Access to primary care for persons with spinal cord injuries in the greater Gaborone area, Botswana

Outcomes 10-years after traumatic spinal cord injury in Botswana - a long-term follow-up study

STUDY DESIGN

Prospective follow-up study.

OBJECTIVES

To describe outcomes, survival, and attendance to routine follow-up visits 10 years post-SCI.

SETTING

The national SCI-rehabilitation center in Botswana.

METHODS

All persons who were admitted with traumatic SCI during a 2-year period, 2011-2013, and survived up to 2 years post-injury were included. Data were collected from the medical records from the follow-up assessment closest to 10 years post-SCI and included demographic and clinical characteristics, functional outcomes, and secondary complications. Data regarding mortalities were received from relatives. Statistical comparisons were made, when possible, between those who attend follow-up assessment and those who did not, and between those who survived up to 10 years post-SCI and those who died.

RESULTS

The follow-up rate was 76% (19/25) of known survivors. No statistically significant factors were found to affect the follow-up rate. Secondary complications rates were for pressure ulcers and urinary tract infections 21%. Self-catheterisation and suprapubic catheter were the preferred methods to manage neurogenic bladder dysfunction. Ten persons (26%) had deceased since 2nd follow-up assessment. The causes of death were probably SCI-related in more than half of the cases.

CONCLUSIONS

This was a follow-up study at year 10 after acute TSCI in Botswana conducted at the national SCI-rehabilitation center. The study supports previous reports regarding the importance of that having specialized SCI units and the need of structured follow-ups, a responsible person in charge of scheduling, and updated patient registers. We found high follow-up rate, low rates of complications and of patients being lost to follow-up.

Non-use of healthcare services among persons with mobility impairments in Cofimvaba, South Africa

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.

A National Accessibility Audit of Primary Health Care Facilities in Brazil-Are People with Disabilities Being Denied Their Right to Health?

Poor accessibility of healthcare facilities is a major barrier for people with disabilities when seeking care. Yet, accessibility is rarely routinely audited. This study reports findings from the first national assessment of the accessibility of primary health care facilities, undertaken in Brazil. A national accessibility audit was conducted by trained staff of all 38,812 primary healthcare facilities in Brazil in 2012, using a 22-item structured questionnaire. An overall accessibility score was created (22 items), and three sub-scales: external accessibility (eight items), internal accessibility (eight items), information accessibility (six items). The main finding is that the overall accessibility score of primary care facilities in Brazil was low (mean of 22, standard deviation (SD) of 0.21, on a 0-100 scale). Accessibility of different aspects of the healthcare facilities was also low, including external space (mean = 31.0, SD = 2.0), internal space (18.9, 1.9) and accessibility features for people with other visual or hearing impairments (6.3, SD = 1.0). Scores were consistently better in the least poor regions of Brazil and in facilities in larger municipality size (indicating more urban areas). In conclusion, large-scale accessibility audits are feasible to undertake. Poor accessibility means that people with disabilities will experience difficulties in accessing healthcare, and this is a violation of their rights according to international and Brazilian laws.