Managing Children with Spina Bifida in sub-Saharan Africa: The Zambian experience?

Purpose:To investigate the management of children with SB and outcome measures used in Zambia.Methods: Aretrospective cross-sectional study was done. Between 2001 and 2010, a total number of 253 children with SB who were managed at both the University Teaching Hospital (UTH) and Beit Cure Hospital (BCH) were identified.Results: Majority (56%) of the patients were aged between 1-6 months (p < 0.001). Hydrocephalus was prevalent in 61% of the patients. Myelomeningocele was the most common (61%) defect and the lumbar region was the common site (60%) (p < 0.001). Majority (28%) of children came from the Southern Province of Zambia (p < 0.001). The majority (81%) of patients were lost to follow-up (p < 0.001). None of the files had outcomes measuring instruments.Conclusions: There is evidence that interventions were given although the outcomes were not measured. The majority of the children came from the Southern Province of the country. Astudy ought to be done to investigate the predominance of the prevalence of SB in that part of Zambia. Many patients were lost to lack of follow-up, hence proper follow-up mechanisms must be instituted by both hospitals. Researchers are challenged to develop measuring instruments that are culturally sensitive and appropriate to the needs of Zambian children

Endoscopic third ventriculostomy and choroid plexus cauterization in childhood hydrocephalus in Zambia

Background: Endoscopic third ventriculostomy (ETV) and Choroid Plexus Cauterization (CPC) have been recommended as reliable surgical options in developing countries for childhood hydrocephalus owing to reported shunt failures in shunt dependency.Objective: To evaluate outcomes of the ETV and ETV-CPC procedures as surgical options for selected forms of hydrocephalus in Zambia.Methods: Between 2007 and 2010, 131 children with hydrocephalus underwent the ETV or ETVCPC procedures at Beit Cure Hospital (BCH) and were eligible for the analysis. Failed ETV was defined as cases that needed subsequent surgical procedures within 6 months of operation.Results: A total number of 110 (84%) children underwent ETV-CPC and 21 (16%) had ETV alone. The overall success rate was 74%, whereas ETV-CPC was 76% and ETV alone was 62% (p < 0.0001). ETV success rate was more likely with children aged one year and above (p < 0.06) and with non-post infectious hydrocephalus (p < 0.29). Age and etiology were not significantly associated with the outcomes.Conclusions: Endoscopic third ventriculostomy is a safe, reliable and effective option for selected forms of hydrocephalus in Zambia. The combination of ETV and CPC was more effective than ETV alone. It is highly recommended that such services be extended to other referral hospitals as options to shunt placement, especially in cases where access for treatment failure is likely to be delayed.Keywords: Hydrocephalus, endoscopic third ventriculostomy, choroid plexus cauterization, Outcomes, Physiotherapy, Zambi

HealthKick: a nutrition and physical activity intervention for primary schools in low-income settings

<p>Abstract</p> <p>Background</p> <p>The burden of non-communicable diseases, including type 2 diabetes, is growing in South Africa. This country has a complex mix of over- and under-nutrition, especially in low-income communities, and concerning levels of physical inactivity in children and youth. This paper describes HealthKick, a school-based nutrition and physical activity intervention in primary schools in these settings aimed at reducing diabetes risk factors.</p> <p>Methods/Design</p> <p>This study includes schools within historically disadvantaged, low-income communities from an urban area close to the city of Cape Town and from two rural areas outside of Cape Town, South Africa. The three Educational Districts involved are Metropole North, Cape Winelands and the Overberg. The study has three phases: intervention mapping and formative assessment, intervention development, and outcome and process evaluation. Sixteen schools were purposively selected to participate in the study and randomly allocated as intervention (eight schools) and control (eight schools).</p> <p>The primary aims of HealthKick are to promote healthful eating habits and increase regular participation in health-enhancing physical activity in children, parents and teachers, to prevent overweight, and reduce risk of chronic diseases (particularly type 2 diabetes); as well as to promote the development of an environment within the school and community that facilitates the adoption of healthy lifestyles.</p> <p>The components of HealthKick are: action planning, toolkit (resource guide, a resource box and physical activity resource bin), and an Educators' Manual, which includes a curriculum component.</p> <p>Discussion</p> <p>This study continues to highlight the key role that educators play in implementing a school-based intervention, but that developing capacity within school staff and stakeholders is not a simple or easy task. In spite of the challenges experienced thus far, valuable findings are being produced from this study, especially from Phase 1. Materials developed could be disseminated to other schools in low-income settings both within and outside of South Africa. Owing to the novelty of the HealthKick intervention in low-income South African primary schools, the findings of the evaluation phase have the potential to impact on policy and practice within these settings.</p

