A qualitative study of the challenges of providing pre-prosthetic rehabilitation in rural South Africa

Background: There is a known shortage of rehabilitation staff in rural settings and a sharp increase in the number of lower limb amputations being performed. A lack of adequate pre-prosthetic rehabilitation will result in worse physical and psychological outcomes for a person with a lower limb amputation, and they will not be eligible to be fitted with a prosthesis. Objective: To explore therapists’ experiences with providing pre-prosthetic rehabilitation in a rural setting. Study design: A qualitative descriptive approach was used to collect and analyse data. Methods: Data were collected from 17 purposively sampled therapists in five district hospitals in a rural community in South Africa. Data were collected in two rounds of focus groups to explore the challenges of providing pre-prosthetic rehabilitation in rural South Africa. Results: The main themes identified in the study were (1) a lack of government health system support, (2) poor socioeconomic circumstances of patients and (3) cultural factors that influence rehabilitation. These themes all negatively influence the therapists’ ability to follow up patients for pre-prosthetic rehabilitation after discharge from hospital. A lack of adequate pre-prosthetic rehabilitation is a substantial barrier to prosthetic fitting in rural South Africa. Patients who do not receive pre-prosthetic rehabilitation have a poorly shaped residuum or other complications such as knee or hip joint contractures which disqualifies them from being referred to prosthetic services. Conclusion: Therapists involved in this study identified the most important barriers to patients having access to prosthetic services. Clinical relevance Pre-prosthetic rehabilitation provides care of the residuum; maintenance or improvement of physical strength, joint range of motion and referral to a prosthetist. By exploring the challenges known to exist in this service, we can identify potential ways to reduce these barriers and improve the lives of those who use it.

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Barriers and facilitators to utilisation of rehabilitation services amongst persons with lower-limb amputations in a rural community in South Africa

Prosthetics and Orthotics International ◽

10.1177/0309364618789457 ◽

2018 ◽

Vol 43 (1) ◽

pp. 95-103 ◽

Cited By ~ 2

Author(s):

Ugendrie Naidoo ◽

Liezel Ennion

Keyword(s):

South Africa ◽

Lower Limb ◽

Rural Areas ◽

Lower Limb Amputation ◽

Barriers And Facilitators ◽

Rural Setting ◽

Limb Amputation ◽

Rehabilitation Services ◽

Personal Factors ◽

Persons With Disabilities

Background: Persons with disabilities who reside in rural areas experience challenges accessing and utilising health services and rehabilitation. Due to the high prevalence of diabetes mellitus in rural regions, the risk of having a lower-limb amputation is increasing. Comprehensive rehabilitation is vital to mitigate the negative impact that a lower-limb amputation has on a person. Objective: To explore the barriers and facilitators to accessing rehabilitation experienced by persons with lower-limb amputations in a rural setting. Study Design: A qualitative descriptive approach was used to collect and analyse data. Methods: Data were collected from 11 conveniently sampled participants from three sub-district hospitals in the rural iLembe district, Kwa-Zulu Natal, South Africa. Data were collected using semi-structured interviews to explore the barriers and facilitators perceived by persons with lower-limb amputations in a rural region. Results: The three main barriers identified in this study were environmental factors, financial constraints and impairments. These barriers negatively impacted the participant’s utilisation of rehabilitation. The two main facilitators identified were environmental facilitators and personal factors which aided participant’s utilisation of rehabilitation. Conclusion: Access to rehabilitation was mainly hindered by the challenges utilising transport to the hospital, while self-motivation to improve was the strongest facilitator to utilising rehabilitation. Clinical relevance Rehabilitation is essential in preparation for prosthetic fitting. If a person cannot access rehabilitation services, they will remain dependent on caregivers. Highlighting the challenges to utilisation of rehabilitation in rural areas can assist to reduce these barriers and improve the functional status of persons with lower-limb amputations.

