Prevalence and factors associated with utilization of rehabilitation services among people with physical disabilities in Kampala, Uganda. A descriptive cross sectional study

Swaibu Zziwa; Harriet Babikako; Doris Kwesiga; Olive Kobusingye; Jacob A. Bentley; Frederick Oporia; Rebecca Nuwematsiko; Abdulgafoor Bachani; Lynn M. Atuyambe; Nino Paichadze

摘要

BackgroundInternational Classification of Functioning and disability (ICF) defines disability as a permanent impairment, activity limitation and restriction in participation in any life situation resulting from any health condition whether congenital or acquired [1, 2]. A physical disability was defined as a permanent mobility, visual, speech and hearing impairment from any health condition whether congenital or acquired [1]. Rehabilitation is a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment [3, 4]. A Health condition refers to disease (acute or chronic), disorder, injury or trauma [3, 5]. According to World Health Organization (WHO), rehabilitation is one of the essential components of the quality health services that should be included in Universal Health Coverage. This means that all individuals should be able to access quality rehabilitation services without fear of financial hardships [6, 7].Worldwide, disability is a major public health concern. Globally, it is estimated that one billion people of the world’s population (15%) live with some form of disability [8].. About 110 to 190 million adults encounter substantial difficulties in their daily lives [8, 9]. In order to reduce the number of person with disabilities (PWDs), the WHO Member States in 2014 endorsed global disability action plan 2014–2021 with the aim to remove barriers and improve access to health services; strengthen and extend rehabilitation and community-based rehabilitation [8]. The plan was adopted in response to 66th World Health Assembly resolution on disability which urges member states to implement the recommendations of the United Nation’s Convention of the Rights of PWDs (CRPD); work towards the inclusion of all PWDs in health care; promote rehabilitation services across the life course and for a range of different health conditions with the goal of attaining good health for all PWDs [10, 11].Furthermore, the WHO Member States, international and professional organizations, non-governmental organizations and rehabilitation experts on 7th February 2017 issued Rehabilitation 2030; call for action [3, 12]. The major aim for bringing together these stakeholders was to inspire them to actively participate in a global effort toward strengthening rehabilitation in health systems, improving rehabilitation governance and investment; expanding a high-quality rehabilitation workforce; and enhancing rehabilitation data collection [3, 6]. WHO’s call for action not only underscores the increasing need for rehabilitation, but also brings awareness to the role rehabilitation can play in achieving UN’s Sustainable Development Goals (SDGs), specifically in ensuring that all people all over the world are able to experience good health and well-being [3, 13].The Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2017 includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017 [14, 15]. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease [14, 16]. Rehabilitation optimizes functioning and supports those with health conditions to remain as independent as possible, to participate in education, to be economically productive, and fulfill meaningful life roles [3, 4].The burden of disability is unevenly distributed between low and high income countries with low and middle income countries carrying the greatest burden of disability compared to high income countries. Globally, it is estimated that there over 600 million PWDs of whom 400 million live in developing countries and about 80 million live in Africa [5, 8, 17]. United Nation’s report maintains that about 40% of Africa’s population consists of PWDs, including 10–15% of school-age children [18] . This percentage would translate into about 300 million people with PWDs in Africa [18]. In Africa, data on utilization of rehabilitation services is still very limited. A population based study conducted among 33 countries in LMIC revealed generally limited access to rehabilitation services. In many countries, rehabilitation centers had collapsed or ceased function and others were not operating adequately [19]. In addition, an extensive survey of rehabilitation doctors in Sub-Saharan Africa identified only six, all in South Africa, for more than 780 million people, while Europe has more than 10,000 and the United States has more than 7000 [20]. Furthermore, a survey of national societies of physical and rehabilitation medicine in Africa revealed that apart from the Northern African countries of Morocco, Tunisia, and Algeria which started the practice of rehabilitation in the twentieth century, almost all of the very few Sub-Sahar

机译：背景技术分类和残疾（ICF）将残疾定义为永久性损害，活动限制和参与任何卫生条件造成的任何生命情况的限制，无论是先天性还是收购的[1,2]。无论是先天性还是收购的任何健康状况，身体残疾被定义为永久性流动性，视觉，言语和听力障碍[1]。康复是一系列干预措施，旨在优化具有与其环境互动的互动条件的个人功能和降低残疾[3,4]。健康状况是指疾病（急性或慢性），疾病，损伤或创伤[3,5]。根据世界卫生组织（世卫组织），康复是应纳入普遍健康保险的质量卫生服务的基本组成部分之一。这意味着所有个人都应该能够获得质量康复服务，而不担心金融困扰[6,7]。世界，残疾是一个主要的公共卫生问题。在全球范围内，据估计，世界上的10亿人口（15％）以某种形式的残疾生活[8] ..约110至1.9亿成年人在日常生活中遇到大量困难[8,9]。为了减少残疾人（PWDS）的人数，世卫组织成员国于2014年批准了全球残疾行动计划2014-2021，旨在消除障碍和改善对卫生服务的获取;加强和延长康复和基于社区的康复[8]。该计划是回应第66届世界卫生大会关于残疾人的解决方案，敦促会员国执行联合国普克斯（CRPD）的权利的建议;努力纳入医疗保健所有婴儿组织;促进整个生命课程的康复服务，以及一系列不同的健康状况，目标是实现所有PWDS的健康[10,11] .Furtimore，世卫组织成员国，国际和专业组织，非政府组织和康复专家2017年2月7日发布康复2030;呼吁采取行动[3,12]。汇集这些利益攸关方的主要目标是激励他们积极参与加强卫生系统康复的全球努力，改善康复治理和投资;扩大高质量的康复劳动力;并增强康复数据收集[3,6]。谁呼吁采取行动不仅强调了康复需求的日益增加，而且还为康复的角色来说，在实现联合国的可持续发展目标（SDGS）方面，特别是在确保全世界所有人能够体验健康和健康方面的康复幸福[3,13]。全球疾病（GBD），伤害和风险因素研究2017年，包括在195个国家和地区的354个原因中综合评估发病率，患病率和年份（YLD）从1990年到2017年[14,15]。以前的GBD研究表明，1990年至2016年的死亡率下降如何导致预期寿命，老龄化的全球人口，以及扩大非致命疾病负担[14,16]。康复优化运作并支持那些具有健康状况的人，以尽可能独立，参与教育，在经济上生产性，并且实现有意义的生活角色[3,4]。在低收入国家之间的残疾负担不均匀地分布在低收入国家之间不均匀与高收入国家相比，低收入和中等收入国家携带最大的残疾负担。在全球范围内，据估计，在发展中国家共有4亿八万的人，其中约有8000万左右的非洲生活[5,8,17]。联合国的报告认为，约有40％的非洲人口由PWD组成，其中包括10-15％的学龄儿童[18]。这一百分比将转化为约300万人，非洲PWDS [18]。在非洲，有关利用康复服务的数据仍然非常有限。在LMIC中的33个国家进行的一项基于人口的研究显示，普遍存在的康复服务有限。在许多国家，康复中心崩溃或停止了功能，其他人没有充分运作[19]。此外，对撒哈拉以南非洲的康复医生进行了广泛的调查，只有六个，南非所有人超过7.8亿人，而欧洲已有超过10,000人，美国拥有7000多[20]。此外，对非洲的国家身份社会的调查显示，除了摩洛哥北部的摩洛哥，突尼斯和阿尔及利亚，在二十世纪开始康复的实践，几乎所有的小撒哈哈

Prevalence and factors associated with utilization of rehabilitation services among people with physical disabilities in Kampala, Uganda. A descriptive cross sectional study

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