Factors affecting regular attendance to rehabilitation care among children with cerebral palsy at Muhimbili National Hospital and the comprehensive community based rehabilitation centre in Dar Es Salaam, Tanzania.

Abstract

Background: Cerebral palsy is a common condition affecting nearly 3% of all live births globally. The mainstay of therapy is physical therapy and rehabilitation. This can reduce disability and improve the quality of life of the child with cerebral palsy. Access to regular rehabilitation services is not documented in Tanzania. This study aims to investigate the enablers and barriers of regular rehabilitation care at tertiary facilities Muhimbili national hospital and the Comprehensive community .based rehabilitation centre Tanzania (CCBRT). Objectives: To determine factors affecting regular attendance to rehabilitation care among children with cerebral palsy at (MNH) and (CCBRT). Methodology: A cross section facility-based study which employed both quantitative and qualitative methods was conducted at Muhimbili National Hospital (MNH) and The Comprehensive Community Based Rehabilitation Centre Tanzania (CCBRT). Participants: A total of 152 Children with cerebral palsy and their parents were consecutively enrolled in the rehabilitation clinic from October 2017 to April 2018. Quantitative data was collected using a structured questionnaire from the parents/caregivers. Data was analysed using statistical package for social science (SPSS) version 20. In qualitative study a total of 50 purposively selected participants were included out of which 32 participants were involved in focused group discussion (FGD) and 18 healthcare givers were selected for an In depth interviews. They participants included parents, health care providers (Paediatrician and nurses), hospital administrators, and rehabilitation professionals. An interview guide and digital tape were employed to collect qualitative data which was transcribed, and then translated, from Swahili to English. Deductive content analysis method was used to analyse qualitative data. Results: Out of 152 children recruited, 93 (61.2%) were from MNH and 59 (38.8%) were from CCBRT. Majority (69.1%) were aged between 12 to 60 months. Among parents/caretakers 140 (92.1%) were females and 12(7.9%) were males their age ranged between 18 to 57years with the mean age of 30.9years and SD+0.7458. Our study identified factors associated with regular attendance to rehabilitation care were marital status 103(91.2%), coverage by health insurance 58(85.5%), and being exempted from payment 69(85.2%). Other factors such as age, sex, education and employment were not associated with regular attendance. Qualitative findings showed that financial and social support from spouses, family members and at the community levels were facilitators of regular attendance, Barriers identified include stigma, misconception and witchcraft ideology. Conclusion: Care of disabled children by two parents, financial capacity and psychosocial support from family and community members are associated with higher utilization of rehabilitation services, Barriers includes negative myths and misconceptions about the disease and stigma among community members. Recommendations: Financial aids such as through insurance coverage, exemption from payments of some services may help the families to care for their infants. Intervention addressing stigma, myths and misconceptions about cerebral palsy are needed to ensure the society is aware of the disability and provide psychosocial supports are recommended.