1
|
Kankam K, Murray L. Rehabilitation of post-stroke aphasia in Ghana. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:1308-1321. [PMID: 38156768 DOI: 10.1111/1460-6984.13000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Aphasia, a common consequence of stroke, which affects both communication and social functioning, and in turn, quality of life, is on the rise due to increases in stroke prevalence and survival rate. The rehabilitation of post-stroke aphasia primarily falls within the purview of speech-language pathology and research supports the effectiveness of such services. However, provision of aphasia rehabilitation services in sub-Saharan Africa is associated with challenges. AIMS This study aimed to examine rehabilitation services for individuals with post-stroke aphasia in Ghana by exploring the roles of the stakeholder groups involved in the assessment and treatment of post-stroke aphasia in Ghana, as well as the challenges they encounter in providing or identifying services. The stakeholder groups included educational institutions, interdisciplinary healthcare professionals, and family caregivers of individuals with post-stroke aphasia. METHODS & PROCEDURES A qualitative case study approach was used to collect and integrate from multiple sources data such as demographic information, interview responses and program syllabi to develop a holistic image. Fifteen respondents from the stroke and speech therapy units at Komfo Anokye and Korle-Bu Teaching Hospitals, University of Ghana, and University of Health and Allied Sciences, Ghana were purposively sampled. Interview questions were developed and centred on aphasia education and training, knowledge of speech-language pathology services, speech-language pathology service delivery, access to speech-language pathology services, challenges in both delivery and access to speech-language pathology services and suggestions for improving speech-language pathology services. In-person and virtual interviews were conducted after demographic information was collected. Interviews were analysed thematically, and demographic information and program syllabi were triangulated with the interview data collected. OUTCOMES & RESULTS All stakeholder groups identified concerns with current aphasia services in Ghana. Issues raised included the insufficient number of speech-language pathologists, lack of awareness of speech-language pathology services for post-stroke aphasia (among healthcare professionals and the public), absence of aphasia management information and clinical training in educational programming, lack of interest in speech-language pathology training programs, financial challenges, spiritual and traditional beliefs and geographic barriers (i.e., speech-language pathology services are currently available in only a few cities). CONCLUSIONS & IMPLICATIONS These findings emphasised the need to improve post-stroke aphasia rehabilitation in Ghana. The process of data collection itself educated respondents on the importance of post-stroke aphasia rehabilitation, and by identifying barriers, strategies to improving services, such as designing standardised aphasia assessments for the Ghanaian context, can now be initiated. WHAT THIS PAPER ADDS What is already known on the subject To address post-stroke aphasia, evidence-based speech-language pathology services are provided. However, there is a paucity of studies on post-stroke aphasia services in Ghana, preventing an accurate report of services and practices in the country. What this study adds This study provides an overview of the existing rehabilitation services for post-stroke aphasia in Ghana. It highlights challenges facing the existing services and suggested strategies to improve post-stroke aphasia services. What are the clinical implications of this work? The study created awareness among healthcare professionals and general public (study participants) about the importance of rehabilitation services for post-stroke aphasia. Based on the study findings, appropriate stakeholders such as policy makers, researchers, and healthcare professionals can further design assessments and interventions to improve rehabilitation, including speech-language pathology services, for post-stroke aphasia in Ghana.
Collapse
Affiliation(s)
- Keren Kankam
- Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Laura Murray
- Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
2
|
Liang Y, Lin Y, Jiao B. Health Interventions May Have Divergent Impacts on Health and Economic Equity: A Case Study of the Community-Based Hypertension Improvement Project in Ghana. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:353-362. [PMID: 38267804 DOI: 10.1007/s40258-024-00871-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND OBJECTIVE Improving health and economic equity are key objectives in priority setting, particularly in low-income and middle-income countries. This study aims to assess the distributional impacts of the Community-based Hypertension Improvement Project (ComHIP) on health and economic outcomes across wealth quintiles in Ghana. METHODS We developed a decision analytical model to simulate a 30 million cohort of Ghanaians aged 15-49 years. The study specified health outcomes as the prevention of stroke cases and averting deaths among those with hypertension. Furthermore, we explored economic impacts, including savings in out-of-pocket costs for stroke patients and government spending. Financial risk protection against catastrophic and impoverishing health expenditures was also examined. We assessed these outcomes across wealth quintiles, and the corresponding concentration indexes (CIXs) were determined. RESULTS It was estimated that ComHIP could prevent 1450 stroke cases and 564 related deaths annually. Health benefits were observed to be more significant among the wealthier quintiles (CIX 0.217), mainly attributed to a higher occurrence of hypertension within these groups. ComHIP was also projected to result in an annual saving of USD 49,885 in individuals' out-of-pocket costs (CIX 0.262) and USD 37,578 in government spending (CIX 0.146). These savings correspond to the prevention of 335 catastrophic health expenditure cases (CIX - 0.239) and 11 impoverishing health expenditure cases (CIX - 0.600). CONCLUSIONS While ComHIP provides greater health benefits to wealthier groups, it offers substantial financial risk protection for the less wealthy. This study highlights the importance of considering equity in both health and financial risk when making priority-setting decisions.
Collapse
Affiliation(s)
- Yizhi Liang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 90 Smith St, Boston, MA, 02120, USA
| | - Yuqian Lin
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 90 Smith St, Boston, MA, 02120, USA
| | - Boshen Jiao
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 90 Smith St, Boston, MA, 02120, USA.
| |
Collapse
|
3
|
Doku A, Tuglo LS, Boima V, Agyekum F, Aovare P, Ali Abdulai M, Godi A, Peters RJG, Agyemang C. Prevalence of Cardiovascular Disease and Risk Factors in Ghana: A Systematic Review and Meta-analysis. Glob Heart 2024; 19:21. [PMID: 38404614 PMCID: PMC10885824 DOI: 10.5334/gh.1307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024] Open
Abstract
Background The increasing cardiovascular disease (CVD) burden threatens the global population as the major cause of disability and premature death. Data are scarce on the magnitude of CVD among the population in West Africa, particularly in Ghana. This study examined the available scientific evidence to determine the pooled prevalence (PP) of CVD and risk factors in Ghana. Methods We searched electronic databases such as PubMed, Google Scholar, the Cochrane Library, Science Direct and Africa Journal Online databases to identify literature published from the start of the indexing of the database to 10th February 2023. All articles published in the English language that assessed the prevalence of CVD or reported on CVD in Ghana were included. Two authors independently performed the study selection, assessed the risk of bias, extracted the data and checked by the third author. The effect sizes and pooled odds ratio (POR) were determined using the random-effects DerSimonian-Laird (DL) model. Result Sixteen studies with 58912 participants from 1954 to 2022 were included in the meta-analysis. Six studies out of 16 reported more than one prevalence of CVD, giving a total of 59 estimates for PP. The PP of CVD in the general population in Ghana was 10.34% (95% Cl: [8.48, 12.20]; l2 99.54%, p < 0.001). Based on the subgroup analysis, the prevalence of CVD was higher in hospital-based settings at 10.74% (95%, confidence interval [Cl]: 8.69, 12.79) than in community-based settings at 5.04% (95% Cl: 2.54, 7.53). The risk factors were male gender (pooled odds ratio [POR]: 1.66; 95% CI: 1.02, 2.70), old age (POR: 1.32; 95% CI: 1.21, 1.45), unemployment (POR: 2.62; 95% CI: 1.33, 5.16), diabetes (POR: 2.79; 95% CI: 1.62, 4.81) and hypertension (POR: 3.41; 95% CI: 1.75, 6.66). Conclusion The prevalence of CVD was high in Ghana. Urgent interventions are needed for the prevention and management of the high burden of CVD and its risk factors.
Collapse
Affiliation(s)
- Alfred Doku
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
- National Cardiothoracic Centre, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Lawrence Sena Tuglo
- Department of Nutrition and Dietetics, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
- Department of Epidemiology, School of Public Health, Nantong University, 9 Seyuan Road, Nantong, Jiangsu, China
| | - Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
| | - Francis Agyekum
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Pearl Aovare
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
| | - Martha Ali Abdulai
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, P.O Box 200, Kintampo-B/E, Ghana
| | - Anthony Godi
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ron J. G. Peters
- Department of Cardiology, University Amsterdam Medical Center, University of Amsterdam, Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
| |
Collapse
|
4
|
Ackah M, Ameyaw L, Appiah R, Owiredu D, Boakye H, Donaldy W, Yarfi C, Abonie US. 30-day in-hospital stroke case fatality and significant risk factors in sub-Saharan-Africa: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002769. [PMID: 38241232 PMCID: PMC10798456 DOI: 10.1371/journal.pgph.0002769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/01/2024] [Indexed: 01/21/2024]
Abstract
Existing studies investigating 30-day in-hospital stroke case fatality rates in sub-Saharan Africa have produced varying results, underscoring the significance of obtaining precise and reliable estimations for this indicator. Consequently, this study aimed to conduct a systematic review and update of the current scientific evidence regarding 30-day in-hospital stroke case fatality and associated risk factors in sub-Saharan Africa. Medline/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycNet (encompassing PsycINFO and PsychArticle), Google Scholar, and Africa Journal Online (AJOL) were systematically searched to identify potentially relevant articles. Two independent assessors extracted the data from the eligible studies using a pre-tested and standardized excel spreadsheet. Outcomes were 30-day in-hospital stroke case fatality and associated risk factors. Data was pooled using random effects model. Ninety-three (93) studies involving 42,057 participants were included. The overall stroke case fatality rate was 27% [25%-29%]. Subgroup analysis revealed 24% [21%-28%], 25% [21%-28%], 29% [25%-32%] and 31% [20%-43%] stroke case fatality rates in East Africa, Southern Africa, West Africa, and Central Africa respectively. Stroke severity, stroke type, untyped stroke, and post-stroke complications were identified as risk factors. The most prevalent risk factors were low (<8) Glasgow Coma Scale score, high (≥10) National Institute Health Stroke Scale score, aspiration pneumonia, hemorrhagic stroke, brain edema/intra-cranial pressure, hyperglycemia, untyped stroke (stroke diagnosis not confirmed by neuroimaging), recurrent stroke and fever. The findings indicate that one in every four in-hospital people with stroke in sub-Saharan Africa dies within 30 days of admission. Importantly, the identified risk factors are mostly modifiable and preventable, highlighting the need for context-driven health policies, clinical guidelines, and treatments targeting these factors.
Collapse
Affiliation(s)
- Martin Ackah
- Faculty of Health and Life Sciences Northumbria University University, Department of Sport, Exercise & Rehabilitation, Newcastle upon Tyne, United Kingdom
| | - Louise Ameyaw
- Department of Medicine, Achimota Government Hospital, Accra, Ghana
| | - Richard Appiah
- Faculty of Health and Life Sciences Northumbria University University, Department of Psychology, Newcastle upon Tyne, United Kingdom
- Department of Occupational therapy, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
| | - David Owiredu
- Centre for Evidence synthesis, University of Ghana, Accra, Ghana
| | - Hosea Boakye
- Department of Physiotherapy, LEKMA Hospital, Accra, Ghana
| | | | - Comos Yarfi
- Department of Physiotherapy, University of Allied and Health Sciences, Ho, Ghana
| | - Ulric S. Abonie
- Faculty of Health and Life Sciences Northumbria University University, Department of Sport, Exercise & Rehabilitation, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
5
|
Sarfo FS, Boateng R, Opare-Addo PA, Gyamfi RA, Nguah SB, Ovbiagele B. Prevalence and predictors of low folate levels among stroke survivors in a country without mandatory folate food fortification: Analysis of a Ghanaian sample. J Stroke Cerebrovasc Dis 2023; 32:107239. [PMID: 37480805 PMCID: PMC10529575 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND While additional folic acid (FA) treatment has a neutral effect on lowering overall vascular risk in countries that mandate FA fortification of food, meta-analytic data suggest that folate supplementation reduces stroke risk in certain patient subgroups, and among people living in countries without mandatory folate food fortification. However, the burden of folate deficiency among adults with stroke in the world's poorest continent is unknown. PURPOSE To assess the prevalence and predictors of folate deficiency among recent ischemic stroke survivors. METHODS We analyzed data among consecutively encountered ischemic stroke patients aged ≥18 years at a tertiary medical center in Kumasi, Ghana between 10/2020 - 08/2021. We identified a modest sample of stroke free adults to serve as a comparator group. Fasting serum folate was measured using a radioimmunoassay and a cut-off of 4ng/mL used to define folate deficiency. Factors associated with serum folate concentration were assessed using a multilinear regression model. RESULTS Comparing stroke cases (n = 116) with stroke-free comparators (n = 20), mean folate concentration was lower among stroke cases (7 ng/ml vs. 10.2 ng/ml, p = 0.004). Frequency of folate deficiency was higher among stroke cases vs. stroke-free controls (31% vs 5%, p = 0.02). Male sex (beta coefficient of -2.6 (95% CI: -4.2, -0.9) and LDL (β: -0.76; -1.4, -0.07) were significantly associated with serum folate concentration. CONCLUSION Almost one in three ischemic stroke survivors have folate deficiency potentially accentuating their risk for further adverse atherosclerotic events in a setting without folate fortification. A clinical trial of folate supplementation among stroke survivors is warranted.
