The challenge of spinal cord injury care in the developing world

Abstract

Great strides have been made in reducing morbidity and mortality following spinal cord injury (SCI), and improving long-term health and community participation; however, this progress has not been uniform across the globe. This review highlights differences in global epidemiology of SCI and the ongoing challenges in meeting the needs of individuals with SCI in the developing world, including post-disaster. Significant disparities persist, with life expectancies of 2 years or less not uncommon for persons living with paraplegia in many developing countries. The international community has an important role in improving access to appropriate care following SCI worldwide.

Traumatic spinal cord injury in the north-east Tanzania – describing incidence, etiology and clinical outcomes retrospectively

“…Lack of pressure relief knowledge, skills, manpower and necessary tools have been identified as factors to the increase of pressure sore incidents [4,14]. The consequences of pressure ulcers include increased LOS, re-hospitalization and increased rehabilitation expenses.…”

“…The consequences of pressure ulcers include increased LOS, re-hospitalization and increased rehabilitation expenses. Pressure ulcers are also a common cause of death to persons with spinal cord injury in many lower income countries [4,14,31]. The magnitude of pressure ulcers, respiratory complications and urinary tract infections partly explain the high in-hospital mortality of 24.4% of all TSCI admissions [32].…”

“…There was a significantly longer mean LOS for the wheelchair-dependent group (p ≤ 0.001) when compared to those who did not need one. Increased hospital stay and bed rest consequently adds to the risk of complications such as pressure ulcers, urinary tract infections and hypostatic pneumonia especially in the older patients and eventually death [14,32,33]. Appropriate wheelchair obtained earlier will enable the individual to be mobile, functional, productive and to interact with the social and physical environment from earlier stage.…”

“…Two prospective hospital-based studies conducted in Gaborone, Botswana and Cape Town, South Africa reported TSCI annual incidences of 13 and 75.6 persons per million population respectively [8,13]. Higher incidence rates can be anticipated in the unreported low income regions due to existence of unsafe occupational socioeconomic and cultural activities within a risky infrastructure [14]. There is a scarcity of reports from rural Africa regarding the magnitude, etiology and clinical outcomes of TSCI.…”

Pressure ulcers in people with spinal cord injury in developing nations

“…6 That said, in light of recent publicity surrounding natural disasters such as the earthquakes in Pakistan (2005), China (2008) and Haiti (2010), there has been a resurgence of interest in improved rehabilitation medicine in the developing world. 3,4,7,8 Physicians and researchers in these parts of the world are starting to document local SCI care and complications, including information about the prevalence and management of PUs. To the authors' knowledge, there are currently no literature reviews compiling these data and examining the prevalence of PUs in the developing world.…”