How do carers of disabled children cope? The Ugandan perspective.
BACKGROUND
Community-based rehabilitation (CBR) was recommended by the World Health Organization in 1989 as the strategy for improving the quality of life of disabled people and their families, which should be built on local knowledge and practices. In Uganda, there is no documentation on how services relate to local knowledge. There is a need for increased knowledge and understanding of how family members cope with their disabled children to provide the basis for future service development.


METHODS
A qualitative phenomenological design was used to develop an in-depth understanding of how Ugandan families cope with their disabled children in their own communities. Data were collected from 52 families with children with disabilities from five impairment groups, through interviews and observations in three districts of Uganda, one urban, two rural.


RESULTS
There are many children with disabilities who are included, loved and cared for by their families. A lot of time and money is spent on seeking a cure. The extended family systems are breaking down and the main burden of caring for a disabled family member generally falls on one, sometimes two, female carers. Male members act as gatekeepers, controlling the key decisions concerning the child and the associated resources.


CONCLUSIONS
CBR should move the focus of their services away from the disabled individual towards the whole family. It is important to provide accurate information about causes and prevention of impairments, the realities of a cure, support and respite for the female carers, and opportunities for the involvement of fathers. This methodology is a practical mechanism for collecting data that have the potential to positively influence and guide the development of CBR practice in the locality. At a conceptual level the data support the philosophy of inclusion, social integration, the importance of trust and respect, and utilizing a holistic approach. These are eminently transferable to other settings.
Hartley
S
S
The Centre of International Child Health, Institute of Child Health, London University, London, UK. s.hartley@ich.ucl.ac.uk
Ojwang
P
P
Baguwemu
A
A
Ddamulira
M
M
Chavuta
A
A
D000223:Adaptation, Psychological; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology*; D002648:Child; D003142:Communication; D017281:Cost of Illness; D019988:Children with Disabilities / Q000193:education / Q000534:rehabilitation*; D005190:Family; D005260:Female; D006266:Health Education; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D010342:Patient Acceptance of Health Care; D011203:Poverty / Q000191:economics; D013315:Stress, Psychological / Q000523:psychology; D014454:Uganda