Collapse
Affiliation(s)
- Fred Stephen Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | | | | | | | - Samuel Blay Nguah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, USA
| |
Collapse
|
6
|
Zheng Z, Li C, Xie RH, Xie H, Fu F, Pan Y, Liao J, Chen X, Yue L. Effectiveness of telehealth interventions on depression symptoms after stroke: A systematic review and meta-analysis. J Affect Disord 2023:S0165-0327(23)00730-9. [PMID: 37247784 DOI: 10.1016/j.jad.2023.05.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Depression symptoms are common after stroke, and affect survivors' recovery of neurological function, ability to return to society, and quality of life. Telehealth has been shown to improve depression symptoms and quality of life among patients post-stroke. However, evidence from clinical trials has not previously been systematically synthesized. OBJECTIVE This study aimed to systematically evaluate the effectiveness of telehealth interventions in reducing depression symptoms among patients post-stroke. METHODS Following the PRISMA guidelines, we conducted a meta-analysis of randomized control trials of telehealth interventions for post-stroke depression symptoms. The quality of included studies was assessed using the Cochrane risk of bias tool. RevMan 5.4 software was used for the meta-analysis. Data were synthesized by fixed (I2 ≤ 50 %) or random (I2 > 50 %) effects models based on a heterogeneity test. RESULTS In total, 10 studies with 1717 participants were included, eight of which were eligible for the meta-analysis. There were no significant differences in efficacy between the telehealth and control groups for depression symptoms (standardized mean difference [SMD] = -0.16, 95 % confidence interval [CI] -0.67 to 0.36; P = .54), quality of life (SMD = 0.00, 95%CI -0.18 to 0.18; P = .99), limb function (SMD = 0.46, 95%CI -0.26 to 1.18; P = .21), and daily living ability (SMD = 0.38, 95%CI -1.39 to 2.15; P = .67). The telemedicine group had significantly lower anxiety scores than the control group (SMD = -1.05, 95%CI -1.22 to -0.89; P < .001). LIMITATIONS The number of RCTs included in the review was relatively small. CONCLUSIONS The efficacy of telehealth interventions in reducing depression symptoms in patients post-stroke is no different from conventional nursing. However, large-scale, high-quality randomized controlled trials are needed to further explore the potential of telehealth interventions in improving mental health among patients post-stroke.
Collapse
Affiliation(s)
- Zhimin Zheng
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Chunxia Li
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ri-Hua Xie
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China; Department of Nursing, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
| | - Hualing Xie
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Fen Fu
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yuhua Pan
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jinyu Liao
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaoying Chen
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Liqun Yue
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
| |
Collapse
|
7
|
Uvere EO, Nichols M, Ojebuyi BR, Isah SY, Calys-Tagoe B, Jenkins C, Obiako R, Owolabi L, Akpalu A, Sarfo FS, Ogunronbi O, Adigun M, Fakunle GA, Hamzat B, Laryea R, Uthman B, Akinyemi JO, Adeleye O, Melikam L, Balogun O, Sule A, Adeniyi S, Asibey SO, Oguike W, Olorunsogbon O, Singh A, Titiloye MA, Musbahu R, Wahab KW, Kalaria RN, Jegede AS, Owolabi MO, Ovbiagele B, Arulogun OS, Akinyemi RO. Capacity-Building for Stroke Genomic Research Data Collection: The African Neurobiobank Ethical, Legal, and Social Implications Project Experience. Biopreserv Biobank 2023; 21:158-165. [PMID: 35759418 PMCID: PMC10125390 DOI: 10.1089/bio.2021.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The fields of stroke genomics, biobanking, and precision medicine are rapidly expanding in sub-Saharan Africa. However, the ethical, legal, and social implications (ELSI) of emerging neurobiobanking and genomic data resources are unclear in an emerging African scientific landscape with unique cultural, linguistic, and belief systems. Objective: This article documents capacity-building experiences of researchers during the development, pretesting, and validation of data collection instruments of the African Neurobiobank for Precision Stroke Medicine-(ELSI) Project. Methods: The African Neurobiobank for Precision Stroke Medicine-ELSI project is a transnational, multicenter project implemented across seven sites in Ghana and Nigeria. Guided by the Community-Based Participatory Research framework, we conducted three workshops with key stakeholders to review the study protocol, ensure uniformity in implementation; pretest, harmonize, and integrate context-specific feedback to ensure validity and adaptability of data collection instruments. Workshop impact was assessed using an open-ended questionnaire, which included questions on experience with participation in any of the workshops, building capacity in Genetic and Genomic Research (GGR), level of preparedness toward GGR, the genomic mini-dictionary developed by the team, and its impact in enhancing understanding in GGR. Data were analyzed qualitatively using a thematic framework approach. Results: Findings revealed the usefulness of the workshop in improving participants' knowledge and capacity toward GGR implementation. It further identified local, context-specific concerns regarding quality data collection, the need to develop culturally acceptable, genomic/biobanking data collection tools, and a mini-dictionary. Participants-reported perceptions were that the mini-dictionary enhanced understanding, participation, and data collection in GGR. Overall, participants reported increased preparedness and interest in participating in GGR. Conclusion: Capacity-building is a necessary step toward ELSI-related genomic research implementation in African countries where scholarship of ELSI of genomics research is emerging. Our findings may be useful to the design and implementation of ELSI-GGR projects in other African countries.
Collapse
Affiliation(s)
- Ezinne O. Uvere
- Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Michelle Nichols
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Babatunde R. Ojebuyi
- Department of Communication and Language Arts, University of Ibadan, Ibadan, Nigeria
| | | | | | - Carolyn Jenkins
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Olumayowa Ogunronbi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Muyiwa Adigun
- Department of Law, University of Ibadan, Ibadan, Nigeria
| | | | - Bello Hamzat
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Ruth Laryea
- University of Ghana Medical School, Accra, Ghana
| | - Babatunde Uthman
- Department of Epidemiology & Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Joshua O. Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Osi Adeleye
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Lois Melikam
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Olubukola Balogun
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Abdullateef Sule
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Sunday Adeniyi
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Shadrack O. Asibey
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wisdom Oguike
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Olorunyomi Olorunsogbon
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Arti Singh
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Musibau A. Titiloye
- Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rabiu Musbahu
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Kolawole W. Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Rajesh N. Kalaria
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ayodele S. Jegede
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa O. Owolabi
- Department of Medicine, University of Ibadan, Ibadan. Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, San Francisco, California, USA
| | - Oyedunni S. Arulogun
- Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rufus O. Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
8
|
Sarfo FS, Nichols M, Opare-Addo PA, Ovbiagele B. Polypill Programs to Prevent Stroke and Cut Costs in Low Income Countries: Moving From Clinical Efficacy to Pragmatic Implementation. Stroke 2023; 54:407-414. [PMID: 36689592 PMCID: PMC9909591 DOI: 10.1161/strokeaha.122.039567] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/16/2022] [Indexed: 01/24/2023]
Abstract
Current projections are that the already overwhelming burden of strokes and atherosclerotic cardiovascular diseases in low- and middle-income countries (LMICs) will continue to rise over the coming decades as the prevalence of traditional vascular risk factors burgeon in these countries. Cardiovascular polypills containing combinations of antihypertensive(s), a statin, with or without aspirin or folic acid in the form of a single pill, represent a viable strategy for both primary and secondary prevention of atherosclerotic cardiovascular diseases in LMICs. Large multicenter trials in LMIC and high-income country (HIC) settings have now clearly demonstrated the beneficial effects of the cardiovascular polypill versus placebo (or usual care) in reducing primary stroke risk by 50%. For survivors of a recent myocardial infarction residing in HICs, the polypill reduced risk of major cardiovascular events by 25% due to improved treatment adherence. Data on the clinical efficacy of the polypill for secondary stroke prevention are scanty both in HICs and LMICs. Cost-effectiveness analyses data from LMICs suggest cost savings with the polypill for primary and secondary prevention of stroke and atherosclerotic cardiovascular diseases. However, major contextual barriers in LMICs need to be surmounted through mixed methods research and hybrid clinical trials to assess its real-world effectiveness, before the adoption of the polypill for primary and secondary atherosclerotic cardiovascular disease prevention in routine clinical practice.
Collapse
Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Michelle Nichols
- Department of Nursing, Medical University of South Carolina, USA
| | | | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
| |
Collapse
|
9
|
Towfighi A, Ovbiagele B. Health Equity and Actionable Disparities in Stroke: 2022 Update. Stroke 2023; 54:374-378. [PMID: 36689598 DOI: 10.1161/strokeaha.122.041892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/24/2023]
Abstract
There are stark inequities in stroke incidence, prevalence, care, and outcomes. This issue of Stroke features manuscripts from the third annual HEADS-UP (Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving) symposium, which took place the day before the International Stroke Conference in February 2022. The 2022 HEADS-UP symposium focused on clinical trials to address stroke inequities. The 2022 Edgar J. Kenton III award was awarded to Moira Kapral. In Kenton Award Lecture-Stroke Disparities Research: Learning from the Past, Planning for the Future, Kapral details 10 key considerations for researchers interested in addressing inequities in stroke. These considerations provide an insightful, evidence-based roadmap for the future of stroke inequities research. In the article, Care Transition Interventions to Improve Stroke Outcomes, Reeves et al highlight barriers faced by historically disenfranchised populations navigating transitions in the stroke continuum of care; summarize clinical trials aimed at enhancing transitions in care, particularly in historically marginalized populations; and stress the importance of co-designing future interventions with patient populations to address inequities. In Telehealth Trials to Enhance Health Equity for Patients With Stroke, Sharrief et al detail how telehealth interventions have the potential to address inequities if they are implemented in a thoughtful manner, addressing the potential factors than can exacerbate a digital divide. Finally, in Polypill Programs to Prevent Stroke and Cut Costs in Low Income Countries: From Clinical Efficacy to Implementation, Sarfo et al review the evidence for polypill strategies in primary and secondary cardiovascular disease prevention in low- and middle-income countries, who bear the majority of the worldwide burden of stroke.
Collapse
Affiliation(s)
- Amytis Towfighi
- University of Southern California, Los Angeles (A.T.)
- Los Angeles County Department of Health Services, CA (A.T.)
| | | |
Collapse
|
10
|
Promise of Physiological Profiling to Prevent Stroke in People of African Ancestry: Prototyping Ghana. Curr Neurol Neurosci Rep 2022; 22:735-743. [PMID: 36181575 DOI: 10.1007/s11910-022-01239-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Worldwide, compared to other racial/ethnic groups, individuals of African ancestry have an excessively higher burden of hypertension-related morbidities, especially stroke. Identifying modifiable biological targets that contribute to these disparities could improve global stroke outcomes. In this scoping review, we discuss how pathological perturbations in the renin-angiotensin-aldosterone pathways could be harnessed via physiological profiling for the purposes of improving blood pressure control for stroke prevention among people of African ancestry. RECENT FINDINGS Transcontinental comparative data from the USA and Ghana show that the prevalence of treatment-resistant hypertension among stroke survivors is 42.7% among indigenous Africans, 16.1% among African Americans, and 6.9% among non-Hispanic Whites, p < 0.0001. A multicenter clinical trial of patients without stroke in 3 African countries (Nigeria, Kenya, and South Africa) demonstrated that physiological profiling using plasma renin activity and aldosterone to individualize selection of antihypertensive medications compared with usual care resulted in better blood pressure control with fewer medications over 12 months. Among Ghanaian ischemic stroke survivors treated without renin-aldosterone profiling data, an analysis revealed that those with low renin phenotypes did not achieve any meaningful reduction in blood pressure over 12 months on 3-4 antihypertensive medications despite excellent adherence. For a polygenic condition such as hypertension, individualized therapy based on plasma renin-aldosterone-guided selection of therapy for uncontrolled BP following precision medicine principles may be a viable strategy for primary and secondary stroke prevention with the potential to reduce disparities in the poor outcomes of stroke disproportionately shared by individuals of African ancestry. A dedicated clinical trial to test this hypothesis is warranted.
Collapse
|
11
|
Riedmann J, Solonavalona AF, Rakotozafy AR, Ralamboson S, Endres M, Siegerink B, Siebert E, Knauss S, Emmrich JV. Proportion of stroke types in Madagascar: A tertiary-level hospital-based case series. PLoS One 2022; 17:e0276199. [PMID: 36240194 PMCID: PMC9565373 DOI: 10.1371/journal.pone.0276199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Like other countries in sub-Saharan Africa, Madagascar has a high burden of stroke. The Malagasy population is unique in sharing both African and Asian ancestry. The proportion of ischemic and hemorrhagic stroke types is unknown for this population. AIM Our aim was to establish the proportion of stroke types and known risk factors for the Malagasy population. METHODS We conducted a single-center, tertiary-level hospital-based case series. We included all patients with a CT-imaging confirmed stroke who presented at the emergency ward of the study hospital between January 1, 2017, and November 20, 2018. RESULTS Of 223 patients with CT-confirmed stroke, 57.4% (128/223, 95% CI: 51-64%) had an ischemic stroke and 42.6% (95/223, 95% CI: 36-49%) had an intracranial hemorrhage. The majority (89.5%; 85/95, 95% CI: 83-96%) of intracranial hemorrhages were intracerebral; 4.2% (4/95, 95% CI: 0-8%) had a subdural hematoma, 5.3% (5/95, 95% CI: 1-10%) had a subarachnoid hemorrhage, there was one isolated intraventricular hemorrhage (1.1%; 1/95, 95% CI: -1-3%). The prevalence of hypertension among stroke patients was high (86.6%; 187/216, 95% CI: 82-91%). CONCLUSIONS Our study is the first to report the proportion of stroke types and known risk factors in Madagascar. We find that the proportion of hemorrhagic strokes was unexpectedly higher than that reported from other countries in sub-Saharan Africa. Our findings highlight the need for a country-specific approach to stroke prevention, treatment, and rehabilitation and provide guidance on public health resource allocation in Madagascar.
