Disability in under-resourced areas in the Western Cape, South Africa : a descriptive analytical study

Disability is a complex construct, and our understanding of it has evolved over the years from a purely medical description to encapsulating the experience of those with disability in the context in which they live. The International Classification of Functioning, Disability and Health (ICF) provides a framework to explore the concept in a biopsychosocial framework taking into account the interaction of a person with a health condition with their environment. The central purpose of this thesis was to explore disability within an under resourced context in order to provide data to service planners to improve the health and well-being of those affected. The exploration of disability involved a cross-sectional survey using instruments based on the ICF framework including the Washington Group Short Set of Questions on Disability, the WHODAS-2, the WHOQOL-BREF and the EQ-5D. The objectives were to establish the prevalence of disability and the description of the impairments, functional limitations and participation restrictions of those identified with disabilities. A total of 950 households were visited in Oudtshoorn (a semi-rural town) and Nyanga (a peri-urban area) and information was gathered on 7336 individuals with a mean age of 30.5 years. The majority of the participants were women. Both areas presented with estimates higher than those from the national census (5.0-6,7%). The urban area of Nyanga presented with a disability prevalence of 13.1% and the semi-rural area of Oudtshoorn with a prevalence of 6.8%. Overall the disability rate was 9.7%. The types of impairment and functional limitations were similar in the two areas, but more severe disability was reported in the semi-rural area, that also had significantly more elderly people. Non-communicable diseases were identified as the major cause of disability in both areas, followed by communicable diseases in Oudtshoorn and unintentional trauma in Nyanga. However, a person was twice as likely to be disabled due to non-communicable disease (Odds Ratio 2.2) when living in Oudtshoorn, and three times more likely to be disabled due to intentional trauma when living in Nyanga (Odds Ratio 0.3). Non-communicable diseases were responsible for the largest number of healthy life years lost. Those living in Nyanga had a higher burden of disability due to their lower quality of life scores as measured by the EQ-5D. Respondents in Nyanga consistently scored higher (worse) on all domains of the WHODAS-2 compared to respondents in Oudtshoorn. Living in Nyanga was associated with a 10% increase in domain scores. However, the pattern of scoring was similar and both areas reported worst functioning for the domains of Getting Around and Life Activities, which are associated with physical mobility. Respondents in Oudtshoorn reported better QoL and HRQoL than those in Nyanga. Functional level predicted the QoL scores, with Nyanga reporting worse functioning. Being employed and married was associated with a higher (better) EQ-5D VAS score, while mobility problems, pain or discomfort and anxiety or depression decreased the score. Transport was the most commonly identified barrier in both areas. Major barriers for those living in Oudtshoorn were Surroundings and Help in the home, whereas Help in the home and Prejudice and discrimination were viewed as the major barriers for respondents in Nyanga. The elderly were the ones most likely to not receive the rehabilitation services that they needed. The conclusions that can be drawn from this research are that context influences the experience of disability, and that disability prevalence alone is an insufficient basis for service planning. Those who experience greater deprivation also have a worse experience of disability. It is therefore essential for South Africa policy makers to view disability through a socio-political lens to ensure the equalisation of opportunities for people with disabilities. Improved quality of life for those living in under-resourced communities should be a priority. Service providers should have a broad range of skills to enable them to address not only the rehabilitation needs of people with disabilities, but also their social needs

Should additional domains be added to the EQ-5D health-related quality of life instrument for community-based studies? An analytical descriptive study

Background: There is increasing interest in monitoring the health-related quality of life (HRQoL) of populations as opposed to clinical populations. The EQ-5D identifies five domains as being most able to capture the HRQoL construct. The question arises as to whether these domains are adequate within a community-based population or whether additional domains would add to the explanatory power of the instrument. Methods: As part of a community-based survey, the responses of 310 informants who reported at least one problem in one domain filled in the EQ-5D three-level version and the WHOQOL-BREF (World Health Organization Quality of Life Scale – Abbreviated version). Using the EQ-5D visual analogue scale (VAS) of rating of health as a dependent variable, the five EQ-5D and four selected WHOQOL-BREF items were entered as dummy variables in multiple regression analysis. Results: The additional domains increased the explanatory power of the model from 52 % (EQ-5D only) to 57 % (all domains). The coefficients of Self-Care and Usual Activities were not significant in any model. The most parsimonious model included the EQ-5D domains of Mobility, Pain/Discomfort, Anxiety/Depression, Concentration, and Sleep (adjusted r2 = .57). Conclusions: The EQ-5D-3 L performed well, but the addition of domains such as Concentration and Sleep increased the explanatory power. The user needs to weigh the advantage of using the EQ-5D, which allows for the calculation of a single summary index, against the use of a set of domains that are likely to be more responsive to differences in HRQoL within community living respondents. The poor predictive power of the Self-Care and Usual Activities domains within this context needs to be further examined

Developing human rights competencies for South African health professional graduates.

