Survey of rehabilitation support for children 0–15 years in a rural part of Kenya

Figures & data

Table 1. Summary of variables used in survey.

Service provider	Service user
1. Provider ID	1. User ID
2. Sex	2. Age range
3. Age group	3. Sex
4. Trained or not	4. Service centre/facility
5. Qualification	5. Residence
6. Service/facility centre	6. Difficulty in doing activities of daily living
7. Details of training	7. Primary & secondary condition
8. Years of training	8. Needs assistance to perform activities of daily living
9. Duration (years) of employment	9. Type of need assistance required
	10. Duration of difficulty (six months or less)
	11. Type of intervention prescribed
	12. Social inclusion (attendance of social activities)

Figure 1. Map of Kilifi District showing the location of rehabilitation facilities and residential location of service users attending rehabilitation at Kilifi District Hospital as a percentage of total caseload (n = 162).

Table 2. Professional training and experience of staff.

		Highest level of professional training
	Staff	None	Short Course	Certificate	Diploma	Degree	Years experience: range (median)	CPD
Health	10	0	0	2	8	0	0–29 (13)	37
Special education	40	3	3	3	26	5	1–20 (5)	89

CPD = number of courses attended for Continuing Professional Development.

Table 3. Service aims and objectives.

Themes	Health	Special education
1. Assessment & diagnosis	“… early diagnosis and intervention for our clients …” (OT); “we diagnose and assess then we come up with the treatment plan … .” (APDK)	“… we assess all the children who are handicapped … special needs in the district, after the assessment we do referral, education intervention and medical intervention” (EARC).
2. Skills acquisition	“… with assistance of exercises it makes the child stable again” (OrthT); “we aim to reduce disability through corrective therapy and activities of daily living … improve and train communication and speech” (OT).	“… children come here illiterate and leave the school literate …” (School A); “… five out of the twelve know some bit of reading … able to count and record the values …” (Unit B).
3. Assistive technology	“… some have come here with weak … unstable neck and I make appliance and fit that child” (OrthT); … mobility aid workshop at Bombolulu … identify people who need those appliances … have these appliances made … also they are brought back for repair … appliances like the crutches, calipers … (APDK).	“… assist parent to make aids … train them on how to create a simple walking aid like a crutch/an improvised walker for children who have got delayed milestone” (EARC).
4. Self-help & independence	“… caretakers back at home, we teach them how they will be assisting those people back at home to make them independent …” (PT); “… if these disable client he/she is not willing to use the appliances then the families can encourage them to …” (OrthT).	“… the child is able to wash herself, to prepare a meal” (School B); “how to take care of themselves. … how to bath, wash utensils, they also have to know toileting and also feeding themselves” (Unit B)
5. Participation	“… discharge our clients back home to await school placement” (OT).	“… we find out that the children are catching up then we take them to the other classes” (Unit D); “… we have manage to take some to secondary school. … others who have gone through technical college” (Unit E).
6. Psychological adaptation	“… the community we expect them to give our clients moral support so that they may also feel important and productive…” (OT); “… holding workshops and seminars for parents … the barazas, visiting the chiefs, going to schools …” (APDK).	“carers - accept the child’s disability” (EARC); “… guidance and counselling to the parents” (Unit C).

Table 4. Challenges to service provision.