Collapse
Affiliation(s)
- Julia Riedmann
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Solofo Ralamboson
- Soavinandriana Military Hospital (CENHOSOA), Antananarivo, Madagascar
| | - Matthias Endres
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Göttingen, Germany
- ExcellenceCluster NeuroCure, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Bob Siegerink
- Center for Stroke Research, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Eberhard Siebert
- Institute of Neuroradiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Samuel Knauss
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Julius Valentin Emmrich
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- * E-mail:
| |
Collapse
|
12
|
Admas M, Teshome M, Petrucka P, Telayneh AT, Alamirew NM. In-hospital mortality and its predictors among adult stroke patients admitted in Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. SAGE Open Med 2022; 10:20503121221122465. [PMID: 36093420 PMCID: PMC9459489 DOI: 10.1177/20503121221122465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Stroke is the second-leading global cause of death next to ischemic heart disease. The burden of stroke mortality, morbidity, and disability is increasing across the world. In Ethiopia, evidence on the survival status of adult stroke patients is insufficient. The purpose of this study is to estimate in-hospital mortality and its predictors among adult stroke patients. Methods Institution-based retrospective follow-up study was conducted on adult stroke patients who were admitted to Debre Markos Comprehensive Specialized Hospital from 1 November 2015 to 31 October 2020. Through simple random sampling, 382 patient charts were selected from 1125 stroke patients for 5 years follow-up period. Data were entered using EpiData™ version 4.1 and exported to Stata/SE™ version 14 for cleaning, coding, categorizing, and analysis. Predictor variables were selected using 95% confidence interval with a corresponding adjusted hazard ratio. Results In this study, 219 (57.33%) males and the mean (standard deviation) age of 57.65 ± 14.3 years. The in-hospital mortality rate of stroke was 12.8%; the median (interquartile range) time to mortality and Glasgow Coma Scale were 7 (4-13) days and 14 (11-15), respectively. The incidence of in-hospital mortality was 29/1000, 11/1000, 8/1000, and 13.6/1000 person-days in the first, second, third, and end of follow-up weeks, respectively. Pneumonia (adjusted hazard ratio = 3.51 (95% confidence interval = 1.86, 6.61)), hemorrhagic stroke (adjusted hazard ratio = 2.03 (95% confidence interval = 1.03, 3.99)), moderate impairment Glasgow Coma Scale (9-12) (adjusted hazard ratio = 2.16 (95% confidence interval = 1.08, 4.29)), severe impairment Glasgow Coma Scale (3-8) (adjusted hazard ratio = 2.38 (95% confidence interval = 1.01, 5.67)), history of hypertension (adjusted hazard ratio = 2.01 (95% confidence interval = 1.08, 3.74)), and increased intracranial pressure (adjusted hazard ratio = 2.12 (95% confidence interval = 1.10, 4.07)) were statistically significant predictors for in-hospital mortality. Conclusion In-hospital mortality of stroke was relatively high, and the median time to mortality was 8 days. Pneumonia, hemorrhagic stroke, Glasgow Coma Scale, history of hypertension, and increased intracranial pressure were identified predictors.
Collapse
Affiliation(s)
- Maru Admas
- Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia
| | - Muluken Teshome
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.,School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - Animut Takele Telayneh
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Nakachew Mekonnen Alamirew
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| |
Collapse
|
13
|
Sarfo FS, Akassi J, Ofori E, Ovbiagele B. Long-term determinants of death after stroke in Ghana: Analysis by stroke types & subtypes. J Stroke Cerebrovasc Dis 2022; 31:106639. [PMID: 35926405 PMCID: PMC9742008 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/17/2022] [Accepted: 07/02/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Determinants of long-term mortality after stroke by mechanistic type and subtype are unknown in sub-Saharan Africa (SSA). Such data are crucial for targeting specific pathophysiologic pathways to improve stroke outcomes in the region. PURPOSE To evaluate rates and predictors of mortality up to 8 years after stroke, by type and subtype, in Ghana. METHODS We prospectively collected data on stroke patients presenting at a tertiary medical facility in Ghana between 2013 and 2018 who were followed up until October 31, 2021. Stroke diagnosis was confirmed using a Computerized Tomography scan; ischemic strokes were mechanistically typed using the TOAST classification while intracerebral hemorrhages were subtyped using the SMASH-U scheme. Demographic and clinical predictors of stroke mortality were evaluated using Cox proportional hazards regression modelling. RESULTS Of 564 patients encountered during the study period, data on vital status were available for 556 (98.6%) subjects at discharge and 442 (78.4%) on follow-up. Mean age was 61.1 ±15.1 years, and 223 (53.1%) were male. Mortality rates at 1, 3, 12, 36, 60 and 96 months were 37.5%, 43.2%, 49.7%, 57.4%, 62.9%, and 73.7% respectively. Three (3) factors remained significantly associated with risk of death namely age, adjusted hazard ratios (aHR) of 1.12 (95%CI: 1.04-1.20), no formal education 1.36 (95% CI: 1.02-1.81) and modified Rankin score 1.67 (95%CI: 1.42 - 1.98) for each unit rise. For ischemic stroke the four (4) factors associated with long-term mortality were low formal education, low monthly income, having diabetes mellitus and higher functional score on admission. For intracerebral hemorrhage, the two factors were increasing age and high functional score. CONCLUSION Stroke severity is the key predictor of long-term mortality after an index stroke in Ghana, regardless of the underlying pathophysiologic mechanism. Instituting acute stroke systems of care to facilitate timely reperfusion efforts may greatly improve long term survival outcomes after stroke in SSA.
Collapse
Affiliation(s)
- Fred Stephen Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - John Akassi
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Emmanuel Ofori
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | |
Collapse
|
14
|
Dai B, Larnyo E, Larnyo A, Nutakor JA, Amerley Amarteifio EN, Frimpong Y, Addai-Dansoh S. Predictors of Healthcare Utilization Among Older Adults with Moderate to Severe Cognitive Limitations in Ghana: A Cross-Sectional Analysis of the WHO Study on Global Ageing and Adult Health (SAGE) Wave 1. Curr Alzheimer Res 2022; 19:585-605. [PMID: 36065914 DOI: 10.2174/1567205019666220905153301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/24/2022] [Accepted: 08/09/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND As the number of older adults in Ghana keeps increasing, so does the prevalence of aging-related diseases and conditions that tend to lead to cognitive decline. However, knowledge on the predicting factors of healthcare utilization among older adults with cognitive limitations is still scarce. OBJECTIVE This study examines the predictive factors of healthcare-seeking behavior among older adults with moderate-to-severe cognitive limitations in Ghana. METHODS Based on Andersen's behavioral model of health service utilization, the study analyzed data from 3106 older adults with moderate to severe cognitive limitations in Ghana aged 50+ using Bivariate Probit Regression and the Heckman Selection Model. RESULTS Results showed that individuals who were aged 75+, living in urban settlements, educated, higher income levels and parents who had some level of education, pension benefits, and both mandatory and voluntary health insurance were more likely to seek inpatient care. Enabling resources such as the national health insurance scheme and other types of medical insurance, household income, pension benefits, and predisposition factors like education influenced outpatient and inpatient healthcare consumption for older adults with moderate to severe cognitive limitations but had little influence on the choice of healthcare facility except for health insurance. CONCLUSION Since the healthcare-seeking behavior of older adults with moderate-to-severe cognitive limitations is driven by an amalgamation of several internal and external factors, there is a need for policy change to understand and cautiously incorporate these factors into the decision to improve equitable access to healthcare services for these individuals, as not all sizes fit all in providing quality care for them.
Collapse
Affiliation(s)
- Baozhen Dai
- Department of Labor and Social Security, School of Public Health, Southeast University, Nanjing, Jiangsu Province 210009, China
| | - Ebenezer Larnyo
- Department of Health Policy and Management, School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| | - Abigail Larnyo
- School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| | - Jonathan Aseye Nutakor
- Department of Health Policy and Management, School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| | - Edwina Naa Amerley Amarteifio
- Department of Health Policy and Management, School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| | - Yaw Frimpong
- Department of Health Policy and Management, School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| | - Stephen Addai-Dansoh
- Department of Health Policy and Management, School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| |
Collapse
|
15
|
Sarfo FS, Commeh ME, Tandoh IO, Agbogbatey M, Ankrah O, Akpalu A, Ovbiagele B. Nationwide rates of outpatient clinic attendance by stroke survivors in Ghana: Analysis by region and facility. J Neurol Sci 2022; 437:120250. [DOI: 10.1016/j.jns.2022.120250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/12/2022] [Accepted: 04/02/2022] [Indexed: 01/30/2023]
|
16
|
Sarfo FS, Ovbiagele B. Utilizing Implementation Science to Bridge Cerebrovascular Health Disparities: a Local to Global Perspective. Curr Neurol Neurosci Rep 2022; 22:293-303. [PMID: 35381952 PMCID: PMC9081275 DOI: 10.1007/s11910-022-01193-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Stroke is a prime example of a medical disorder whose incidence, prevalence, and outcomes are strongly characterized by health disparities across the globe. This scoping literature review seeks to depict how implementation science could be utilized to advance health equity in the prevention, acute treatment, and post-acute management of stroke in the underserved regions of high-income countries as well as in all low-income countries. RECENT FINDINGS A major reason for the persisting and widening cerebrovascular disease disparities is that evidence-based stroke prevention and treatment interventions have been differentially translated (if at all) to various populations and settings. The field of implementation science is endowed with frameworks, theories, methodological approaches, and outcome measures, including equity indices, which could be harnessed to facilitate the translation of evidence-based interventions into clinical practice for underserved and vulnerable communities. Encouragingly, there are several novel frameworks, which eminently merge implementation science constructs with health equity determinants, thereby opening up key opportunities to bridge burgeoning worldwide gaps in cerebrovascular health equity.
Collapse
Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Private Mail Bag, Kumasi, Ghana.
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
| |
Collapse
|
17
|
Sarfo FS, Ovbiagele B. Key determinants of long-term post-stroke mortality in Ghana. J Neurol Sci 2022; 434:120123. [PMID: 34974202 PMCID: PMC8979649 DOI: 10.1016/j.jns.2021.120123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/14/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Stroke affects a predominantly young to middle-aged population in Africa and is associated with poor outcomes. There are limited data on patient-level determinants of long-term stroke survival on the continent. PURPOSE To assess factors associated with long-term, all-cause mortality among stroke survivors in a Ghanaian medical system. METHODS We analyzed the dataset of clinical trial involving hypertensive stroke survivors (n = 60) who enrolled in a 9-month study primarily assessing the effect of an m-health intervention on blood pressure control. This was a single tertiary center study conducted in a Ghanaian medical center. Participants or relatives were contacted by a phone call to assess vital status 4.5 years after stroke onset. Demographic, psycho-social and vascular risk factors data were collected during the study. Cox proportional hazards regression modeling was used to assess the factors associated with death. RESULTS Among the study participants, long term information was obtainable on 58 of 60 (97%). After a median follow-up of 52 months [IQR: 48 to 53 months], 16 participants had died, resulting in a mortality rate of 27.6% (95% CI of 16.6% - 40.9%). Upon adjustment for confounders, the two factors independently associated with long-term mortality were resistant hypertension (Hazard Ratio 3.99; 95% CI: 1.29-12.37] and depression (Hazard Ratio 1.18; 95% CI: 1.05-1.31; per unit rise on the Hamilton Depression Scale). CONCLUSION In this convenience sample of recent stroke patients in Ghana, over a quarter had died within 5 years of index stroke onset. Resistant hypertension and depression may be modifiable therapeutic targets to improve outcomes in these patients.
Collapse
Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
| |
Collapse
|
18
|
Haematological Indices and Antioxidant Enzyme Activity in Ghanaian Stroke Patients. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1203120. [PMID: 35281592 PMCID: PMC8913147 DOI: 10.1155/2022/1203120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 02/07/2023]
Abstract
Background Stroke is a cardiovascular disorder causing mortality globally and long-lasting harm worldwide. The disease occurs when the blood flow to the brain is either interrupted or blocked. This disruption leads to the increase in reactive oxygen species (ROS), especially superoxide free radicals, resulting in oxidative stress. The superoxide radicals are removed by superoxide dismutase (SOD), a key antioxidant enzyme. In this work, we investigated haematological indices and superoxide dismutase enzyme activity in Ghanaian patients with stroke and healthy control participants. Materials and Methods Thirty stroke patients attending a stroke clinic and thirty apparently healthy control participants were recruited into the study. Blood samples were collected to determine haematological indices and SOD enzyme activity in red blood cells. Results The stroke patients had significantly high blood parameters such as white blood cell (p < 0.001), neutrophil (p < 0.001), lymphocyte (p = 0.003), and eosinophil (p < 0.001) comparing with study participants without stroke, who were the control group in the study. Other blood parameters such as red blood cell, (p < 0.001), haemoglobin (p < 0.001), and haematocrit (p < 0.001) levels and mean cell haemoglobin concentration (p = 0.030), platelet (p = 0.010), and plateletcrit (p = 0.027) were high in stroke patients comparing with study control participants and statistically significant. Blood lymphocyte levels observed in stroke patients correlated negatively and significantly with SOD activity levels. SOD activity levels were significantly lower in stroke patients compared with the control group (p < 0.001). Low values of the antioxidant enzyme SOD activity levels, lymphocytes, and high values of plateletcrit were significant predictors of stroke. Conclusion Haematological parameters such as WBC, lymphocyte, platelet levels, and red cell indices were significantly different in the stroke patients being studied. There was negative correlation between lymphocyte significantly with SOD activity and high oxidative stress in stroke patients compared with the control group. Lymphocytes and plateletcrit levels were also good predictors of the occurrence of stroke.
