SOCIO-ECONOMIC INFLUENCES ON HEALTH AND REHABILITATION OF PHYSICALLY HANDICAPPED RURAL CHILDREN FEBRUARY 1992.

HERBERT MUYINDA AND TOM BARTON

EXECUTIVE SUMMARY:

In this project, we have studied the interrelationship of social-economic factors with the health care and rehabilitation of physically handicapped rural children. The study gathered information regarding community and household factors affecting children with movement disabilities in Kayunga Sub-county, Mukono District, Uganda. Data was collected through interviews, focus group discussion and observations.

The research was stimulated by our awareness of deficits in basic information about the needs of physically handicapped rural children in this country. This led to concern about neglect and deterioration in their health care, especially as there have been substantial problems in the rest of the health system during the two past decades. The aim of the research was to gather this information and then to disseminate it to the relevant agencies and to the local community. It is hoped that this effort might improve the understanding, health and welfare of these children and others similarly affected throughout the rural areas of this country.

The field work was conducted during February, 1991, in five RC2s (parishes), and with four villages in each RC2. Seventy-two families with physically handicapped children were identified and interviewed, along with a number of RC executives (5), health workers (2), and chiefs (12). Focus group discussions were carried out with mothers of disabled children, Parent-Teacher Association (PTA) officials, teachers, church representatives, RC executives and the Community based Rehabilitation (CBR) representative in the area. Observations were made about doorways, steps, and latrines at the schools and the homes of handicapped children.

Major findings of this study included information about the influences of family structure, especially the effects of parental separation and fostering on child health and welfare; data was also gathered about constraints to the health of disabled children related to the transportation, family health practices, traditional beliefs, and community attitudes about the health care and rehabilitation of disabled children.

An important aspect of the study was clarification of some indicators for quality of home care given to vulnerable children. Handicapped children who were not living with either of their biological parents or whose parents were separated were approximately twice as vulnerable as those who were living together with both parents. The vulnerable children and very low immunisation rates, less school attendance for the same group, less money spend on their health care in the past year, and were less likely to have any movement aids to ease their handicapping condition

Lack of special facilities for disabled children has made their health care and rehabilitation more difficult. Local beliefs and attitudes have also hindered parents from participating in local rehabilitation programmes or taking their handicapped children to health centres. Other factors affecting their care include general poverty in the rural area, low morale among the poorly paid health workers, and lack of local efforts to set up rehabilitation programmes by parents, RCs and the community. Finally it was suggested by a number of respondents that government has been insufficiently active in assisting these children.

The Following are the major recommendations arising from this study:

1. There should be at least one health worker per sub-county with some specific training in the care and rehabilitation of handicapped children

2. Education of local communities and RCs regarding the health, rehabilitation, and welfare needs of handicapped children, especially the most vulnerable children whose parents are separated or the child is not living with either of the biological parents; this training could be facilitated by sub-county level health workers, and use the assistance of available parents of such children

3. Local initiatives should be promoted that improve the welfare and rehabilitation potential of handicapped children; parents, teachers, local RCs and the full local community should be involved in such efforts. This work could also be promoted and encouraged by the above mentioned sub-county health worker. For example, ramps could be installed instead of steps of entering schools, handrails placed in school latrines, etc.

4. Greater decentralisation is needed for the few special programmes that cater to the needs of handicapped children, i.e., those that do assessments, train parents and children provide needed equipment, etc.