Jennifer Jelsma

Soraya Maart

Division of Physiotherapy, University of Cape Town

Purpose

A  community based survey of disability was undertaken in some of the least resourced areas of Cape Town to investigate the impact and causes of disability within these areas. This paper will present preliminary results related to the reported causes of disability.

Relevant

South Africa is at the crux of an epidemiological transition, and suffers under a quadruple burden of disease, with both infectious diseases and chronic diseases of life-style (CDL) combining with trauma and HIV to shorten the life span of the population. What is not clear is whether disability is similarly caused by these killer diseases.

Participants

Cluster sampling was used to identify 1000 households that were proportionally representative of those living in brick houses, in back yards and in informal settlements. The heads of the households were interviewed and asked to identify whether there were any people with disabilities living within their households. Those identified as having disabilities or their proxies were then interviewed.

Methods

Validated questions were used to screen for disability and self-reported causes of disability were recorded..

Analysis

The respondents’ description of the cause of disability was recoded into categories including trauma, infection, CDL and Maternal and Child Health causes as well as specific diagnoses where possible. Descriptive analysis was undertaken.

Results

These are preliminary results and rather than give an incorrect prevalence rate in this paper, the denominator has not been included.  At the time of analysis, 750 households had been visited and 110 people were reported as being disabled.  CDL were reported as being the most common cause of disability (38%), followed by Trauma (31%), which included accidental trauma (car accidents = 8%) and assault (16%), and poor maternal and child health (22%). Surprising infection only accounted for 8%, with two people attributing disability to HIV.

Conclusions

The causes of disability are in most cases the same as the reported causes of mortality, apart from infection, and specifically HIV.

Implications

Management of CDL at a primary health care level appears to be essential. The large number of participants reporting arthritis, hypertension and diabetes is cause for concern and physiotherapists need to develop strategies to deal with this disease cluster. Trauma survivors need intervention in the acute stage and there is an important role for the physiotherapist to prevent complications and there is a need to provide early physiotherapy management for children with birth trauma.  Physiotherapists can fulfil an essential role at the primary care level in under resourced communities.

Key words

Epidemiology, disability , burden of disease.

Acknowledgements

Funding was received from the EuroQol Foundation, the National Research Foundation and the Research Committee of the University of Cape Town.