Collapse
|
19
|
Kumi F, Bugri AA, Adjei S, Duorinaa E, Aidoo M. Quality of acute ischemic stroke care at a tertiary Hospital in Ghana. BMC Neurol 2022; 22:28. [PMID: 35039001 PMCID: PMC8762857 DOI: 10.1186/s12883-021-02542-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Information on the quality of acute ischemic stroke care provided in lower-to-middle income countries is limited. Objective This study was undertaken to examine the quality of acute ischemic stroke care provided at Tamale Teaching Hospital in Ghana. Methods The medical records of patients admitted into the medical ward of the hospital between January to October 2021 were reviewed retrospectively. Extent of compliance to 15 stroke performance indicators were determined. Results Under the study period, 105 patients were admitted at the hospital with acute ischemic stroke. The mean (±SD) age was 65 ± 12 years; 38.1% were males; 65.7% had National Health Insurance Scheme coverage. Glasgow Coma Scale was the only functional stroke rating scale used by physicians to rate stroke severity. About a quarter of the patients had CT scan performed within 24 h of admission. Less than a quarter of the patients had a last known well time documented. Rate of thrombolytic administration was 0%. Less than a quarter of the patients were prescribed venous thromboembolism prophylaxis on the day of admission or day after. Only 13.8% of patients had documented reasons for not being prescribed venous thromboembolism prophylaxis. Antiplatelet therapy was prescribed to 33.3% of the patients by the end of day 2 of admission. Anticoagulation was prescribed to all patients who had comorbid condition of atrial fibrillation as part of the discharge medications. More than half of the patients were discharged to go home with statin medications. Documented stroke education was provided to 31.4% caretakers or patients. Slightly less than half of the patients were assessed for or received rehabilitation. Less than a quarter had documented dysphagia screening within 24 h of admission. None of the patient had their stroke severity rated with National Institutes of Health Stroke Scale on arrival. No patient obtained carotid imaging assessment by end of day 2. Conclusion There were several gaps in the quality of acute ischemic stroke care provided to patients at the Tamale Teaching Hospital. With the exception of discharging patients on statin medications, there was poor adherence to all other stroke performance indicators.
Collapse
Affiliation(s)
- Frank Kumi
- Pharmacy Unit, King's Medical Center, Tamale, Ghana.
| | - Amos A Bugri
- Pharmacy Directorate, Tamale Teaching Hospital, Tamale, Ghana
| | - Stephen Adjei
- Pharmacy Directorate, Tamale Teaching Hospital, Tamale, Ghana
| | - Elvis Duorinaa
- Pharmacy Directorate, Tamale Teaching Hospital, Tamale, Ghana
| | - Matthew Aidoo
- Department of Pharmacology, University for Development Studies, Tamale, Ghana
| |
Collapse
|
20
|
Abate TW, Zeleke B, Genanew A, Abate BW. The burden of stroke and modifiable risk factors in Ethiopia: A systemic review and meta-analysis. PLoS One 2021; 16:e0259244. [PMID: 34723996 PMCID: PMC8559958 DOI: 10.1371/journal.pone.0259244] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 10/16/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The burden and contribution of modifiable risk factors of stroke in Ethiopia are unclear. Knowledge about this burden and modifying risk factors is pivotal for establishing stroke prevention strategies. In recent decades, the issue of lifestyle and behavioral modification is a key to improve the quality of life. The modifiable risk factors are an importance as intervention strategies aimed at reducing these factors can subsequently reduce the risk of stroke. So far, many primary studies were conducted to estimate the burden of stroke and modifiable risk factors in Ethiopia. However, the lack of a nationwide study that determines the overall pooled estimation of burden and modifiable risk factors of stroke is a research gap. METHODS To conduct this systemic review and meta-analysis, we are following the PRISMA checklist. Three authors searched and extracted the data from the CINAHL (EBSCO), MEDLINE (via Ovid), PubMed, EMcare, African Journals Online (AJOL), and Google scholar. The quality of the primary study was assessed using the Newcastle-Ottawa Scale (NOS) by two independent reviewers. The primary studies with low and moderate risk of bias were included in the final analysis. The authors presented the pooled estimated burden of stroke and its modifiable risk factors. The registered protocol number in PROSPERO was CRD42020221906. RESULTS In this study, the pooled burden of hemorrhagic and ischemic stroke were 46.42% (95%CI: 41.82-51.53; I2 = 91.6%) and 51.40% (95%CI: 46.97-55.82; I2 = 85.5%) respectively. The overall magnitude of modifiable risk factor of hypertension, alcohol consumption and dyslipidemia among stroke patients were 49% (95%CI: 43.59, 54.41), 24.96% (95CI%:15.01, 34.90), and 20.99% (95%CI: 11.10, 30.88), respectively. The least proportion of stroke recovery was in the Oromia region (67.38 (95%CI: 41.60-93.17; I2 = 98.1%). Farther more, the proportion of stroke recovery was decreased after 2017 (70.50 (56.80-84.20). CONCLUSIONS In our study, more than 90% of stroke patients had one or more modifiable risk factors. All identified modifiable stroke risk factors are major public health issues in Ethiopia. Therefore, strategy is designed for stroke prevention to decrease stroke burden through targeted modification of a single risk factor, or a cluster of multiple risk factors, used on a population, community, or individual level.
Collapse
Affiliation(s)
- Teshager Weldegiorgis Abate
- Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Balew Zeleke
- Department of Pediatric and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ashenafi Genanew
- Department of Pharmacology, School of Health Sciences, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | | |
Collapse
|
21
|
Cissé K, Samadoulougou DRS, Bognini JD, Kangoye TD, Kirakoya-Samadoulougou F. Using the first nationwide survey on non-communicable disease risk factors and different definitions to evaluate the prevalence of metabolic syndrome in Burkina Faso. PLoS One 2021; 16:e0255575. [PMID: 34351987 PMCID: PMC8341491 DOI: 10.1371/journal.pone.0255575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The burden of cardiovascular diseases is rising in the developing world including Sub-Saharan Africa. The rapid rise of cardiovascular disease burden is in part due to undetected and uncontrolled cardiovascular risk factors. The clustering of metabolic syndrome (MetS) components is associated with a high risk of cardiovascular diseases. This complex biochemical disorder is still poorly studied in western Africa. In this study, we aimed to determine the prevalence of metabolic syndrome and its determinants among the adult population in Burkina Faso. METHODS We performed a secondary analysis of the data from the first national survey on non-communicable diseases risk factors using the World Health Organization (WHO) Stepwise approach. We included 4019 study participants aged 25 to 64 years. The metabolic syndrome prevalence was estimated using six different definitions. RESULTS The mean age was 38.6±11.1 years. Women represented 52.4% and three quarters (75%) lived in rural areas. The overall prevalence of metabolic syndrome according to the different definitions was 1.6% (95%CI:1.1-2.2) for the American College of Endocrinology, 1.8% (95%CI: 1.3-2.4) for the WHO, 4.3% (95%CI:3.5-5.2) for the National Cholesterol Education Program Adult Treatment Panel III, 6.2% (95%CI: 5.1-7.6) for the AAH/NHBI, 9.6%(95%CI: 8.1-11.3) for the International Diabetes Federation and 10.9% (95%: 9.2-12.7) for the Joint Interim Statement. The metabolic syndrome components with the highest prevalence were low High density lipoprotein (63.3%), abdominal obesity (22.3%) and hypertension (20.6%). People living in urban areas and those with older age have higher prevalence of metabolic syndrome regardless of the definition used. CONCLUSION Our findings suggest various levels of prevalence of MetS according to the definition used. Identifying the most appropriate criteria for MetS among the adult population is important to early detect and treat this syndrome and its components at the primary health care level to control the rising burden of cardiovascular diseases in the context of ongoing epidemiological transition in the country.
Collapse
Affiliation(s)
- Kadari Cissé
- Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium
- Departement Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | | | - Joel Dofinissery Bognini
- Centre National de la Recherche Scientifique et Technologique, Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Tiga David Kangoye
- Institut national de santé publique (INSP), CNRFP, Ouagadougou, Burkina Faso
| | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
22
|
Telehealth Interventions to Support Self-Management in Stroke Survivors: A Systematic Review. Healthcare (Basel) 2021; 9:healthcare9040472. [PMID: 33921183 PMCID: PMC8071480 DOI: 10.3390/healthcare9040472] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 12/11/2022] Open
Abstract
Telehealth (TH) intervention is a method to optimize self-management (SM) support in stroke survivors. Objectives of this study included identifying the TH-SM intervention's focus and SM support components, the TH delivery type, and the TH-SM support effects on stroke survivors. Five databases were searched for the years 2005-2020 to identify TH-SM support interventions for stroke survivors. Randomized controlled trials and quasi-experimental, one-group re-post study designs were included. Ten studies were reviewed. TH-SM support focused on post-stroke depression, obesity management, participation, functional mobility, and activities of daily living. The TH delivery type most used in selected studies was messaging. Regarding the SM support components, the education component was used in all studies, and psychological support and lifestyle advice and support were used in 8 out of 10 studies. TH-SM intervention had positive effects in terms of goal achievement for SM behavior, emotional state, and mobility of clinical outcomes, and TH acceptance in stroke survivors. Although the TH-SM-supported intervention effects were not found consistently in all outcomes, this review discovered a positive effect on various SM-related outcomes. In addition, TH delivery types and SM support components showed the possibility of various options to be considered for intervention. Therefore, we suggest that TH-SM supported intervention is a positive alternative for SM support in stroke survivors.
Collapse
|
23
|
Kiss P, Carcel C, Hockham C, Peters SAE. The impact of the COVID-19 pandemic on the care and management of patients with acute cardiovascular disease: a systematic review. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:18-27. [PMID: 33151274 PMCID: PMC7665454 DOI: 10.1093/ehjqcco/qcaa084] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023]
Abstract
Background The COVID-19 pandemic has disrupted healthcare services around the world, which may have serious implications for the prognosis of patients with acute cardiovascular disease. We conducted a systematic review to assess the extent to which health services related to the care and management of acute cardiovascular events have been impacted during the COVID-19 pandemic. Methods PubMed, MedRxiv and Google Scholar were searched for observational studies published up to August 12, 2020 for studies that assessed the impact of the pandemic on the care and management of people with acute CVD. Results In total, 27 articles were included. Of these, 16 examined the impact on acute coronary syndromes (ACS), eight on strokes, one on ACS and strokes, and 2 on other types of CVD. When comparing the COVID-19 period to non-COVID-19 periods, eleven studies observed a decrease in ACS admissions ranging between 40 and 50% and five studies showed a decrease in stroke admissions of between 12 and 40%. Four studies showed a larger reduction in non-ST-segment elevation myocardial infarctions (NSTEMI) compared to ST-segment elevation myocardial infarctions (STEMI). A decrease in the number of reperfusion procedures, a shortening in the lengths of stay at the hospital, and longer symptom-to-door times were also observed. Conclusions The COVID-19 pandemic has led to a substantial decrease in the rate of admissions for acute CVD, reductions in the number of procedures, shortened lengths of stay at the hospital and longer delays between the onset of the symptoms and hospital treatment. The impact on patient’s prognosis needs to be quantified in future studies.
Collapse
Affiliation(s)
- Pauline Kiss
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Cheryl Carcel
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Carinna Hockham
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.,The George Institute for Global Health, UNSW, Sydney, Australia.,The George Institute for Global Health, Imperial College London, London, UK
| |
Collapse
|
24
|
Sarfo FS. Associations between hypertension knowledge, awareness, and treatment and stroke occurrence across the globe: time to act on what we know. Heart 2020; 107:heartjnl-2020-318019. [PMID: 33318083 DOI: 10.1136/heartjnl-2020-318019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Neurology Unit, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
25
|
Sarfo FS, Ovbiagele B. Apparent Treatment Resistant Hypertension Among Stroke Survivors in Ghana. J Stroke Cerebrovasc Dis 2020; 29:105401. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105401] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/23/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023] Open
|
26
|
Chauwa L, Appiah CA, Nsiah K, Sarfo FS. Nutritional risk markers among stroke out-patients at the neurology clinic of a teaching hospital in Ghana. Pan Afr Med J 2020; 37:258. [PMID: 33598073 PMCID: PMC7864258 DOI: 10.11604/pamj.2020.37.258.16929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/31/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction stroke survivors are at risk of malnutrition due to inadequate dietary intake, as a result of neurological disorders causing dysphagia, depression and impaired ability to self-feed. There is paucity of information on nutritional status of stroke survivors after discharge from hospital care, hence, this study sought to determine the nutritional risk markers among stroke out-patients at the Neurology Clinic of Komfo Anokye Teaching Hospital, Kumasi, Ghana. Methods a cross-sectional study was conducted among 106 stroke survivors at Komfo Anokye Teaching Hospital, Kumasi, Ghana. Nutritional status of stroke survivors was assessed, using body mass index (BMI) and mid upper arm circumference (MUAC). Biochemical and haematological nutrition indicators including total serum protein, serum albumin, total lymphocyte count, uric acid and haemoglobin were also determined. Independent t-test and ANOVA were used to test differences between mean values. Results the mean age of study participants was 58.47±14.2 years, with 56% being females. Overall, 96 (88.7%) of the participants had malnutrition, of whom 66 (68.8%) were undernourished, while 30 (31.2%) had overnutrition. It was also found that 38.7% of the participants were anaemic, based on haemoglobin levels. Using mean BMI, stroke survivors who had been discharged over five years were significantly overweight (p = 0.010). Conclusion there was high level of malnutrition among stroke out-patients in this study. The most common nutrition-related problem in the stroke survivors studied was anaemia. Findings from this study suggest the need for nutrition intervention strategies to address the high burden of malnutrition among the stroke survivors.
