Epidemiology, Functioning and Reintegration into the Community of Patients with Spinal Cord Injuries in Kenya

Abstract

Background Spinal cord injury (SCI) occurs when damage to the spinal cord affects its structure and function, leading to neurological impairments in motor, sensory, and autonomic functions, depending on the severity and location of the injury. Globally, the primary objectives of SCI care remain consistent, highlighting the need for epidemiological data to guide medical and governmental organizations in allocating resources effectively. Functional outcomes are influenced by factors such as injury severity, rehabilitation quality, staff-to-patient ratio, and community support. Successful reintegration into the community is essential for individuals with SCI to regain competence and achieve life satisfaction. This study aimed to examine the epidemiology, functional outcomes, and community reintegration of SCI patients in Kenya. Methodology The study was conducted in three counties in Kenya: Machakos, Nairobi, and Mombasa. A mixed- methods design was employed in three phases. Phase I: Focused on the epidemiology of SCI through a retrospective cross-sectional design that involved reviewing medical records from a four-year period. The sample size included 159 participants from Nairobi, 61 from Machakos, and 70 from Mombasa. Phase II: Utilized an explanatory sequential mixed-methods design. The quantitative component involved a prospective longitudinal study using the SCIM III tool for activity-level functional outcomes and the CHART tool for participation-level functional outcomes. The qualitative component employed a grounded theory design to explore factors affecting reintegration, using CHIEF and LSQ outcome measures. Quantitative data were analyzed using SPSS version 15, while qualitative data were processed with ATLAS Ti software. Phase III: Focused on developing guidelines to improve community reintegration using the Delphi procedure study design. In round one, demographic data were analyzed through frequency distribution and percentages, while qualitative data underwent thematic content analysis. In round two, a Likert scale was used to rate participants' statements in terms of importance, and SPSS was used to analyze measures of central tendency and variations. In round three, participants re-rated statements from round two using a Likert scale, and SPSS was employed again to assess the level of agreement among participants. Results The results reveals that spinal cord injuries (SCI) primarily affect young, working-age males with limited education, with motor traffic accidents and falls being the leading causes. Incomplete injuries were more common in road accidents, while falls resulted in more severe injuries. Preventive measures, such as road safety campaigns and workplace safety programs, are crucial in reducing SCI cases. The study also highlights the high prevalence of neuropathic pain among male patients, emphasizing the need for specialized pain management. Functional outcome assessments showed significant recovery, especially in individuals with incomplete injuries, though challenges in respiration and sphincter management persist, necessitating long-term, multidisciplinary rehabilitation. Social participation 14 improved notably, with functional ability and injury severity being strong predictors of recovery, alongside psychosocial factors like social support and depression. Environmental and societal barriers, particularly affecting younger, lower-income, and less-educated individuals, remain significant obstacles to healthcare access and community reintegration. Racial disparities were evident, with Black participants facing greater accessibility and social acceptance challenges. The Delphi study further identified key factors for successful reintegration, such as removing physical barriers, strengthening community support, and improving access to assistive technology and healthcare policies. Major barriers included stigma, financial struggles, inadequate infrastructure, and insufficient specialist training. The study underscores the need for a holistic, multidisciplinary approach that integrates physical, social, and economic interventions to foster independence, social participation, and long-term well-being for individuals with SCI. Conclusion The study provided comprehensive insights into the epidemiology of SCI in Kenya, revealing that most cases occurred among males aged 26–35 years with primary education. This study highlights the significant challenges faced by individuals with spinal cord injuries (SCI), particularly young, working- age males with limited education. Motor traffic accidents and falls were the leading causes, with incomplete injuries more common in road accidents and severe injuries resulting from falls. While functional outcomes showed significant improvements, persistent challenges in respiration, sphincter management, and neuropathic pain emphasize the need for long-term, multidisciplinary rehabilitation. Social and environmental barriers, especially for lower-income and less-educated individuals, further hinder recovery and reintegration. Racial disparities in accessibility and social acceptance were also evident. The Delphi study identified key factors for successful reintegration, including removing physical barriers, strengthening community support, and improving healthcare policies. Addressing systemic gaps such as stigma, financial struggles, and inadequate specialist training is crucial. Ultimately, a holistic, multidisciplinary approach is essential to enhance independence, social participation, and long-term well-being for individuals with SCI.