Themes	Health	Special education
1. Staffing	“… we are few in the hospital and we cannot leave the department without a therapist just to follow a client at home …” (OT); “… the services are now getting to be known and people have started to come in numbers but the staff are very few” (OrthT).	“… it wouldn’t be easy for a regular teacher to handle these children because of that lack of special training” (Unit C).
2. Resources	“… using the old type of machinery for our services … problems having it repaired. … at times the government is not able to buy all those machines” (PT); “… we are buying this local material, which are very poor … I am not producing much and of good quality” (OrthT).	“… early identification of the children which is a big problem … most of the child report to school quite late …” (School A); “… things that can make the children acquire this skills are not available …” (School B); “… we have insufficient classrooms … we have learners of 3 levels of learning but all in this one room …” (Unit D).
3. Transport	“… not able to follow some clients at home … this is because of the distance from the hospital” (OT).	“if we can get transport right in the villages I feel we are able to do something” (EARC); “the means of transport to reach those children is another challenge” (Unit E).
4. Socio-economic status	“… the parent comes from very far and has just borrowed money to come … most of these mothers you may find the father have left them because of the child with disability …” (APDK).	“… for most parents even paying that little amount of 2000 Ksh per term becomes a big issue … .” (School A); “… the parents cannot afford the basic requirement for their children …” (Unit A) “… from families that cannot support themselves … we have to take care of them fully from clothing feeding and learning materials in class …” (Unit E).
5. Beliefs & attitudes	“… the community is the worse, most of them think that to be disabled is a curse so they pity these people …” (OrthT).	“some parent feel … if these children learn together with normal children … they will eventually be handicapped too …” (EARC); “the community has a negative attitude … most of the times they segregate the disabled” (Unit B).

Table 5. Sustainability of service.

Theme	Health	Special education
1. Government funding	“… [staff] employed by the government … cost sharing in the hospital … helps us to purchase facilities for our clients” (OT); “some continued training of the physiotherapists …” (PT); “… normally very little amount of money when we consider the type of materials we require” (OrthT).	“… we depend on government grants” (EARC); “… grants like salary grants and food grants …” (School A); “… the grant that we get apart from the free primary education where every child is allocated 1000 … an extra 2000 shillings every year” (Unit C).
2. Donations	“… aid from friends and donors who brought in a few equipments” (OT); “… [no] donor funding to the hospital for quite a long time. … we are happy for whatever we are given” (PT).	“… food and everything are supported by … one donor … borrow money from well wishers …” (School B); “other donors have given us some iron sheets and our local authority has put up a modern classroom for us” (Unit A); “we invite business men around who after coming to see what we do in the unit then they give out something” (Unit D).
3. Service user contribution	“… clients at home … fund the visits or the relatives” (PT); cost sharing because there are appliances that they pay for like the wheel chair there is a small fee… (APDK).	“we also charge our parent a minimal fee of about 2000 Ksh …” (School A).
4. Self-sufficiency	“… we do a lot of improvisation which is not giving good results” (OrthT).	“… we keep cows and chicken for eggs …” (School A); “… raise what we can afford to start buying food for the children” (Unit D); “… what make us running is that the school has poultry as a daily project and whatever we get from those areas helps us meet our needs” (Unit E).

Table 6. Number (%) of service users with difficulties in daily activities (Health: n = 162; Special education: n = 276).

	Range of difficulties
Service sector	Sitting	Walking	Standing	Seeing	Speaking	Breathing	Dressing	Hearing	Understanding	Reading	Washing
Health	82 (51%)	130 (80%)	130 (80%)	0	0	0	130 (80%)	0	1 (5%)	0	130 (80%)
Special education	12 (4%)	29 (11%)	20 (7%)	25 (9%)	13 (5%)	3 (1%)	89 (32%)	147 (53%)	226 (82%)	247 (89%)	100 (36%)

Table 7. Intervention approaches identified by service providers for children on caseload/school register.

	Intervention approaches			No. of times cited
Intervention categories	Health	Special education	Both	Health	Special education
A. Splinting & physical  support	Back slabs; splinting (bilateral, long leg, cork up, serial, hip joint); callipers; wedges; special boot; arch support; prosthesis			43	0
B. Physical manipulation & sensory support	Passive movements; sensory stimulation; positioning; massage; sitting; ambulation; electrotherapy; steam exercise; heating/heat therapy			30	0
C. Exercises	Stretching; exercise (gym, neck, home); walking in parallel bars; weight lifting; riding on static bike; transfer exercise		Rehabilitation exercise	119	21
D. Equipment provision		Equipment; spectacles & telescope; hearing aid		0	11
E. Educational support		Reading & writing; learning Braille; integration		0	269
F. Communication		Speech work; Kenyan sign language		0	144
G. Social support		Home visits		0	16