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Background: In Uganda 13% of persons have at least one form of disability. The United Nations’ Convention on the Rights of Persons with Disabilities guarantees persons with disabilities the same level of right to access quality and affordable healthcare as persons without disability. Understanding the needs of women with walking disabilities is key in formulating flexible, acceptable and responsive health systems to their needs and hence to improve their access to care. This study therefore explores the maternal and newborn health (MNH)-related needs of women with walking disabilities in Kibuku District Uganda. Methods: We carried out a qualitative study in September 2017 in three sub-counties of Kibuku district. Four In-depth Interviews (IDIs) among purposively selected women who had walking disabilities and who had given birth within two years from the study date were conducted. Trained research assistants used a pretested IDI guide translated into the local language to collect data. All IDIs were audio recorded and transcribed verbatim before analysis. The thematic areas explored during analysis included psychosocial, mobility, health facility and personal needs of women with walking disabilities. Data was analyzed manually using framework analysis. Results: We found that women with walking disabilities had psychosocial, mobility, special services and personal needs. Psychosocial needs included; partners’, communities’, families’ and health workers’ acceptance. Mobility needs were associated with transport unsuitability, difficulty in finding transport and high cost of transport. Health facility needs included; infrastructure, and responsive health services needs while personal MNH needs were; personal protective wear, basic needs and birth preparedness items. Conclusions: Women with walking disabilities have needs addressable by their communities and the health system. Communities, and health workers need to be sensitized on these needs and policies to meet and implement health system-related needs of women with disability.
We carried out a cross sectional qualitative study in September 2017 using In-depth Interviews (IDIs) to explore the maternal and newborn health experiences of WWD who had given birth between September 2015 and September 2017. WWD were selected as the study participations because studies have shown that they are often marginalized and do not easily access maternal and newborn health services [9], [17]. This study was carried out in Kibuku District, which is located in the Eastern region of Uganda with a population of 202,033 people and with 52% of the population being female. People with walking disabilities aged over 2 years account for 4% of Kibuku’s population or 7, 109 people [19]. Kibuku’s predominately rural population is mostly engaged in crop farming, animal husbandry, petty trading, and brick making. Kibuku has two counties, namely Kabweri and Kibuku, 17 sub-counties and 86 parishes. This study was carried out in 3 sub-counties (Kibuku town council, Kibuku rural, and Goligoli) as it was part of a larger study to inform a community scorecard intervention. We conducted 4 in-depth interviews (IDIs) with purposively selected participants in the sub-counties of Kadama, Kibuku rural, and Goligoli. Through the District Health Office, the Village Health Team (VHT) coordinators of the three different sub-counties were asked to identify any WWD who had given birth between September 2015 and September 2017. Only four WWD who fitted our desired criteria were identified from all the three sub counties. The reason we restricted selection to WWD who had given birth two years before the study date was to take advantage of the relatively fresh MNH experiences and to reduce potential retention bias among the participants. The IDIs were conducted within the participants’ homes to explore the MNH needs of WWD. We recruited two experienced female research assistants who had a good working knowledge of English and of Lugwere (the local language) and trained them in data collection. Investigators also actively participated in the data collection process. We translated the IDI guide from English to Lugwere, then back-translated and compared to ensure consistency and pre-tested the IDI guide in Kampala district, Central Uganda. We received written consent from participants to participate in the study and to audio record interviews that lasted on average two hours. The research assistants transcribed the IDIs verbatim taking care not to alter meaning since the interviews were in the local language. We analyzed the data manually using framework analysis [20, 21]. The typed transcripts were each read several times and a thematic framework was developed based on psychosocial, mobility, health facility and personal needs. We then systematically applied this framework to each of our transcripts and sifted, charted and sorted material according to key issues and themes. Quotes from the transcripts that elaborately illustrated meanings or key message from the analysis were also identified. Ethical clearance was obtained from the Makerere University School of Public Health Research and Ethics Committee (MakSPH HDREC) and approval from the Uganda National Council of Science and Technology (UNCST), study number SS 4323. Permission to carry out the research was further sought from the Kibuku District Health Office. The objectives, benefits and risks of the study were explained to the study participants and written informed consent obtained from all the four WWD. All data obtained during the study were treated as confidential and anonymous identifiers were used. We restricted data access to only the investigators and the two research assistants.
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