Physiotherapy management of spina bifida in Lusaka, Zambia
Background: Spina Bifida (SB) is one of the leading causes of disability in children globally. Its management in Sub-Saharan countries is quite challenging and has shown to be an expensive public health problem. A recent study on SB has shown that physiotherapy is poorly utilised in Zambia. Although it is very cardinal in the rehabilitation of children right from birth, very little is known on the role of physiotherapy in the management of children with SB. Aim: To investigate the role of physiotherapy in the management of SB patients both at the University Teaching Hospital (UTH) and Beit Cure International Hospital (BCIH) during the period: January 2010 to December 2014. Study design: A sequential explanatory mixed study design was used for this study. An adapted validated data extraction form was used to capture quantitative data from hospital records, while an interview guide was used in in-depth interviews and Focus Group Discussion (FGDs) with specialist physiotherapists. Data analysis: Quantitative data was analysed using SPSS version 23 and descriptive statistics represented on graphs, charts and tables in form of percentages and frequency distributions. Qualitative data was audiotaped during the focus group discussion and in-depth interviews, transcribed verbatim and thematic analysis was used. Results: A total number of 207 children with SB were managed during the period under review at the two hospitals with the most prevalent type of SB being myelomeningocele and hydrocephalus at 69.4%, commonly located in the lumbar region 53.3%, prone in female patients 55.6%. A total of 38% had an increased tone while 2% had low tone indicating the need for physiotherapy. Through purposive sampling, a total of eight physiotherapists took part in the qualitative study. Results showed that there are poor referral systems for physiotherapy at the two hospitals making follow up quite difficult at times. Information on physiotherapy sessions was not included in patient files but only indicated in the physiotherapy departmental registers. Some physiotherapists felt that their role in the rehabilitation process was not known amongst team members such as surgeons. However, the availability of assistive devices at the hospitals helped provide better services which in turn promoted improvement in patients and also contributed to motivation. Conclusion: Having undergone some training as rehabilitation team members, all the physiotherapists noted that training helped to empower them, gain experience and changed attitudes of some rehabilitation team towards them. It is therefore recommended that the referral system and documentation be improved upon in order to effectively work together as a rehabilitation team with common goals.