Secondary health conditions in people with spinal cord injury in South Africa: Prevalence and associated factors

Abstract

Background. People with spinal cord injury (SCI) experience preventable secondary health conditions (SHCs) that worsen the disability, reduce the quality of life and affect health and wellbeing. There is limited information on the prevalence of SHCs and the associated factors to inform planning and practice in South Africa (SA). Objectives. To identify the prevalence of SHCs and the associated factors in people with SCI. Methods. We conducted a retrospective review of patients’ medical records at a tertiary academic hospital and a rehabilitation hospital in Gauteng Province, SA. Data collected included demographic data, injury profile, SHCs and associated factors. Data were summarised using descriptive statistics of frequency and percentages. Fisher’s exact test was used to determine the association between SHCs and sociodemographic and clinical variables. The Mann-Whitney U-test was used to determine the associated risk factors for SHCs. Multinomial regression was used to determine the predictors of the frequency of SHCs. Results. A total of 425 records were reviewed, 68.0% of patients were male, and the median (interquartile range) age was 45 (35 - 56) years. The majority (93.7%) of the patients had SHCs, and 78% had ≥2 SHCs. Significant predictors of having >3 SHCs were the duration of SCI (p=0.01), site of injury in the upper (p=0.03) and lower (p=0.01) thoracic spine, being unemployed (p=0.04), and public hospital income classification (H0 = social grant/unemployed, H1 = earning ZAR0 - 70 000 per annum single income/ZAR0 - 100 000 per annum household income, and Road Accident Fund; p=0.03, p=0.03 and p=0.01, respectively). Conclusions. Secondary health conditions were prevalent among patients with SCI. People with SCI experience multimorbidity that requires multiple management strategies. These findings point to the need for prevention strategies to minimise the occurrence of SHCs.