Published: 19-05-2016 14:11 | Updated: 20-05-2016 02:24

Assault is the most common cause of traumatic spinal cord injury in South Africa

The number of people who suffer a traumatic spinal cord injury (TSCI) in South Africa are among the highest in the world, and the most common cause of the TSCIs is assault. In a new thesis, Conran Joseph, doctoral student at the Division of Physiotherapy, presents the epidemiology of TSCI in Sweden and in South Africa.

Dissertation on May 20, see further information here.

What´s the main focus of your thesis?

My thesis examined the epidemiology of traumatic spinal cord injuries (TSCI), that is, how many people are affected by it per year and how it is caused, in two contextually-different contexts – Cape Town, South Africa and Stockholm, Sweden.

As we may know, such an injury causes an unprecedented change in the lives of those affected by it, in that it greatly impact health and functioning. In addition, it poses an enormous burden on society. Because of the personal experiences of a TSCI and its associated healthcare costs, it remains important to prevent this devastating health condition. This thesis aimed to determine how many people sustained a TSCI in one-year, in both contexts, the mechanisms (how it is caused) of injury, and who are at most risk. Another aim was to investigate the met and unmet needs, specifically rehabilitation, of persons with TSCI.

Which are the most important results?

We found that the number of persons affected by TSCI in South Africa was among the highest in the world, whereas the number of injuries in Sweden corresponded well with figures found in other Western European countries. Very uniquely, the leading cause of injury in South Africa was assault, which accounted for more than the majority of cases, whereas the leading of injury in Sweden was due to falls.

We further found that the need exists to adopt outcome measures that reflect the typical and relevant aspects of functioning (these are tasks, roles and responsibilities). Despite the shortcomings of outcome measure use in South Africa, we found that chronic survivors, that is, people living with a TSCI for more than three years, were able to effectively participate at home and in their societies, given the diverse range of challenges (for example, paralysis, obstacles in society, and unresponsiveness of authorities) that they experienced as they attempt to reclaim important elements (activities) of the past into the future.

How can this new knowledge be useful for people, or contribute to the improvement of their health?

The epidemiologic studies defining the ‘what’, ‘who’, ‘where’, ‘when’ and ‘how’ could assist with the planning of primary prevention in order to curb the occurrence of TSCI’s in South Africa and Sweden. Furthermore, this information will assist with the allocation of rehabilitation services and resources necessary for optimizing the functioning, health and wellbeing of newly-injured survivors of TSCI in both contexts. It is important to understand the experience of living with an SCI in the developing world and now by investigating the measures used to plan rehabilitation, we know that it is essential to adopt gold standard measures or develop instruments that more accurately measures what matters after an injury of this kind.

We also know that participation – one of the major goals of health care systems – is possible in resource-constraint contexts, but that negative intervening conditions seem to impact the spectrum of it. This information could be used to develop personal and context-specific rehabilitation services that improve the overall health and wellbeing after a TSCI.

What´s in the future for you? Will you keep on conducting research?

I see the past four years of doctoral education as just the start of a wonderful journey of scientific exploration and discovery, and I will continue to keep the ’individual’ at the core of my curiosity and questioning. After all, we do this to build societies that are responsive, just and fair. My plan is to remain in academia for a very long time and continue the research I have started between South Africa and Sweden.

The thesis

Traumatic spinal cord injury in South Africa and Sweden : epidemiologic features and functioning



Conran Joseph

Organizational unit: Sektionen för fysioterapi