Human rights are social or material entitlements which are recognised universally in national and international law and that address fundamental human needs. They inhere in all people by virtue of their humanity, and represent a standard to which governments can be held accountable

The impact of an employee wellness programme in clothing/textile manufacturing companies: a randomised controlled trial

BACKGROUND: The prevalence of health risk behaviours is growing amongst South African employees. Health risk behaviours have been identified as a major contributor to reduced health related quality of life (HRQoL) and the increased prevalence of non-communicable diseases. Worksite wellness programmes promise to promote behaviour changes amongst employees and to improve their HRQoL. The aim of this study was to evaluate the short-term effects of an employee wellness programme on HRQoL, health behaviour change, body mass index (BMI) and absenteeism amongst clothing and textile manufacturing employees. METHODS: The study used a randomised control trial design. The sample consisted of 80 subjects from three clothing manufacturing companies in Cape Town, South Africa. The experimental group was subjected to a wellness programme based on the principles of cognitive behaviour therapy (CBT) as well as weekly supervised exercise classes over six weeks. The control group received a once-off health promotion talk and various educational pamphlets, with no further intervention. Measurements were recorded at baseline and at six weeks post-intervention. Outcome measures included the EQ-5D, Stanford Exercise Behaviours Scale, body mass index and absenteeism.Data was analysed with the Statistica-8 software program. Non-parametric tests were used to evaluate the differences in the medians between the two groups and to determine the level of significance. The Sign test was used to determine the within group changes. The Mann-Whitney U test was used to determine the difference between the two groups. RESULTS: At six weeks post intervention the experimental group (39 subjects) demonstrated improvement in almost every parameter. In contrast, apart from an overall decrease in time off work and a reduction in BMI for all study participants, there was no significant change noted in the behaviour of the control group (41 subjects). Seventy percent of the experimental group had improved HRQoL EQ-5D VAS scores post intervention, indicating improved perceived HRQoL. In comparison, only 58% of the control group had improved HRQoL EQ-5D VAS scores post intervention. There was no significant difference between the two groups at baseline or at six weeks post intervention. CONCLUSION: An employee wellness programme based on the principles of CBT combined with weekly aerobic exercise class was beneficial in improving the perceived HRQoL and changing health-related behaviours of clothing manufacturing employees. However, it cannot be concluded that the EWP was more effective than the once off health promotion talk as no significant changes were noted between the two groups at 6-weeks post intervention.This trial has been registered with ClinicalTrials.gov (trial registration number NCT01625039)

Attitudes, knowledge and treatment of low back pain amongst nurses in the Eastern Cape, South Africa

Background: One of the high-risk professions for the development of musculoskeletal problems is nursing. Studies have reported that there is a high prevalence of low back pain (LBP) amongst South African nurses, but very little is known regarding the prevention and self-treatment principles for LBP in this group. Objectives: The objective of this study is to evaluate the knowledge, attitudes and beliefs about the prevention and self-treatment principles for LBP amongst nursing staff in Cecilia Makiwane Hospital, Eastern Cape. Methods: The study population consisted of all qualified nurses employed at the hospital. A cross-sectional survey with a purposive convenience sampling method was used. A questionnaire was designed using literature from established sources. The questionnaire was distributed manually and data obtained were analysed using EPI-INFO4. Results: The study found that the majority of the participants experienced LBP on a regular basis. The participants could identify the most important physical risk factors associated with the development of LBP, but neglected the psychological risk factors. Action taken after the development of LBP included professional consultations as well as medication and bed rest.The participants identified the different components of a preventative exercise programme but only focused on the physical and not psychological components associated with LBP. Conclusions: LBP is a serious problem amongst the nurses at the hospital, but no proactiveapproach is taken in order to address this problem. Policy guidelines and a comprehensive prevention and treatment programme need to be designed and implemented to address this issue

An Exploratory Investigation into the Quality of Life of People with Multi-Drug Resistant Pulmonary Tuberculosis (MDR-PTB) Using the ICF Core Sets: A Preliminary Investigation

Introduction: People diagnosed with multidrug resistant pulmonary tuberculosis (MDR-PTB) is subjected to prolonged hospitalization in South Africa. It has thus become essential for research to shift its focus from a purely medical approach, but to include social and environmental factors when looking at the impact of the disease on those affected. Aim: To explore the factors affecting individuals with multi-drug resistant pulmonary tuberculosis during long-term hospitalization using the comprehensive ICF core-sets for obstructive pulmonary disease (OPD) and cardiopulmonary (CPR) conditions at Brooklyn Chest Hospital (BCH). Methods: A quantitative descriptive, cross-sectional study design was utilized. A convenient sample of 19 adults at Brooklyn Chest Hospital were interviewed. Results: Most participants reported a decrease in exercise tolerance levels (b455: n=11). However it did not limit participation. Participants reported that a lack of privacy in the environment (e155) was a barrier to health. The presence of health professionals (e355) and the provision of skills development services (e585) are facilitators to health and well-being. No differences exist in the functional ability of HIV positive and negative participants in this sample. Conclusion: The ICF Core Sets appeared valid in identifying the barriers and facilitators experienced by individuals with MDR-PTB admitted to BCH. The hospital environment must be improved to add to the QoL of those admitted, especially improving privacy within the wards. Although the social grant is seen as a facilitator, greater emphasis must be placed on preparing individuals to be economically active in the labour for when they are discharged