The process of rehabilitation for 0-6 year old children with cerebral palsy at Kenyatta National Hospital, Kenya
Year: 2018
Type: article
Study design: Observational Study
Abstract: Introduction: Cerebral palsy is one of the leading causes of disability globally.The number of new cases of children with cerebral palsy (CP) is on the increase.Rehabilitation is the most common intervention used to help children with CP in Kenya.Early initiation of the rehabilitation process, and involvement of the family are important for optimal functional outcomes for children with cerebral palsy.This study aimed to establish the incidence of children under six years old with CP at the physiotherapy and occupational therapy department at Kenyatta National Hospital, Kenya in 2015.This was done in order to establish the need for rehabilitation services.Furthermore, the study aimed to explore and describe the direct patient process of care as part of the current rehabilitation process followed for children with CP from the age of 0to 6 years in order to identify any room for improvement. Study population and Methodology: Data were collected in two phases.Phase A consisted of collecting information pertaining to the number of new cases (incidence) of children with CP under six years of age in 2015 treated at the therapy (occupational and physiotherapy) departments at KNH.For this purpose, all records of children with CP under the age of six years at the rehabilitation department in 2015 were included and reviewed.For Phase B, a mixed methods approach and a parallel convergent design were used to explore the direct patient process of care component of the rehabilitation process.In Phase B, three instruments were used to collect data: 1) Data extraction sheet (to review documentation on treatment given), 2) Semi-structured interviews with caregivers of children with CP (to determine involvement in rehabilitation) and 3) Focus group discussions with rehabilitation staff (to triangulate findings).The initial review of the medical records to document the treatment provided at the therapy departments consisted of 70 medical folders that were randomly selected.System random sampling was used to select medical records for review using Slovin's formula n = .The total numbers of available records were 360, and the sample size was 70.Twenty parents/caregivers of children with CP were conveniently sampled and interviewed to determine their involvement in the rehabilitation process.Finally eight medical personnel were purposively sampled based on their involvement in the rehabilitation of children with CP at the hospital.Quantitative data relating to the incidence of CP in children under 6 years in 2015 wereiii analysed descriptively by using frequencies.Quantitative data from phase B pertaining to the process of rehabilitation were also analysed using descriptive statistics in SSP version 22. Qualitative data was analyzed by using thematic content analysis methods.Results: The incidence of CP in children under the age of six years in 2015, at the therapy departments of KNH was 30 per 1 000 live births.Cerebral Palsy was more common amongst males than females (p = 0.030).A lack of multidisciplinary team approach to rehabilitation was identified in this study, as well as the limited rehabilitation techniques used during treatment of children with CP.Parents and caregivers were not effectively involved in the rehabilitation process during therapy sessions to continue the rehabilitation programme at home.Conclusion: There is a relatively high incidence of children under 6 years with CP at this hospital, which highlights the need for the provision of early intervention and rehabilitation.There was a lack of a multidisciplinary team (MDT) approach to the rehabilitation process for young children with cerebral palsy, and limited techniques were used during therapy.Caregivers were also not sufficiently involved in the process of rehabilitation.Furthermore, there was low attendance recorded of children with CP in 2015 at Kenyatta National Hospital (KNH) in Kenya.Some of the reasons given for the low attendance at the rehabilitation clinics were the high cost of rehabilitation services charged for patients and few specialized staff assigned to the rehabilitation clinics at KNH.The rehabilitation clinics should reduce or waive their service charge for the rehabilitation of children with CP under the age of six years.This could potentially encourage earlier intervention and a more holistic approach to rehabilitation in this setting.
Author: Daniel Odhiambo Ngota
Language: English
Subfield: Rehabilitation
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2915277414