Exploring work-related spinal cord injuries in Gauteng Province, South Africa

Pefile, Ntsikelelo (2013-03)

Thesis (MScMedSc)--Stellenbosch University, 2013.

Thesis

ENGLISH ABSTRACT: Introduction Spinal cord injury (SCI) is devastating and impacts negatively on an individual’s functioning and social participation. A good legal framework in South Africa promotes health and safety in the workplace, but there are no specific guidelines regarding prevention of spinal cord injuries. Before any preventative programme can be embarked upon, stakeholders must understand the current situation. Therefore the aim of the study was to describe work-related spinal cord injuries in Gauteng Province, South Africa, to provide employers and policy makers with the information necessary to develop SCI preventative strategies in the workplace. Methodology This was a descriptive, retrospective study in which both quantitative and qualitative methods were utilised. The research was completed in two private rehabilitation units in Gauteng Province, South Africa. During the first (quantitative) phase 135 medical files/records of persons admitted between 1999–2009, who had suffered work-related SCIs, were perused. No sampling was done. Data was collected using a data-collection tool developed by the researcher, the International Classification of Function (ICF) checklist and the Functional Independence Measure+Functional Assessment Measure (FIM+FAM). In the second (qualitative) phase, key informants representing employees who sustained SCI at work were interviewed. Participants were sampled purposively. Data in phase one was analysed using the Statistical Package for the Social Sciences, version 18, and content analysis was used to analyse qualitative data. Results The most affected age range was 26–35. The male-to-female ratio was 6.69:1. Blacks (79.3%) were more affected by work-related SCIs. The majority of these occurred in urban (49.6%) and peri-urban (39.3%) areas. The service (34.8%), engineering (14.8%), mining (14%) and construction (9.6%) were the most affected industries. The most affected occupations were labourers (25.9%) and professionals (23.7%). The security cluster (police and security officers) within the service industry was the most affected (55.3%). Motor vehicle accidents (48.9%), violence (20.7%) and falls (16.3%) were the major causes of work-related SCIs. The most affected region of the spine was cervical (41.5%) although the majority were classified as paraplegic (58.5% sustained thoracic and lumbar lesions). The majority (51% of work-related SCIs were classified as complete). The average length of stay (LOS) in-patient rehabilitation was 65.76 days. There was a marginal correlation between LOS and functional FIM+FAM scores (r=-0.32). The average cost of rehabilitation was R101 386.84 per person. There were statistically significant functional gains following rehabilitation (p=0.000). Re-employment levels were high, at 54%. Participants with lumbar lesions showed statistically higher re-employment levels than those with other level lesions (p=0.036). The findings of phase two of the study showed a degree of non-compliance of employees and employers to safety standards in the workplace. Conclusions and recommendations Findings indicated high levels of motor vehicle accidents and gunshot wounds. Motor vehicle accidents could, in some cases be related to un-roadworthy vehicles or transgressing traffic laws. Employers and employees should adhere to national laws as well as internal health and safety regulations in order to reduce SCI at work. In addition a national database on work-related SCI should be kept. Training of employees and employers in compliance in health and safety matters in the workplace is necessary. Monitoring of compliance by both employees and employers should be vigorous.

AFRIKAANSE OPSOMMING: Inleiding Individue se funksie en sosiale deelname word negatief beinvloed deur `n spinaalkoordbesering. Suid Afrika beskik oor `n goeie wetlike raamwerk wat gesondheid en veiligheid in die werkplek bevorder, maar daar bestaan geen spesifieke riglyne vir die voorkoming van spinaalkoordbeserings in die werkplek nie. Dit is belangrik dat alle belanghebbendes die huidge situasie verstaan voordat enige voorkomende programme van stapel gestuur kan word. Die doel van die studie was om werkverwante spinaalkoordbeserings in Gauteng Provinsie, Suid-Afrika, te beskryf, om sodoende werkgewers en beleidmakers te voorsien met die nodige inligting om voorkomende strategieë te ontwikkel. Metodologie Gemengde metodes van data insameling en ontleding is in hierdie beskrywende, retrospektiewe studie gebruik. Die navorsing is in twee privaat Rehabilitasie Eenhede in Gauteng Provinsie, Suid-Afrika gedoen. Gedurende die kwantitatiewe fase van die studie is inligting ingesamel uit 135 mediese rekords van persone wat werkverwante spinaalkoordbeserings opgedoen het en tussen 1999 en 2009 rehabilitasie in een van die twee eenhede ontvang het. Geen steekproefneming is gedoen. Data is ingesamel deur gebruik te maak van 'n data-insameling instrument wat deur die navorser ontwikkel is, die ICF checklist en die FIM+FAM. In die tweede (kwalitatiewe) fase is onderhoude met sleutel informante i.e. werknemers wat spinaalkoordbeserings by die werk opgedoen het, gedoen. Data in fase een is ontleed met behulp van SPSS weergawe 18 en tematiese analise is gebruik om kwalitatiewe data te analiseer. Resultate Die mees geaffekteerde ouderdomsgroep was 26-35. Die verhouding tussen mans en vrouens wat beserings opgedoen het was 6.69:1. Lede van die swart bevolkingsgroep het die mees algemeenste voorgekom onder die deelnemers (79,3%). Die meerderheid van beserings het in stedelike (49,6%) en semi-stedelike gebiede (39,3%) voorgekom. Die industrieë waar beserings die mees algemeenste voorgekom het was dienslewering (34,8%), ingenieurswese (14,8%), mynbou (14%) en konstruksie (9.6%). Arbeiders (25,9%) en professionele mense (23,7%) was die beroepe waarin dit die meeste voorgekom het. Polisie en sekuriteits beamptes (55.3%) was die meeste geraak in die diens industrie. Motorvoertuigongelukke (48,9%), geweld (20,7%) en valle (16,3%) was die grootste oorsake van die beserings. Die meeste beserings het aan die servikale (41.5%) deel van die rug voorgekom, alhoewel daar in totaal meer persone was met paraplegie (58.5% torakale en lumbale letsels). Die meeste beserings was volledig (51%). Die gemiddelde lengte van binne pasient verblyf was 65,76 dae. Daar was 'n marginale korrelasie tussen lengte van verblyf en Funksionele FIM+FAM tellings (r= -0.32). Die gemiddelde koste van rehabilitasie was R101 386.84 per persoon. Deelnemers het statisties beduinde funksionele vordering gemaak tydens rehabilitasie (p=0.000). Vier en vyftig persent van deelnemers het teruggekeer na `n werk na rehabilitasie. `n Lumbale letsel het deelnemers se kanse om terug te keer na werk statisties beduidend verhoog (p=0.036). Bevindinge in die tweede fase van die studie het daarop gedui dat werknemers en werkgewers nie altyd veiligheidsreëls en regulasies in die werkplek gevolg nie het nie. Gevolgtrekkings en aanbevelings Motorvoertuigongelukke en skietwonde het tot baie van die beserings gelei. In sommige gevalle kon die motorvoertuigongeluk toegeskryf word aan onpadvaardige voertuie of oortreding van verkeerswette. Werkgewers en werknemers moet aan landswette sowel as interne veiligheids reëls gehoorsaam wees om die voorkoms van spinaalkoordbesering in die werkplek te verminder. Voorts moet `n nasionale databasis van werk verwante spinaalkoordbeserings in die lewe geroep word. Werknemers en werkgewers moet opgelei word ten opsigte van veiligheid in die werkplek. Die nakoming van veiligheidsreels en regulasies deur beide werknemers and werkgewers moet ferm gemonitor word.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/79812
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