Who gets the disability grant in South Africa? An analysis of the characteristics of recipients in urban and rural areas.

BACKGROUND: This study was to establish whether there was a difference in the characteristics of people who received a disability grant and those who did not in rural and urban samples of isiXhosa-speaking people with disability in South Africa. SAMPLE: The sample was a convenience sample and was identified through a 'snowballing' process. INSTRUMENTATION: A demographic survey and isiXhosa versions of the International Classification of Functioning, Disability and Health (ICF) and EQ-5D, a health-related quality of life measure were utilized. RESULTS: The sample consisted of 244 rural and 61 urban respondents, demonstrating a preponderance of physical disabilities. The groups who received or did not receive grants were equivalent in terms of age, gender, marital status and employment status. A significantly higher proportion of rural dwellers accessed the grant. The grant holders displayed significantly more problems related to mobility and to technology and policies and services relating to mobility and transport. Those who did not receive grants reported more barriers with regard to the attitudes of health workers but not with regard to any other aspect of social support. CONCLUSIONS AND RECOMMENDATIONS: The majority of men and women with disability identified in this study received the grant, whether or not they lived in remote rural or in urban areas. As there were few differences between the groups, it is likely that several non-grant holders might qualify if they were informed of the grant and applied. The role of medical doctors as 'gatekeepers' to the grant might need to be examined.

Exploring ICF components in a survey among Xhosa speakers in Eastern & Western Cape, South Africa.

PURPOSE: To contribute to the testing and development of the ICF model by exploring the relationship between activity limitations, participation restrictions and environmental barriers. METHOD: Structured questionnaire-based interviews were carried out among a convenience sample of 950 households counting 4917 individuals in Eastern and Western Cape, South Africa. Approximately half of the households had at least one individual with disability, while the other half represented controls in the study. Activity limitations, participation restrictions and environmental barriers were operationalized by means of questions drawn directly from the ICF checklist. RESULTS: Principal component analyses supported a four-component solution for the activity and participation variables, and a two-component solution for the barrier variables. Scales for each sub-component were produced by adding the individual items under each sub-component. Male respondents are more restricted than females when it comes to social activities, individual care, education and mobility barriers. While respondents in Western Cape scored higher (more limitations and restrictions) on the activity and participation sub-scales individual care, daily activities and education, Eastern Cape respondents scored higher on both the environmental barrier sub-scales. CONCLUSIONS: A viable structure of sub-components under the broader ICF concepts has been demonstrated. The study has provided some support to viewing activity limitations and participation restrictions as two independent dimensions, but also invites further studies and refinement of the model.

The determinants of health-related quality of life in urban and rural isi-Xhosa-speaking people with disabilities.

This study aimed to establish the determinants of health-related quality of life in a rural and an urban sample of Xhosa-speaking people with disability. The sample was a convenience sample and was identified through a 'snowballing' process initiated by enumerators who were all members of Disabled People South Africa. The Xhosa version of the EQ-5D was utilized and the visual analogue scale which ranges from 0 (worst imaginable health state) to 100 (best imaginable health state) was used as the dependent measure. The sample consisted of 244 rural and 61 urban respondents, demonstrating a preponderance of physical disabilities. The urban sample reported more problems in each of the descriptor domains. The visual analogue scale score showed a bimodal distribution. The results of the multiple regression analysis indicated that the presence of pain detracted most from health-related quality of life (-20%), followed by anxiety and depression (-10%), and difficulty with performance of usual activities (-10%). Rural participants, with the same impairment level, reported 8% poorer health-related quality of life. The mean visual analogue scale scores were low (in the 60s), and would indicate that the majority of people living with disability do not necessarily adapt to their functional limitations and continue to experience diminished health-related quality of life. The bimodal distribution, however, did indicate that some respondents enjoyed good health-related quality of life. There is a need to manage symptoms, particularly pain and depression, as these have a severe negative impact on health-related quality of life. The rural setting seemed to contribute to a worse perceived health-related quality of life. This effect needs to be factored in when evaluating programmes.