Perceived and experienced restrictions in participation and autonomy among adult survivors of stroke in Ghana

Background: Many stroke survivors do not participate in everyday life activities. Objectives: To assess the perceived and experienced restrictions in participation and autonomy among adult stroke survivors in Ghana. Methods: The "Impact on Participation and Autonomy Questionnaire" (IPAQ) instrument was administered in a survey of 200 adult stroke survivors to assess perceived restrictions in participation and autonomy, followed by in-depth interviews with a sub-sample on the restrictions they experienced in participation. Results: Perceived restrictions in participation were most prevalent in the domains of education and training (3.46±0.79), paid or voluntary work (2.68±0.89), helping and supporting other people (2.20±0.82), and mobility (2.12±0.79). There were significant differences in two domains between survivors who received physiotherapy and those who received traditional rehabilitation. Over half of the survivors also perceived they would encounter severe problems in participation in the domains of paid or voluntary work, mobility, and education and training. The sub-sample of stroke survivors (n=7) mostly experienced restrictions in participation and autonomy in going outside the house, working, and in fulfilling family roles. Conclusions:If these perceptions and experiences are not addressed during rehabilitation, they could further inhibit the full participation and social integration of stroke survivors. promoting practices

Framing a vision for physiotherapy research: synthesizing educators' viewpoints in Cape Town

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Processes in widening access to undergraduate allied health sciences education in South Africa

The purpose of this manuscript is to describe the processes followed in initiating and managing widening access to allied health sciences education at the University of Cape Town, South Africa. In response to national higher education policy imperatives in South Africa and in anticipation of the first cohort of Outcome Based Education (OBE) school leavers entering tertiary education, the School of Health and Rehabilitation Sciences at the university launched an extensive intra- and cross-programme transformation project in 2004. The project afforded four undergraduate professional programmes, namely audiology, occupational therapy, physiotherapy and speech therapy, an opportunity to address common educational and contextual drivers. These included, among others, the need for increased access and throughput of historically under-represented students in higher education. An advisory task team, named the curriculum review management team (CRMT), was engaged in envisaging, navigating and containing a complex socio-political process involving many stakeholders with disparate ideas, practice approaches, and focal concerns. The use of the Gale and Grant model of change management, augmented by the Community of Practice conceptual framework, to assist with these processes is described.AJHPE 2012;4(1):34-39. DOI:10.7196/AJHPE.13

Inclusion of rehabilitation medicine concepts in school of medicine resources

Purpose: To perform a gap analysis of rehabilitation medicine learning objectives (RMLOs) coverage within school of medicine (SOM) curriculum and educational resources as a basis for development of educational resources to fill any identified gaps. Method: Following ethics approval, interviews were carried out with SOM academics and clinicians to assess the relevance of a set of RMLOs and the extent to which RMLOs were addressed in SOM resources. Interviewee opinion was quantified via Likert scales and additional free comments were subjected to thematic analysis. Results: Most RMLOs were perceived as relevant by more than half of the 18 participants. There was evidence of relevant material relating to each RMLO in SOM resources. Thematic analysis suggested that rehabilitation medicine was addressed at the SOM in less detail than outlined in the RMLOs, and that additional rehabilitation content could be included in SOM resources across a number of courses and year levels. Conclusions: Rehabilitation medicine is considered relevant by clinicians and academics at the SOM. The most effective way of filling identified gaps in coverage of rehabilitation medicine at the SOM will be via engagement across a number of medical and surgical disciplines