Collapse
Affiliation(s)
- Lloyd Chauwa
- Department of Biochemistry and Biotechnology, Faculty of Biosciences, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Human Nutrition and Health, Faculty of Food and Human Sciences, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
| | - Collins Afriyie Appiah
- Department of Biochemistry and Biotechnology, Faculty of Biosciences, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwabena Nsiah
- Department of Biochemistry and Biotechnology, Faculty of Biosciences, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Fred Stephen Sarfo
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Neurology Unit, Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| |
Collapse
|
27
|
Ojo T, Ryan N, Birkemeier J, Appleton N, Ampomah I, Glozah F, Adongo PB, Adanu R, Boden-Albala B. Adapting a skills-based stroke prevention intervention for communities in Ghana: a qualitative study. Implement Sci Commun 2020; 1:104. [PMID: 33292870 PMCID: PMC7672911 DOI: 10.1186/s43058-020-00084-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 10/08/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Stroke is a major cause of death in Ghana. Evidence-based interventions for stroke prevention have been successful in the US; however, in low- and middle-income countries (LMICs), such interventions are scarce. The "Discharge Education Strategies for Reduction of Vascular Events" (DESERVE) intervention led to a 10-mmHg reduction in systolic blood pressure (SBP) among Hispanic survivors of mild/moderate stroke and transient ischemic attack (TIA) at 1-year follow-up. Our objectives were to capture the perceptions of a diverse set of stakeholders in an urban community in Ghana regarding (1) challenges to optimal hypertension management and (2) facilitators and barriers to implementation of an evidence-based, skills-based educational tool for hypertension management in this context. METHODS This exploratory study used purposive sampling to enroll diverse stakeholders in Accra (N = 38). To identify facilitators and barriers, we conducted three focus group discussions: one each with clinical nurses (n = 5), community health nurses (n = 20), and hypertensive adults (n = 10). To further examine structural barriers, we conducted three key informant interviews with medical leadership. All interviews were audio recorded and transcribed. Thematic analysis was carried out via deductive coding based on Proctor's implementation outcomes taxonomy, which conceptualizes constructs that shape implementation, such as acceptability, adoption, appropriateness, cost, and feasibility. RESULTS Findings highlight facilitators, such as a perceived fit (appropriateness) of the core intervention components across stakeholders. The transferable components of DESERVE include: (1) a focus on risk knowledge, medication adherence, and patient-physician communication, (2) facilitation by lay workers, (3) use of patient testimonials, (4) use of a spirituality framework, and (5) application of a community-based approach. We report potential barriers that suggest adaptations to increase appropriateness and feasibility. These include addressing spiritual etiology of disease, allaying mistrust of biomedical intervention, and tailoring for gender norms. Acceptability may be a challenge among individuals with hypertension, who perceive relative advantage of alternative therapies like herbalism. Key informant interviews highlight structural barriers (high opportunity costs) among physicians, who perceive they have neither time nor capacity to educate patients. CONCLUSIONS Findings further support the need for theory-driven, evidence-based interventions among hypertensive adults in urban, multiethnic Ghana. Findings will inform implementation strategies and future research.
Collapse
Affiliation(s)
- Temitope Ojo
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA.
| | - Nessa Ryan
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA
| | - Joel Birkemeier
- Global Health Program, New York University School of Global Public Health, New York, NY, USA
| | - Noa Appleton
- Department of Population Health, New York University Langone Health, New York, NY, USA
| | | | - Franklin Glozah
- Department of Social and Behavioral Sciences, University of Ghana School of Public Health, Accra, Ghana
| | - Philip Baba Adongo
- Department of Social and Behavioral Sciences, University of Ghana School of Public Health, Accra, Ghana
| | - Richard Adanu
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Bernadette Boden-Albala
- Departments of Health Society and Behavior and Epidemiology, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA
- Department of Neurology, School of Medicine, University of California, Irvine, CA, USA
| |
Collapse
|
28
|
Ismail A, Reffien MAM, Ibrahim NM, Sobri HNM, Abidin NDIZ, Rusli SASS, Selamat EM. Factors Associated With Length of Stay for Patients With Stroke in Malaysia. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2020; 3:134-138. [PMID: 37260578 PMCID: PMC10229015 DOI: 10.36401/jqsh-20-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 10/02/2020] [Indexed: 06/02/2023]
Abstract
Introduction Globally, stroke continues to become a significant public health issue contributing to one of the significant causes of morbidity and mortality. The study aimed to describe the characteristics of patients with stroke who were admitted to a teaching hospital in Malaysia and to determine the factors associated with length of stay (LOS). Methods This is a single-center, cross-sectional study using in-patient data maintained by the Case-Mix Unit of a teaching hospital in Malaysia from 2016 to 2017. The study included all patients with International Classification of Disease (ICD) code 164 (stroke, not specified as hemorrhage or infarct). The significance of association was determined using nonparametric tests in the form of the Mann-Whitney U test and the Kruskal-Wallis test. Results A total of 162 stroke patients from 2016 to 2017 from Case-Mix database were included in the study. The age ranged from 31 to 97 years old. The minimum and maximum LOS for patients with stroke ranged from 1 to 17 days. The severity of illness was found to be significantly associated with longer LOS (p < 0.001); however, age, sex, and presence of co-morbidities did not show any significant association. Conclusion Despite its limitations, this study is an essential first step to examine the characteristics of patients with stroke and to determine the factors associated with LOS.
Collapse
Affiliation(s)
- Aniza Ismail
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia
| | - Muhammad Alimin Mat Reffien
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia
| | - Norlinah Mohamed Ibrahim
- Department of Medicine, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia
| | - Hanani Nabilah Mohd Sobri
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia
| | - Noor Dalila Inche Zainal Abidin
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia
| | - Sharifah Ain Shameera Syed Rusli
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia
| | - Ellyana Mohd Selamat
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia
| |
Collapse
|
29
|
Antecedent febrile illness and occurrence of stroke in West Africa: The SIREN study. J Neurol Sci 2020; 418:117158. [PMID: 33002758 DOI: 10.1016/j.jns.2020.117158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/23/2020] [Accepted: 09/24/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute infections have been posited as potential precipitants or triggers of the occurrence of stroke among adults with traditional vascular risk factors. We evaluated associations between stroke occurrence and reported febrile illness within 4 weeks (potential antecedent infections) among West Africans. METHODS The Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with radiologically confirmed strokes. Controls were stroke-free adults matched with cased by age, gender and ethnicity. Detailed evaluations for vascular, lifestyle and psychosocial factors were performed. Participants were asked for evidence of any febrile illness within the past 4 weeks. We used conditional logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval. RESULTS Among 3588 stroke cases recruited in Ghana and Nigeria between August 2014 and July 2018, 363 cases (10.1%) reported having a febrile illness within the 4 weeks prior to stroke occurrence. Having an antecedent infection was associated with stroke occurrence with an unadjusted OR of 1.19 (1.00-1.51) but aOR of 0.83 (0.59-1.17) upon adjusting for traditional vascular risk factors. Stress, aOR of 4.69 (2.59-8.50) and consumption of green vegetables 2.27 (1.35-2.85) were associated with antecedent febrile illness. CONCLUSION 1 in 10 stroke cases reported antecedent history of febrile illness prior to occurrence of stroke but no independent association was observed in this study. Infectious exposures may be important triggers of cardiovascular events requiring further exploratory studies to better understand the role of this emerging risk factor.
Collapse
|
30
|
Ayisi‐Boateng NK, Mohammed A, Opoku DA, Sarfo FS. Frequency & factors associated with apparent resistant hypertension among Ghanaians in a multicenter study. J Clin Hypertens (Greenwich) 2020; 22:1594-1602. [PMID: 32815641 PMCID: PMC8029809 DOI: 10.1111/jch.13974] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/23/2020] [Accepted: 05/31/2020] [Indexed: 12/14/2022]
Abstract
Apparent resistant hypertension (ARH) is rife among people living with hypertension and is associated with significant morbidity and mortality. There is however paucity of data from sub-Saharan Africa on the burden of ARH. We sought to report on the frequency and factors associated with ARH among a cohort of Ghanaians with hypertension. A cross-sectional study involving 2912 participants with hypertension enrolled at five health facilities in Ghana. ARH was defined as either office BP ≥ 140/90 mm Hg on 3 or more antihypertensive medications or on 4 or more antihypertensive medications regardless of BP. Factors associated with ARH were evaluated in a multivariate logistic regression model. We found 550 out of 2,912 (18.9%) of study participants had ARH. Out of these 550 subjects, 511 (92.9%) were on 3 or more antihypertensive medications with BP ≥ 140/90 mm Hg and 39 (7.1%) were on 4 or more antihypertensive medications with BP ≥ 140/90 mm Hg. The prevalence of ARH was 15.5% among elderly aged 75 + years (n = 341), 20.7% among 65-74 years (n = 588), and 18.9% among those ≤ 64 years (n = 1983). The adjusted odds ratio (95% CI) of factors independently associated with ARH was duration of hypertension, 1.05 (1.03-1.06) for each year rise; eGFR < 60 mL/min, 1.73 (1.33-2.25); and diabetes mellitus, 0.59 (0.46-0.76). Attaining secondary level education and residence in a peri-urban setting were significantly associated with ARH though not in a dose-dependent manner. ARH is rife among Ghanaians and may negatively impact on cardiovascular outcomes in the long term.
Collapse
Affiliation(s)
- Nana Kwame Ayisi‐Boateng
- Department of MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
- University HospitalKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Aliyu Mohammed
- School of Public HealthKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Douglas Aninng Opoku
- School of Public HealthKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Fred Stephen Sarfo
- Department of MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
- Komfo Anokye Teaching HospitalKumasiGhana
| |
Collapse
|
31
|
Amegbor PM, Rosenberg MW. Health and socioeconomic risk factors for overnight admission among older adults in Ghana. JOURNAL OF POPULATION AGEING 2020. [DOI: 10.1007/s12062-020-09294-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
32
|
Magnitude of risk factors and in-hospital mortality of stroke in Ethiopia: a systematic review and meta-analysis. BMC Neurol 2020; 20:309. [PMID: 32814556 PMCID: PMC7437163 DOI: 10.1186/s12883-020-01870-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/23/2020] [Indexed: 12/17/2022] Open
Abstract
Background The morbidity and mortality of stroke is disproportionately high in developing countries owing to the poor health care system and poor neurologic interventions. Though a number of studies were conducted to estimate the in-hospital mortality rate of stroke in Ethiopia, the lack of a nationwide study that determines the overall magnitude of risk factors and in-hospital mortality rate of stroke is an important research gap. Meta-analysis is key to improve the accuracy of estimates through the use of more data sets. Thus, this study was aimed to determine the overall magnitude of risk factors and in-hospital mortality rate of stroke in Ethiopia. Methods This study was conducted following the PRISMA checklist. We searched from Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library databases for studies. Each of the original studies was assessed using a tool for the risk of bias adapted for cross-sectional studies. Data were pooled and a random effect meta-analysis model was fitted to provide the overall magnitude of risk factors and in-hospital mortality rate of stroke. Also, the subgroup analyses were performed to examine how the in-hospital mortality rate varies across different groups of studies. Results In this study, the overall magnitude of hypertension, diabetes mellitus, and atrial fibrillation among stroke patients were 47% (95%CI: 40–54), 8% (95CI%:6–12), and 10% (95%CI: 5–19), respectively. The overall in-hospital mortality of stroke in Ethiopia was 18% (95%:14–22). The highest magnitude of in-hospital mortality of stroke was observed in SNNPR and the lowest was noted in Tigray region. In addition, the magnitude of the in-hospital mortality rate of stroke was 15.1% (95%CI: 11.3–19.4), and 19.6%(95%CI: 14.1–25.7), among studies published before and after 2016, respectively. Conclusions Our pooled result showed that nearly one-fifth of stroke patients have died during hospitalization. The most common risk factor of stroke among the included studies was hypertension followed by atrial fibrillation and diabetes mellitus. There is a need for a better understanding of the factors associated with high blood pressure, especially in countries with a high risk of stroke.
