Economic and Livelihood Impacts of Caregiving for People with Epilepsy in Rural South Africa: A Focused Secondary Qualitative Analysis

Informal caregiving for people with epilepsy may involve financial pressures and restricted livelihood opportunities. This focused secondary qualitative analysis examined 60 caregiver interviews from Limpopo and Mpumalanga Provinces, South Africa, originally collected to explore caregiving experiences and social acceptability. The sample comprised 30 participants per province, including 46 women and 14 men. All transcripts were reanalysed using inductive reflexive thematic analysis. Five themes were developed: caregiving constrained employment and income-generating opportunities; caregiving created direct financial costs for households; continuous supervision disrupted everyday livelihood activities; families depended on social grants, relatives and community support; and caregivers’ accounts of cumulative household economic vulnerability. Participants described leaving or declining employment, interrupting education, meeting transport and everyday care expenses, and relying on grants, relatives, borrowing or irregular work. These findings represent reported experiences rather than quantified economic impacts. Although categorical participant characteristics were available, changes in earnings and caregiving expenditure were not systematically measured. Care recipients’ clinical characteristics and functional independence were not systematically assessed. The Caregiving Stress Process Model and Sustainable Livelihoods Framework supported interpretation after theme development; the proposed relationships were not validated causal pathways. This analysis extends earlier publications from the same dataset by examining connections among livelihood restrictions, reported expenses and household resources. Epilepsy services should consider caregivers’ livelihood circumstances during assessment and referral. Potential transport, social-protection and shared-care responses require further evaluation.