristics of psychiatric patients attending community mental health clinics in the Gauteng Province of South Africa. METHODS A cross sectional interview-based study was conducted with 121 adult patients attending community psychiatric clinics. To reduce the impact of acute psychiatric symptoms on subjective QoL, only clinically stable patients were included. Sociodemographic details and clinical characteristics were recorded. Subjective QoL was assessed using the World Health Organization QOL-Bref scale (WHOQOL-Bref), and severity of psychiatric illness measured with the Brief Psychiatric Rating Scale, expanded version 4.0 (BPRS-E). RESULTS Just over half of the sample rated their overall QoL as good or very good. Residual psychiatric symptomatology was the strongest predictor of a poor QoL in all four domains of the WHOQOL-Bref. The most severe BPRS scores were for the symptoms of depression, anxiety and somatic concern. Perceived social support significantly predicted a better QoL in the psychological, social relationships and environmental domains. CONCLUSION This study highlights the negative impact of residual psychiatric symptoms on subjective QoL and the importance of social support in enhancing QoL.
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Affiliation(s)
- Dumakazi Mapatwana
- 1 Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- 2 Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,3 KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Jonathan K Burns
- 1 Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.,4 Institute of Health Research, University of Exeter, Exeter, UK
| | - Lesley J Robertson
- 5 Department of Psychiatry, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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21
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Mitra S. From Disability in Resource-Poor Settings to Policy and Research Opportunities in Global Health. Am J Public Health 2018; 108:1163-1165. [PMID: 30089002 DOI: 10.2105/ajph.2018.304597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sophie Mitra
- Sophie Mitra is with the Department of Economics, Fordham University, New York, NY
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