Collapse
|
33
|
Sarfo FS, Mensah NO, Opoku FA, Adusei-Mensah N, Ampofo M, Ovbiagele B. COVID-19 and stroke: Experience in a Ghanaian healthcare system. J Neurol Sci 2020; 416:117044. [PMID: 32702560 PMCID: PMC7363605 DOI: 10.1016/j.jns.2020.117044] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 01/10/2023]
Abstract
Background The novel coronavirus disease 19 (COVID-19) causes multi-system disease including possibly heightened stroke risk. Data from high-income countries (HIC) suggest disruptions to care delivery with reduced stroke admissions and administration of acute stroke reperfusion therapies. We are unaware of any published data on the impact of the COVID-19 pandemic on stroke admissions and outcomes in sub-Saharan Africa. Purpose To compare rates of stroke admissions and case fatality between corresponding periods in 2020 and 2019, within a hospital system in Ghana, to assess the potential impact of the COVID-19 pandemic. Methods We compared monthly stroke admissions and mortality rates between January to June 2020 vs. January to June 2019 at the Komfo Anokye Teaching Hospital, a tertiary medical center in Ghana. Predictors of in-patient mortality were assessed using a multivariate logistic regression model. Results Stroke admissions were higher in January to June 2020 vs. January to June 2019 (431 vs. 401), an increase of +7.5% (95% CI: 5.1–10.5%). There was also a rise in recurrent stroke admissions in 2020 vs. 2019 (19.0% vs. 10.9%, p = .0026). Stroke case fatality trended higher in 2020 vs. 2019 (29.3% vs. 24.2%, p = .095) with an adjusted odds ratio of 1.22 (95% CI: 0.89–1.68). Conclusion While an influence of secular trends cannot be excluded, the COVID-19 outbreak coincided with a comparatively significant rise in initial and recurrent stroke admissions at this Ghanaian tertiary hospital. Continued surveillance at this hospital, as well as assessment of this issue at other sites in Africa is warranted. 7.5% increase in stroke admissions. 10% rise in recurrent stroke admissions. 5% higher stroke case fatality.
Collapse
Affiliation(s)
- Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | | | | | | | - Michael Ampofo
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bruce Ovbiagele
- Department of Neurology, University of California San Francisco, USA
| |
Collapse
|
34
|
Sarfo FS, Mobula LM, Adade T, Commodore-Mensah Y, Agyei M, Kokuro C, Adu-Gyamfi R, Duah C, Ovbiagele B. Low blood pressure levels & incident stroke risk among elderly Ghanaians with hypertension. J Neurol Sci 2020; 413:116770. [PMID: 32172015 PMCID: PMC7250714 DOI: 10.1016/j.jns.2020.116770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clinical trial data indicate that more intensive blood pressure (BP) lowering below standard cut-off targets is associated with lower risks of strokes in the elderly. There is a relative paucity of real-world practice data on this issue, especially among Africans. OBJECTIVE To assess BP control rates, its determinants, and whether a lower BP < 120/80 mmHg is associated with a lower incident stroke risk among elderly Ghanaians with hypertension. METHODS We retrospectively evaluated data, which were prospectively collected as part of a cohort study involving adults with hypertension and/or diabetes in 5 Ghanaian hospitals. BP control was defined using the JNC-8 guideline of <150/90 mmHg for elderly with hypertension aged >60 years or 140/90 mmHg for those with diabetes mellitus. Risk factors for poor BP control were assessed using multivariable logistic regression models. We calculated incident stroke risk over an 18-month follow-up at 3 BP cut-off's of <120/80, 120-159/80-99, and > 160/100 mmHg. RESULTS Of the 1365 elderly participants with hypertension, 38.2% had diabetes mellitus and 45.8% had uncontrolled BP overall. Factors associated with uncontrolled BP were higher number of antihypertensive medications prescribed adjusted odds ratio of 1.45 (95% CI: 1.27-1.66), and having diabetes 2.56 (1.99-3.28). Among the elderly, there were 0 stroke events/100py for BP < 120/80 mmHg, 1.98 (95%CI: 1.26-2.98) for BP between 120 and 159/80-99 mmHg and 2.46 events/100py (95% CI: 1.20-4.52 at BP > 160/100 mmHg. CONCLUSION A lower BP target <120/80 mmHg among elderly Ghanaians with hypertension is associated with a signal of lower incident stroke risk. Pragmatic trials are needed to evaluate lower BP targets on stroke incidence in Africa.
Collapse
Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Linda Meta Mobula
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Titus Adade
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Martin Agyei
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Collins Kokuro
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | | | | |
Collapse
|
35
|
Frequency and factors linked to refractory hypertension among stroke survivors in Ghana. J Neurol Sci 2020; 415:116976. [PMID: 32535251 DOI: 10.1016/j.jns.2020.116976] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Refractory hypertension (RfH) is a rare, severe phenotype of resistant hypertension, linked to higher risk of adverse cardiovascular outcomes. Little is known about the association of RfH with stroke type and subtype. OBJECTIVE To determine the prevalence and predictors of RfH among stroke survivors in Ghana. METHODS We interrogated the dataset of a prospectively collected registry of hypertensive patients seen between July 2015 and June 2019, at five hospitals in Ghana. We compared stroke survivors to stroke-free controls. Clinic-based blood pressure was measured using a standardized protocol and antihypertensive medications were assessed via review of medical records and inspection of pills. Refractory hypertension was defined as office BP ≥140/90 mmHg on ≥5 classes of antihypertensive medications. Multivariate logistic regression models were constructed to assess factors associated with RfH. RESULTS Of 3927 hypertensive patients (1169 stroke survivors, 2758 controls), 86 had RfH for an overall prevalence of 2.2% (95% CI: 1.8-2.7%). Among patients with RfH, 5.8% (4.5-7.3%) were stroke survivors vs. 0.7% (0.4-1.0%) were stroke-free (p < .0001). Adjusted odds ratio (95% CI) for factors associated with RfH were being male (1.81, 1.15-2.85), age < 60 years (2.64, 1.59-4.40), chronic kidney disease (2.09, 1.21-3.60), and known stroke (7.53, 4.35-13.04). RfH was associated with intracerebral hemorrhage, (11.43, 5.65-23.14), ischemic stroke (9.76, 5.47-17.42), lacunar stroke (13.58, 6.45-28.61), and non-lacunar ischemic stroke (3.67, 1.04-13.02). CONCLUSION Presence of RfH is significantly accentuated among stroke survivors. Intensified efforts are warranted to identify and aggressively address barriers to control in these patients to avert subsequent vascular events.
Collapse
|
36
|
Sarfo FS, Mobula L, Plange‐Rhule J, Gebregziabher M, Ansong D, Sarfo‐Kantanka O, Arthur L, Sablah J, Gavor E, Burnham G, Ofori‐Adjei D. Longitudinal control of blood pressure among a cohort of Ghanaians with hypertension: A multicenter, hospital‐based study. J Clin Hypertens (Greenwich) 2020; 22:949-958. [DOI: 10.1111/jch.13873] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/12/2020] [Accepted: 03/04/2020] [Indexed: 01/28/2023]
Affiliation(s)
- Fred S. Sarfo
- Department of Medicine Kwame Nkrumah University of Science & Technology Kumasi Ghana
- Department of Medicine Komfo Anokye Teaching Hospital Kumasi Ghana
| | - Linda Mobula
- Johns Hopkins University School of Medicine Baltimore MD USA
- Johns Hopkins University Bloomberg School of Public Health Baltimore MD USA
| | | | | | - Daniel Ansong
- Department of Medicine Kwame Nkrumah University of Science & Technology Kumasi Ghana
- Department of Medicine Komfo Anokye Teaching Hospital Kumasi Ghana
| | | | - Lynda Arthur
- Ghana Access and Affordability Program Accra Ghana
| | | | - Edith Gavor
- Ghana National Drugs Programme Ministry of Health Accra Ghana
| | - Gilbert Burnham
- Johns Hopkins University School of Medicine Baltimore MD USA
- Johns Hopkins University Bloomberg School of Public Health Baltimore MD USA
| | - David Ofori‐Adjei
- Department of Medicine & Therapeutics University of Ghana School of Medicine and Dentistry Accra Ghana
| |
Collapse
|
37
|
Sarfo FS, Ovbiagele B. Prevalence and predictors of statin utilization among patient populations at high vascular risk in Ghana. J Neurol Sci 2020; 414:116838. [PMID: 32325358 DOI: 10.1016/j.jns.2020.116838] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Inadequate implementation of evidence-based preventive measures for individuals at high risk of cardiovascular disease (CVD) will only worsen the current epidemic of CVDs in sub-Saharan Africa. We assessed rates and predictors of statin utilization among two high CVD risk patient populations, people with type 2 diabetes mellitus (T2DM) and those with stroke, encountered across five hospitals in Ghana. METHODS A cross-sectional study among 1427 patients with T2DM and 159 stroke survivors encountered at 5 hospitals (1 primary-level, 2 secondary level and 2 tertiary level) in Ghana between July 2015 and June 2018. We collected baseline demographic and clinical details including statin prescription from medical records. Factors associated with statin prescription among T2DM for primary prevention and stroke survivors for secondary prevention were evaluated using multivariate logistic regression analysis. RESULTS Among patients with T2DM without CVDs, 240 (16.8%) were on statins for primary prevention. Factors associated with statin use among diabetics expressed as aOR (95% CI) were being treated at a tertiary level hospital 5.86 (3.22-10.68), hypertension comorbidity 1.80 (1.25-2.60), and lower income 0.43 (0.26-0.70). Among 159 stroke survivors, 22 (14.0%) were on statins with the following associated factors: lower income 0.16 (0.03-0.77), secondary level vs. tertiary level education 0.21 (0.05-0.97) and having T2DM 4.69 (1.63-13.49). CONCLUSION Approximately 1 in 6 individuals with T2DM without CVD and 1 in 7 stroke survivors are prescribed statins in Ghana. Efforts to bridge this practice gap and improve access to life saving preventative medications for CVD risk reduction in low-and-middle income countries are urgently warranted.
Collapse
Affiliation(s)
- Fred Stephen Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
| |
Collapse
|
38
|
Hertz JT, Sakita FM, Limkakeng AT, Mmbaga BT, Appiah LT, Bartlett JA, Galson SW. The burden of acute coronary syndrome, heart failure, and stroke among emergency department admissions in Tanzania: A retrospective observational study. Afr J Emerg Med 2019; 9:180-184. [PMID: 31890481 PMCID: PMC6933214 DOI: 10.1016/j.afjem.2019.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/26/2019] [Accepted: 07/12/2019] [Indexed: 12/11/2022] Open
Abstract
Introduction The prevalence of cardiovascular disease in sub-Saharan Africa is substantial and growing. Much remains to be learned about the relative burden of acute coronary syndrome (ACS), heart failure, and stroke on emergency departments and hospital admissions. Methods A retrospective chart review of admissions from September 2017 through March 2018 was conducted at the emergency department of a tertiary care center in northern Tanzania. Stroke admission volume was compared to previously published data from the same hospital and adjusted for population growth. Results Of 2418 adult admissions, heart failure and stroke were the two most common admission diagnoses, accounting for 294 (12.2%) and 204 (8.4%) admissions, respectively. ACS was uncommon, accounting for 9 (0.3%) admissions. Of patients admitted for heart failure, uncontrolled hypertension was the most commonly identified etiology of heart failure, cited in 124 (42.2%) cases. Ischemic heart disease was cited as the etiology in only 1 (0.3%) case. Adjusting for population growth, the annual volume of stroke admissions increased 70-fold in 43 years, from 2.9 admissions per 100,000 population in 1974 to 202.2 admissions per 100,000 in 2017. Conclusions The burden of heart failure and stroke on hospital admissions in Tanzania is substantial, and the volume of stroke admissions is rising precipitously. ACS is a rare diagnosis, and the distribution of cardiovascular disease phenotypes in Tanzania differs from what has been observed outside of Africa. Further research is needed to ascertain the reasons for these differences. In northern Tanzania, acute coronary syndrome is a rare admission diagnosis Heart failure and stroke are the most common admission diagnoses The burden of stroke admissions in this community is rising rapidly
Collapse
Affiliation(s)
- Julian T. Hertz
- Division of Emergency Medicine, Duke University, 2301 Erwin Rd, Durham, NC 27710, United States of America
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, United States of America
- Corresponding author at: Duke Global Health Institute, Box 102359, Duke University, Durham, NC 27710, United States of America.
| | - Francis M. Sakita
- Department of Emergency Medicine, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Alexander T. Limkakeng
- Division of Emergency Medicine, Duke University, 2301 Erwin Rd, Durham, NC 27710, United States of America
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Research Institute, Kilimanjaro Christian Medical University, PO Box 3010, Moshi, Tanzania
| | - Lambert T. Appiah
- Department of Cardiology, Komfo Anokye Teaching Hospital, PO Box 1934, Kumasi, Ghana
| | - John A. Bartlett
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, United States of America
| | - Sophie W. Galson
- Division of Emergency Medicine, Duke University, 2301 Erwin Rd, Durham, NC 27710, United States of America
| |
Collapse
|
39
|
Nichols M, Singh A, Sarfo FS, Treiber F, Tagge R, Jenkins C, Ovbiagele B. Post-intervention qualitative assessment of mobile health technology to manage hypertension among Ghanaian stroke survivors. J Neurol Sci 2019; 406:116462. [PMID: 31610382 PMCID: PMC7653548 DOI: 10.1016/j.jns.2019.116462] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/07/2019] [Accepted: 09/12/2019] [Indexed: 01/04/2023]
Abstract
Stroke is a leading cause of death in Africa and a key modifiable risk factor for the index and recurrent stroke is through the adequate management of blood pressure. Recent guidelines encourage management beyond clinic settings, yet implementation of these guidelines can be challenging, especially in resource constrained regions, such as in Sub-Saharan Africa. Mobile health technology may offer an innovative and cost-effective approach to improve BP monitoring and facilitate adherence to antihypertensive medications. Stroke survivors (n = 16) and their caregivers (n = 8) who participated in a 3-month feasibility study were invited to share post-intervention insights via focus groups (n = 3). Clinician (n = 7) input on intervention delivery and clinical impressions was also obtained via a separate focus group (n = 1). Four major themes emerged highlighting the ability to self-monitor, the use of technology as an interventional tool, training and support, and post-intervention adherence. Overwhelming receptivity toward home blood pressure monitoring and the use of mobile health (mHealth) was noted. Feedback indicated benefits in having access to equipment and that message prompts facilitated adherence. Post-intervention adherence declined following study intervention, indicating a need for increased exposure to facilitate long-term behavioral change, although participants conveyed a heightened awareness of the importance of BP monitoring and lifestyle changes needed.