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Experiences of lower limb prosthetic users in a rural setting in the Mpumalanga Province, South Africa

Prosthetics and Orthotics International ◽

10.1177/0309364618792730 ◽

2018 ◽

Vol 43 (2) ◽

pp. 170-179 ◽

Cited By ~ 3

Author(s):

Liezel Ennion ◽

Sarah Manig

Keyword(s):

South Africa ◽

Service Delivery ◽

Rural Area ◽

Lower Limb ◽

Functional Independence ◽

Structured Interview ◽

Rural Setting ◽

Limb Amputation ◽

Mpumalanga Province ◽

Lower Limb Prosthesis

Background: Ambulation with a prosthesis is the ultimate goal of rehabilitation for a person with a major lower limb amputation. Due to challenges with prosthetic service delivery in rural settings, many patients with amputations are not benefitting from prosthetic interventions. Inaccessibility to prosthetic services results in worse functional outcomes and quality of life. Learning from the experiences of current prosthetic users in this setting can assist to improve prosthetic service delivery. Objectives: To explore the experiences of lower limb prosthetic users and to understand the importance of a lower limb prosthesis to a prosthetic user in a rural area of South Africa. Study design: A generic qualitative approach and an explorative design were utilised in this study. Methods: A semi-structured interview guide was used to collect data from nine prosthetic users in a rural area in the Mpumalanga province of South Africa. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Demographic details and information related to acute in-patient rehabilitation were analysed descriptively. Results: All participants were independent in activities of daily living with their prosthesis and participated actively in their community. Participants reported that their prosthesis was essential to their functioning. High travel cost was highlighted as a barrier to the maintenance of their prosthesis. Patients were dissatisfied with being unemployed. Conclusion: Prosthetic intervention positively influences function, independence and community participation. Challenges relating to the accessibility, cost and maintenance of prosthetics should be a priority to ensure continued functional independence for prosthetic users. Clinical relevance Understanding the importance of a prosthesis to a prosthetic user validates prosthetic intervention for persons living with an amputation in a rural setting and is vital in establishing and remodelling effective systems for prosthetic service delivery.

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Struggling for Independence: Youth Unemployment and the Decline in Marriage in Rural South Africa

PsycEXTRA Dataset ◽

10.1037/e618052011-020 ◽

2008 ◽

Author(s):

Sarah Mathis

Keyword(s):

South Africa ◽

Youth Unemployment ◽

Rural South ◽

Rural South Africa

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Faculty Opinions recommendation of Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1119349.575533 ◽

2008 ◽

Author(s):

Heather Jaspan

Keyword(s):

South Africa ◽

Randomised Controlled Trial ◽

Sexual Behaviour ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Stepping Stones ◽

Rural South ◽

Cluster Randomised ◽

Randomised Controlled ◽

Rural South Africa

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Investigating competencies needed by European-trained doctors in rural South African hospitals

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v12i1.2322 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

James R. Barnacle ◽

Oliver Johnson ◽

Ian Couper

Keyword(s):

South Africa ◽

South African ◽

Online Survey ◽

Rural District ◽

Eastern Cape ◽

Rural Medicine ◽

Rural South ◽

District Hospitals ◽

Kwazulu Natal ◽

Postgraduate Diploma

Background: Many European-trained doctors (ETDs) recruited to work in rural district hospitals in South Africa have insufficient generalist competencies for the range of practice required. Africa Health Placements recruits ETDs to work in rural hospitals in Africa. Many of these doctors feel inadequately prepared. The Stellenbosch University Ukwanda Centre for Rural Health is launching a Postgraduate Diploma in Rural Medicine to help prepare doctors for such work.Aim: To determine the competencies gap for ETDs working in rural district hospitals in South Africa to inform the curriculum of the PG Dip (Rural Medicine).Setting: Rural district hospitals in South Africa.Methods: Nine hospitals in the Eastern Cape, KwaZulu-Natal and Mpumalanga were purposefully selected by Africa Health Placements as receiving ETDs. An online survey was developed asking about the most important competencies and weaknesses for ETDs when working rurally. The clinical manager and any ETDs currently working in each hospital were invited to complete the survey.Results: Surveys were completed by 19 ETDs and five clinical managers. The top clinical competencies in relation to 10 specific domains were identified. The results also indicate broader competencies required, specific skills gaps, the strengths that ETDs bring to South Africa and how ETDs prepare themselves for working in this context.Conclusion: This study identifies the important competency gaps among ETDs and provides useful direction for the diploma and other future training initiatives. The diploma faculty must reflect on these findings and ensure the curriculum is aligned with these gaps.

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