Caring for children with physical disability in Kenya: potential links between caregiving and carers' physical health.

BACKGROUND: The health of a carer is a key factor which can affect the well-being of the child with disabilities for whom they care. In low-income countries, many carers of children with disabilities contend with poverty, limited public services and lack assistive devices. In these situations caregiving may require more physical work than in high-income countries and so carry greater risk of physical injury or health problems. There is some evidence that poverty and limited access to health care and equipment may affect the physical health of those who care for children with disabilities. This study seeks to understand this relationship more clearly. METHODS: A mixed methods study design was used to identify the potential physical health effects of caring for a child with moderate-severe motor impairments in Kilifi, Kenya. Qualitative data from in-depth interviews were thematically analysed and triangulated with data collected during structured physiotherapy assessment. RESULTS: Carers commonly reported chronic spinal pain of moderate to severe intensity, which affected essential activities. However, carers differed in how they perceived their physical health to be affected by caregiving, also reporting positive benefits or denying detrimental effects. Carers focussed on support in two key areas; the provision of simple equipment and support for their children to physically access and attend school. CONCLUSIONS: Carers of children with moderate-severe motor impairments live with their own physical health challenges. While routine assessments lead to diagnosis of simple musculoskeletal pain syndromes, the overall health status and situation of carers may be more complex. As a consequence, the role of rehabilitation therapists may need to be expanded to effectively evaluate and support carers' health needs. The provision of equipment to improve their child's mobility, respite care or transport to enable school attendance is likely to be helpful to carers and children alike.

How do children perceive health to be affected by domestic water carrying? Qualitative findings from a mixed methods study in rural South Africa.

BACKGROUND: Nearly 50% of South African children lack access to clean safe water and many regularly carry water loads. The health effects of carrying water have not been well researched or considered when estimating the burden of disease due to suboptimal water supply. Improved access to safe water has potential to create important health and economic benefits, by reducing childhood exposure to risk factors for injury or disease. The aim of this study was to identify which domains of health children perceive as affected by water carrying. METHODS: Qualitative research was used within a broader mixed methods design to investigate children's perceptions about health and water carrying in Limpopo Province, South Africa. Qualitative data from eight semi-structured interviews and three 'natural group meetings', involving a sample of 30 children, were analysed using the framework approach of Ritchie and Spencer. The results were mapped to the International Classification of Functioning Disability and Health (ICF). RESULTS: Children broadly conceptualize and describe health to include the functions they perform and activities in which they participate. They perceived water carrying as impacting upon health in various ways, for example to make life better by facilitating water usage, or to make life worse through accidents and pain. Children's accounts demonstrate that they can identify and explain complex interactions between activities, participation and health. CONCLUSIONS: The ICF framework facilitates the communication of children's perceptions of health and of relationships between health and water carrying. The model thus derived from their views incorporates not only commonly accepted conceptualizations of health condition, body structure and physiological function, but also of functioning through activities and social participation. Children's accounts suggest a possible association between water carrying and symptoms typical of musculoskeletal disorders. However, further research into the strength of association between water carrying and musculoskeletal disorders is needed.