Collapse
Affiliation(s)
- Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States of America.
| | - Arti Singh
- KNUST Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Fred Stephen Sarfo
- Department of Medicine, Neurology Unit, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Frank Treiber
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States of America.
| | - Raelle Tagge
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, United States of America.
| | - Carolyn Jenkins
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States of America.
| | - Bruce Ovbiagele
- School of Medicine, University of California San Francisco, San Francisco, CA, United States of America.
| |
Collapse
|
40
|
Sarfo FS, Mobula LM, Arthur L, Plange-Rhule J, Burnham G, Sablah J, Gavor E, Ansong D, Sarfo-Kantanka O, Adu Gyamfi R, Duah J, Abraham B, Ofori-Adjei D. Differential pricing of medicines to improve access to medicines for hypertension and diabetes control in Ghana: The Ghana Access and Affordability Program, a multi-center prospective trial. Gates Open Res 2019. [DOI: 10.12688/gatesopenres.13044.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Access to medicines for hypertension and diabetes mellitus (DM) management is challenging in resource-limited countries. We sought to assess whether differential pricing of medicines based on socio-economic status would improve affordability of antihypertensive and anti-diabetic medications. A quasi-experimental, prospective cohort study was implemented at five Ghanaian health facilities, using medicines differentially priced by three pharmaceutical companies. Methods: Adult patients ≥18 years with hypertension or DM were enrolled and assigned to a lower tiered differential price (DP arm) or market price (MP arm) based on minimum wage earning or a score >6/18 on a multi-dimensional poverty index scale. Study medicines were purchased at either the DP or MP when prescribed. Participants were followed for 18 months to assess blood pressure (BP) and glycemic control. Predictors of ability to purchase study medicines were assessed using parsimonious logistic regression models. Results: 3,296 participants were enrolled with mean age of 57±12.7 years, 76.6% females. 1,869 (56.7%) had hypertension, 422 (12.8%) had DM, and 1,005 (30.5%) with both hypertension and DM. Average follow-up was 14 months. There were prescriptions of study medications for 526 participants of which 238 (45.2%) were able to make purchases at DP 60.9% versus MP 39.1%. Independent predictors of purchasing ability were higher income, MP arm, willingness to purchase additional medicines, and being at tertiary level institution. Conclusions: Approximately 45% of Ghanaians could afford prescribed study medicines provided at a differential pricing mechanism albeit at an unsustainable basis. Further price reductions are expected to enhance access to medicines for hypertension and DM control.
Collapse
|
41
|
Sarfo FS, Agbenorku M, Adamu S, Obese V, Berchie P, Ovbiagele B. The dynamics of Poststroke depression among Ghanaians. J Neurol Sci 2019; 405:116410. [PMID: 31425901 DOI: 10.1016/j.jns.2019.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/17/2019] [Accepted: 07/22/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The very few published data on post-stroke depression (PSD) among indigenous Africans have covered its prevalence and predictors. We sought to evaluate the dynamics of PSD in a cohort of Ghanaian stroke survivors followed for 9 months after an acute stroke. METHODS Stroke survivors in this prospective cohort were adults aged >18 years with CT scan confirmed stroke, recruited into a randomized controlled trial to assess the feasibility of an mHealth technology-enabled, nurse guided intervention for blood pressure control. PSD was assessed a secondary outcome measure using the Hamilton Depression Rating Scale (HDRS) at enrollment, months 3, 6, and 9. Those with a score of >7 points on HDRS were categorized as depressed. A multivariate logistic regression analysis was performed to identify independent predictors of PSF. RESULTS Mean age of study participants was 55.1 ± 12.7 years with 65% being males. Ischemic strokes comprised 76.6% of study population. Prevalence of PSD at baseline was 78.6%, 43.6% at month 3, 41.1% at month 6 and 18.2% at month 9 (p < .0001). Factors significantly associated with PSD at baseline were higher NIH Stoke Scale score (adjusted OR 1.51, 95% CI: 1.03-2.23) and pain (adjusted OR 7.18, 95% CI: 1.52-33.89). NIHSS score (adjusted OR, 1.99, 95% CI: 1.12-3.52) as associated with PSD at month 9. CONCLUSION 80% Ghanaian stroke survivors have early PSD declining to 20% at month 9. Stroke severity is the persistent factor associated with PSD at baseline and follow-up, and good be a target for screening and promptly treating PSD.
Collapse
Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Manolo Agbenorku
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Sheila Adamu
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Vida Obese
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Patrick Berchie
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
| | | |
Collapse
|
42
|
Waweru P, Gatimu SM. Mortality and functional outcomes after a spontaneous subarachnoid haemorrhage: A retrospective multicentre cross-sectional study in Kenya. PLoS One 2019; 14:e0217832. [PMID: 31188844 PMCID: PMC6561561 DOI: 10.1371/journal.pone.0217832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/20/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Despite a reduction in poor outcomes in recent decades, spontaneous subarachnoid haemorrhage (SAH) remains associated with severe disability and high mortality rates. The exact extent of these outcomes is however unknown in Africa. This study aimed to determine the mortality and functional outcomes of patients with SAH in Kenya. METHODS We conducted a retrospective multicentre cross-sectional study involving patients admitted with SAH to three referral hospitals in Nairobi. All patients with a confirmed (primary) discharge diagnosis of first-time SAH between January 2009 and November 2017 were included (n = 158). Patients who had prior head trauma or cerebrovascular disease (n = 53) were excluded. Telephone interviews were conducted with surviving patients or their next of kin to assess out-of-hospital outcomes (including functional outcomes) based on modified Rankin Scale (mRS) scores. Chi-square and Fisher's exact tests were used to assess associations between mortality and functional outcomes and sample characteristics. RESULTS Of the 158 patients sampled, 38 (24.1%) died in hospital and 42 (26.6%) died within 1 month. In total, 87 patients were discharged home and followed-up in this study, of which 72 reported favourable functional outcomes (mRS ≤2). This represented 45.6% of all patients who presented alive, pointing to high numbers of unfavourable outcomes post SAH in Kenya. CONCLUSIONS Mortality following SAH remains high in Kenya. Patients who survive the initial ictus tend to do well after treatment, despite resource constraints. LIMITATIONS The study findings should be interpreted with caution because of unavoidable limitations in the primary data. These include its retrospective nature, the high number of patients lost to follow up, missing records and diagnoses, and/or possible miscoding of cases.
Collapse
Affiliation(s)
- Peter Waweru
- Neurosurgery Department, M.P Shah Hospital, Nairobi, Kenya
| | | |
Collapse
|
43
|
Sarfo FS, Nichols M, Singh A, Hardy Y, Norman B, Mensah G, Tagge R, Jenkins C, Ovbiagele B. Characteristics of hypertension among people living with HIV in Ghana: Impact of new hypertension guideline. J Clin Hypertens (Greenwich) 2019; 21:838-850. [PMID: 31125188 DOI: 10.1111/jch.13561] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/02/2019] [Accepted: 03/23/2019] [Indexed: 12/15/2022]
Abstract
Data on the burden of hypertension among people living with HIV (PLWH) in Africa are limited, especially after new expert consensus hypertension guidelines were published in 2017. The authors sought to assess the prevalence and factors associated with hypertension among PLWH. This is a cross-sectional study involving PLWH on combination antiretroviral therapy (cART) (n = 250) compared with sex-matched cART-naïve PLWH (n = 201) in Ghana. Hypertension was defined as blood pressure ≥ 140/90 mm Hg or use of antihypertensive drugs. The authors also assessed the prevalence and predictors associated with hypertension using the recent guideline recommended cutoff BP ≥ 130/80 mm Hg. Multivariate logistic regression models were fitted to identify factors associated with hypertension among PLWH. The mean age of PLWH on cART was 45.7 ± 8.6 years, and 42.9 ± 8.8 years among PLWH cART-naive with 81% of study participants being women. The prevalence of hypertension among PLWH on cART and PLWH cART-naïve was 36.9% and 23.4%, P = 0.002 at BP ≥ 140/90 mm Hg and 57.2% and 42.3%, respectively, P = 0.0009, at BP ≥ 130/80 mm Hg. Factors associated with hypertension at BP ≥ 140/90 mm Hg in the PLWH group with adjusted odds ratio (95% CI) were increasing age, 2.08 (1.60-2.71) per 10 years, and body mass index, 1.53 (1.24-1.88) per 5 kg/m2 rise. At BP ≥ 130/80 mm Hg, cART exposure, aOR of 1.77 (95% CI: 1.20-2.63), family history of hypertension, aOR of 1.43 (1.12-1.83), and hypertriglyceridemia, aOR of 0.54 (0.31-0.93), were associated with hypertension. Among PLWH, cART exposure was associated with higher prevalence of hypertension per the new guideline definition, a finding which warrants further investigation and possible mitigation.
Collapse
Affiliation(s)
- Fred Stephen Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Michelle Nichols
- Medical University of South Carolina, Charleston, South Carolina
| | - Arti Singh
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Betty Norman
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Ralle Tagge
- Medical University of South Carolina, Charleston, South Carolina
| | - Carolyn Jenkins
- Medical University of South Carolina, Charleston, South Carolina
| | | |
Collapse
|
44
|
Hertz JT, Madut DB, William G, Maro VP, Crump JA, Rubach MP. Perceptions of Stroke and Associated Health-Care-Seeking Behavior in Northern Tanzania: A Community-Based Study. Neuroepidemiology 2019; 53:41-47. [PMID: 30986785 PMCID: PMC6842572 DOI: 10.1159/000499069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/22/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Little is known about knowledge of stroke symptoms, perceptions of self-risk, and health-care-seeking behavior for stroke in East Africa. METHODS A 2-stage randomized population-based cluster survey with selection proportional to population size was performed in northern Tanzania. Self-identified household health-care decision makers were asked to list all symptoms of a stroke. They were further asked if they thought they had a chance of having a stroke and where they would present for care for stroke-like symptoms. A socioeconomic status score was derived via principal component analysis from 9 variables related to wealth. RESULTS Of 670 respondents, 184 (27.4%) knew a conventional stroke symptom and 51 (7.6%) thought they had a chance of having a stroke. Females were less likely to perceive themselves to be at risk than males (OR 0.49, 95% CI 0.28-0.89, p = 0.014). Of respondents, 558 (88.3%) stated they would present to a hospital for stroke-like symptoms. Preference for a hospital was not associated with knowledge of stroke symptoms or perception of self-risk but was associated with a higher socioeconomic status score (p < 0.001). CONCLUSIONS Knowledge of stroke symptoms and perception of self-risk are low in northern Tanzania, but most residents would present to a hospital for stroke-like symptoms.
Collapse
Affiliation(s)
- Julian T Hertz
- Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USA,
| | - Deng B Madut
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Venance P Maro
- Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - John A Crump
- Otago Global Health Institute, University of Otago, Dunedin, New Zealand
| | - Matthew P Rubach
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
45
|
Sarfo FS, Nichols M, Gebregziabher M, Tagge R, Asibey SO, Jenkins C, Ovbiagele B. Evaluation of Vascular Event Risk while on Long-term Anti-retroviral Suppressive Therapy [EVERLAST]: Protocol for a prospective observational study. eNeurologicalSci 2019; 15:100189. [PMID: 31011634 PMCID: PMC6460293 DOI: 10.1016/j.ensci.2019.100189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/23/2019] [Accepted: 03/29/2019] [Indexed: 12/11/2022] Open
Abstract
Background & objective Cardiovascular disease (CVD) risk among the HIV population is high due to a combination of accelerated atherosclerosis from the pro-inflammatory milieu created by chronic HIV infection and the potentially adverse metabolic side effects from cART (combination antiretroviral therapy) medications. Although sub-Saharan Africa (SSA) bears 70% of the global burden of HIV disease, there is a relative paucity of studies comprehensively assessing CVD risk among people living with HIV on the continent. The overarching objective of the Evaluation of Vascular Event Risk while on Long-term Anti-retroviral Suppressive Therapy (EVERLAST) Study is to characterize the burden of CVD among HIV patients on ART in Ghana, and explore factors influencing it. Methods The EVERLAST study incorporates prospective CVD risk assessments and a convergent mixed methods approach. This prospective study will evaluate CVD risk by measuring Carotid Intimal Media Thickness (CIMT) and presence of traditional medical and lifestyle vascular risk among 240 Ghanaian HIV patients on antiretroviral therapy compared with age- and sex-matched HIV uninfected (n = 240) and HIV positive ART naïve controls (n = 240). A contextual qualitative analysis will also be conducted to determine attitudes/perceptions of various key local stakeholders about CVD risk among HIV patients. The primary outcome measure will be CIMT measured cross-sectionally and prospectively among the three groups. A host of secondary outcome variables including CVD risk factors, CVD risk equations, HIV associated neurocognitive dysfunction and psychological well-being will also be assessed. Conclusion EVERLAST will provide crucial insights into the unique contributions of ART exposure and environmental factors such as lifestyle, traditional beliefs, and socio-economic indicators to CVD risk among HIV patients in a resource-limited setting. Ultimately, findings from our study will be utilized to develop interventions that will be tested in a randomized controlled trial to provide evidence to guide CVD risk management in SSA. EVERLAST seeks to assess the burden and determinants of cardiovascular risk among Ghanaian HIV patients A mixed methods study with prospective analyses of CVD risk factors among HIV patients and HIV-negative controls over 12 months Primary outcome measure is sub-clinical carotid atherosclerosis measured using B-mode ultrasound. Secondary outcome measures include neurocognitive dysfunction, and CVD events.
Collapse
Affiliation(s)
- Fred Stephen Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Corresponding author at: Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Private Mail Bag, Kumasi, Ghana.
| | | | | | - Raelle Tagge
- Medical University of South Carolina, Charleston, USA
| | | | | | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
| |
Collapse
|
46
|
Owolabi M, Sarfo FS, Akinyemi R, Gebreyohanns M, Ovbiagele B. The Sub-Saharan Africa Conference on Stroke (SSACS): An idea whose time has come. J Neurol Sci 2019; 400:194-198. [PMID: 30991160 DOI: 10.1016/j.jns.2019.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/28/2019] [Indexed: 12/19/2022]
Abstract
Stroke is a leading cause of global morbidity and mortality. Sub-Saharan Africa (SSA), where an unprecedented rise in stroke burden is currently raging, has the highest age-standardized stroke incidence, stroke prevalence, and stroke mortality rates. This is in sharp contrast to the relative decline in stroke incidence in high-income countries over the past four decades through better awareness and control of vascular risk factors. Compared to other groups, Africans tend to have a higher risk of stroke, higher percentage of the hemorrhagic type and much poorer outcomes. Indeed, stroke levies a heavy toll on the developing SSA economy by affecting a relatively younger age group. In this commentary, we examine the disproportionately high burden of stroke in the setting of grossly inadequate resources and evidence-based interventions. We propose an annual pan-regional stroke conference (starting in 2020) to harness global resources and local talent with the goal of galvanizing action to tackle this escalating burden. We anticipate that a successful conference series could become a rallying point for the eventual establishment of an African Stroke Organization.
Collapse
Affiliation(s)
- Mayowa Owolabi
- Department of Medicine, University of Ibadan, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, University of Ibadan, Ibadan, Nigeria.
| | | | - Rufus Akinyemi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
| |
Collapse
|
47
|
Dantas LF, Marchesi JF, Peres IT, Hamacher S, Bozza FA, Quintano Neira RA. Public hospitalizations for stroke in Brazil from 2009 to 2016. PLoS One 2019; 14:e0213837. [PMID: 30889198 PMCID: PMC6424448 DOI: 10.1371/journal.pone.0213837] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 03/01/2019] [Indexed: 12/22/2022] Open
Abstract
Background Stroke is the third major cause of death in the world and the second in Brazil. The purpose of this work was to assess the stroke-related hospitalization, in-hospital mortality, and case fatality rates under the Brazilian Unified Health System (SUS) from 2009 to 2016. Methods We evaluated the hospital admissions for stroke and their associated outcomes using data from the Hospital Information available at the Informatics Department of SUS. We selected hospitalization registries according to stroke diagnosis codes from the International Statistical Classification of Diseases and Related Health Problems (ICD-10). We identified the association of age and sex with patient death through multiple logistic regression and calculated the rates of hospitalization, mortality and case-fatality per 100,000 inhabitants using age-adjustment methodology. Results We analyzed 1,113,599 stroke hospitalizations. From 2009 to 2016, the number of admissions increased from 131,122 to 146,950 and the absolute number of in-hospital deaths increased from 28,731 to 31,937. Younger age and male sex were significantly associated with patient survival. Our results showed that the annual age-adjusted hospitalization and in-hospital mortality rates decreased by 11.8% and 12.6%, respectively, but the case fatality rate increased for patients older than 70 years. Conclusions Although the age-adjusted hospitalization and in-hospital mortality rates declined, the total number of hospitalization and deaths have increased. It is expected a continuous increase over the next years of stroke admissions with the rapid aging of the Brazilian population. Efforts should be renewed targeting risk factors, access to hospital and rehabilitation in particular for the elderly population.
Collapse
Affiliation(s)
- Leila F. Dantas
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Janaina F. Marchesi
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Igor T. Peres
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fernando A. Bozza
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- IDOR, D’Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
- * E-mail:
| | - Ricardo A. Quintano Neira
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
48
|
Sarfo FS, Berchie P, Singh A, Nichols M, Agyei-Frimpong M, Jenkins C, Ovbiagele B. Prevalence, Trajectory, and Predictors of Poststroke Fatigue among Ghanaians. J Stroke Cerebrovasc Dis 2019; 28:1353-1361. [PMID: 30797644 DOI: 10.1016/j.jstrokecerebrovasdis.2019.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND PURPOSE Poststroke fatigue (PSF) is rife among stroke survivors and it exerts a detrimental toll on recovery from functional deficits. The burden of PSF is unknown in sub-Saharan Africa. We have assessed the prevalence, trajectory, and predictors of PSF among 60 recent Ghanaian stroke patients. METHODS Study participants in this prospective cohort (recruited between January 2017 and June 2017) were stroke survivors, aged greater than 18 years, with CT scan confirmed stroke of less than 1-month onset. PSF was assessed using the Fatigue Severity Scale (FSS) at enrollment, months 3, 6, and 9. Those with a score of greater than or equal to 4 points on FSS were categorized as "fatigued." A multivariate logistic regression analysis was performed to identify independent predictors of PSF at enrollment and at month 9. RESULTS Sixty-five percent (65%) of our sample were males with a mean age of 55.1 ± 12.7 years. In addition to all participants having hypertension, 85% had dyslipidemia and 25% had diabetes mellitus. Ischemic strokes comprised 76.6% of the study population. The prevalence of PSF was 58.9% at baseline and declined to 23.6% at month 9, P = .0002. Diabetes mellitus was significantly associated with PSF at baseline with an adjusted odds ratio of 15.12 (95% CI: 1.70-134.30), P = .01. However, at month 9, age greater than or equal to 65 years, adjusted odds ratio (aOR) of 7.02 (95% CI: 1.16-42.52); female sex, aOR of 8.52 (1.23-59.16), and depression, aOR of 8.86 (1.19-65.88) were independently associated with PSF. CONCLUSIONS Approximately 6 out of 10 Ghanaian stroke survivors experience PSF within the first month of stroke onset. PSF persists in approximately 1 out of 4 stroke survivors at 10 months after the index stroke. Further studies to elucidate the underlying mechanisms for PSF are required and adequately powered interventional multicenter trials are eagerly awaited to provide solid evidence base for the clinical management of PSF.
Collapse
Affiliation(s)
- Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Patrick Berchie
- Medical University of South Carolina, Charleston, South Carolina
| | - Arti Singh
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michelle Nichols
- Northern California Institute of Research & Education, California
| | | | - Carolyn Jenkins
- Northern California Institute of Research & Education, California
| | | | | |
Collapse
|
49
|
Cardiovascular Disease Healthcare Utilization in Sub-Saharan Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030419. [PMID: 30717120 PMCID: PMC6388380 DOI: 10.3390/ijerph16030419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/11/2019] [Accepted: 01/26/2019] [Indexed: 01/03/2023]
Abstract
Sub-Saharan African (SSA) countries face a growing burden of cardiovascular disease (CVD), attributed to economic, nutritional, demographic, and epidemiological transitions. These factors increase the prevalence of CVD risk factors, and the CVD burden overlaps with a high prevalence of infectious diseases. This review aimed to understand CVD healthcare utilization determinants and levels in SSA. We conducted a systematic search of the literature on major databases for the period 2008⁻2018 using exhaustive combinations of CVD and utilization indicators as search terms. Eighteen studies from eight countries were included in this review. Most studies (88.8%) followed the quantitative methodology and largely focused on inpatient stroke care. Two-thirds of patients sought care within 24 h of suffering a stroke, and the length of stay (LOS) in hospital ranged between 6 and 81 days. Results showed a rising trend of CVD admissions within total hospital admissions. Coverage of physiotherapy services was limited and varied between countries. While few studies included rural populations, utilization was found to be negatively associated with rural residence and socioeconomic status. There is a need to extend healthcare provision in SSA to ensure access to the CVD continuum of care.
Collapse
|
50
|
Akinyemi RO, Sarfo FS, Akinyemi J, Singh A, Onoja Akpa M, Akpalu A, Owolabi L, Adeoye AM, Obiako R, Wahab K, Sanya E, Komolafe M, Ogbole G, Fawale M, Adebayo P, Osaigbovo G, Sunmonu T, Olowoyo P, Chukwuonye I, Obiabo Y, Adeniji O, Fakunle G, Melikam E, Saulson R, Yaria J, Uwanruochi K, Ibinaiye P, Adeniyi Amusa G, Suleiman Yahaya I, Hamisu Dambatta A, Faniyan M, Olowoniyi P, Bock-Oruma A, Chidi Joseph O, Oguntade A, Kolo P, Laryea R, Lakoh S, Uvere E, Farombi T, Akpalu J, Oyinloye O, Appiah L, Calys-Tagoe B, Shidali V, Abdulkadir Tabari N, Adebayo O, Efidi R, Adeleye O, Owusu D, Ogunjimi L, Aridegbe O, Lucius Imoh C, Sanni T, Gebreziabher M, Hemant T, Arulogun O, Ogunniyi A, Jenkins C, Owolabi M, Ovbiagele B. Knowledge, attitudes and practices of West Africans on genetic studies of stroke: Evidence from the SIREN Study. Int J Stroke 2019; 14:69-79. [PMID: 30040054 PMCID: PMC8325169 DOI: 10.1177/1747493018790059] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND It is crucial to assess genomic literacy related to stroke among Africans in preparation for the ethical, legal and societal implications of the genetic revolution which has begun in Africa. OBJECTIVE To assess the knowledge, attitudes and practices (KAP) of West Africans about stroke genetic studies. METHODS A comparative cross-sectional study was conducted among stroke patients and stroke-free controls recruited across 15 sites in Ghana and Nigeria. Participants' knowledge of heritability of stroke, willingness to undergo genetic testing and perception of the potential benefits of stroke genetic research were assessed using interviewer-administered questionnaire. Descriptive, frequency distribution and multiple regression analyses were performed. RESULTS Only 49% of 2029 stroke patients and 57% of 2603 stroke-free individuals knew that stroke was a heritable disorder. Among those who knew, 90% were willing to undergo genetic testing. Knowledge of stroke heritability was associated with having at least post-secondary education (OR 1.51, 1.25-1.81) and a family history of stroke (OR 1.20, 1.03-1.39) while Islamic religion (OR=0.82, CI: 0.72-0.94), being currently unmarried (OR = 0.81, CI: 0.70-0.92), and alcohol use (OR = 0.78, CI: 0.67-0.91) were associated with lower odds of awareness of stroke as a heritable disorder. Willingness to undergo genetic testing for stroke was associated with having a family history of stroke (OR 1.34, 1.03-1.74) but inversely associated with a medical history of high blood pressure (OR = 0.79, 0.65-0.96). CONCLUSION To further improve knowledge of stroke heritability and willingness to embrace genetic testing for stroke, individuals with less formal education, history of high blood pressure and no family history of stroke require targeted interventions.
Collapse
Affiliation(s)
- Rufus O Akinyemi
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria,Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria,Federal Medical Centre, Abeokuta, Nigeria
| | - Fred S Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Arti Singh
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Matthew Onoja Akpa
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Albert Akpalu
- Department of Medicine, University of Ghana, Accra, Ghana
| | - Lukman Owolabi
- Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Abiodun M. Adeoye
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria,Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Emmanuel Sanya
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Godwin Ogbole
- Department of Radiology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Michael Fawale
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Philip Adebayo
- Department of Medicine, Ladoke Akintola University Teaching Hospital, Ogbomoso, Nigeria
| | - Godwin Osaigbovo
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Taofiki Sunmonu
- Department of Medicine, Federal Medical Centre, Owo, Nigeria
| | - Paul Olowoyo
- Department of Medicine, Federal University Teaching Hospital, Ido-Ekiti, Nigeria
| | | | - Yahaya Obiabo
- Department of Medicine, Delta State University Teaching Hospital, Igharra, Nigeria
| | | | - Gregory Fakunle
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ezinne Melikam
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Raelle Saulson
- Department of Neurosciences, Medical University of South Carolina, Charleston, USA
| | - Joseph Yaria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Phillip Ibinaiye
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | | | | | | | - Mercy Faniyan
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Peter Olowoniyi
- Department of Medicine, Federal Medical Centre, Umuahia, Nigeria
| | - Andrew Bock-Oruma
- Department of Medicine, Delta State University Teaching Hospital, Igharra, Nigeria
| | - Odo Chidi Joseph
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Philip Kolo
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Ruth Laryea
- Department of Medicine, University of Ghana, Accra, Ghana
| | - Sulaiman Lakoh
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Ezinne Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Temitope Farombi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Olalekan Oyinloye
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Lambert Appiah
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | - Vincent Shidali
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | | | - Oladimeji Adebayo
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Richard Efidi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Dorcas Owusu
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Luqman Ogunjimi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | | | - Taofeeq Sanni
- Department of Medicine, Federal University Teaching Hospital, Ido-Ekiti, Nigeria
| | | | - Tiwari Hemant
- Department of Epidemiology, University of Alabama at Birmingham, Alabama, USA
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Carolyn Jenkins
- Department of Neurosciences, Medical University of South Carolina, Charleston, USA
| | - Mayowa Owolabi
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria,Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Ovbiagele
- Department of Neurosciences, Medical University of South Carolina, Charleston, USA
| | | |
Collapse
|