1
|
Kumar A, Khurana D, Pattanaik S, Kumar M, Kaur S, Krishnan NC, Ghai S, Modi M, Nagi M, Chellappa R, Gairolla J, Munjal DK, Kumar P. A mobile application-based post-stroke care strategy for survivors and their caregivers for prevention and management of post-stroke complications - "Stroke Home Care:" Development and feasibility. J Neurosci Rural Pract 2024; 15:217-226. [PMID: 38746514 PMCID: PMC11090587 DOI: 10.25259/jnrp_411_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/10/2023] [Indexed: 05/16/2024] Open
Abstract
Objectives In developing nations such as India, a disparity exists between the available resources for stroke rehabilitation and the substantial burden of stroke cases. Consequently, the provision of cost-effective and multidisciplinary post-stroke rehabilitation care to stroke survivors becomes of paramount importance. The utilization of mobile applications (apps) for stroke care has been on the rise, offering a personalized and pragmatic solution with the potential for wider reach in settings constrained by limited resources. To address the unmet needs in the prevention and management of post-stroke complications, we conceptualized a strategy known as a mobile application-based post-stroke care strategy for both survivors and their caregivers. Materials and Methods The scope of the app's focus was determined based on the incidence of post-stroke complications within a prospective cohort of stroke patients, in conjunction with existing literature. An initial "web-based mobile app" prototype was crafted to align with the identified focus area. Before the development of the final app version, a feasibility study was conducted involving 30 participant dyads (comprising a patient and a caregiver). Content validity was evaluated by a panel of 20 stroke experts encompassing neurologists, nurses, physiotherapists, and psychologists. Results The "Stroke Home Care" (SHC) mobile app was conceived as a web-based educational tool aimed at preventing and managing post-stroke complications. It seeks to train caregivers of immobile stroke patients in the administration of preventive and therapeutic care procedures, thereby potentially enhancing survivors' quality of life and alleviating caregivers' burden. The feasibility and validity studies indicated "high satisfaction" levels among most caregivers and experts (>75%), with the remainder expressing "satisfaction" and no "dissatisfaction" regarding app utilities. Stroke experts unanimously deemed the app "appropriate", with consensus on contents, video quality, video length, and voice clarity. Caregivers reported "satisfactory" user experiences, encountering no issues during app installation or operation. Suggestions from both caregivers and experts were integrated into the final app version. Conclusion The "SHC" app represents a feasible and well-received innovation tailored for the use by caregivers of stroke survivors. Consequently, the initial feasibility of the developed app serves as a precursor to a randomized controlled clinical trial aimed at substantiating its effectiveness within the post-stroke survivor and caregiver population. Notably, within resource-constrained contexts, this app has the potential to be a pivotal tool for post-stroke care.
Collapse
Affiliation(s)
- Ashok Kumar
- National Institute of Nursing Education, Chandigarh, India
| | - Dheeraj Khurana
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Smita Pattanaik
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mukesh Kumar
- Department of Industrial Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sukhpal Kaur
- National Institute of Nursing Education, Chandigarh, India
| | | | - Sandhya Ghai
- National Institute of Nursing Education, Chandigarh, India
| | - Manish Modi
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Nagi
- National Institute of Nursing Education, Chandigarh, India
| | - Rajan Chellappa
- Department of Physical Medicine and Rehabilitation, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Divesh Kumar Munjal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pramod Kumar
- Department of Nursing, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
2
|
Oronti IB, Iadanza E, Pecchia L. Hypertension Diagnosis and Management in Africa Using Mobile Phones: A Scoping Review. IEEE Rev Biomed Eng 2024; 17:197-211. [PMID: 35763465 DOI: 10.1109/rbme.2022.3186828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Target 3.4 of the third Sustainable Development Goal (SDG) of the United Nations (UN) General Assembly proposes to reduce premature mortality from non-communicable diseases (NCDs) by one-third. Epidemiological data presented by the World Health Organization (WHO) in 2016 show that out of a total of 57 million deaths worldwide, approximately 41 million deaths occurred due to NCDs, with 78% of such deaths occurring in low-and-middle-income countries (LMICs). The majority of investigations on NCDs agree that the leading risk factor for mortality worldwide is hypertension. Over 75% of the world's mobile phone subscriptions reside in LMICs, hence making the mobile phone particularly relevant to mHealth deployment in Africa. This study is aimed at determining the scope of the literature available on hypertension diagnosis and management in Africa, with particular emphasis on determining the feasibility, acceptability and effectiveness of interventions based on the use of mobile phones. The bulk of the evidence considered overwhelmingly shows that SMS technology is yet the most used medium for executing interventions in Africa. Consequently, the need to define novel and superior ways of providing effective and low-cost monitoring, diagnosis, and management of hypertension-related NCDs delivered through artificial intelligence and machine learning techniques is clear.
Collapse
|
3
|
Addressing Hypertension Care in Africa (ADHINCRA): Study protocol for a cluster-randomized controlled pilot trial. Contemp Clin Trials 2023; 125:107077. [PMID: 36592818 DOI: 10.1016/j.cct.2022.107077] [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: 07/26/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Uncontrolled hypertension is a major risk factor for cardiovascular disease. Evidence-based interventions to improve hypertension control in high-income countries have not been translated equally in sub-Saharan Africa (SSA). The objective of the Addressing Hypertension Care in Africa (ADHINCRA) Study was to test the feasibility and signal of efficacy of a multilevel, nurse-led, mobile health enhanced intervention in improving hypertension control in Ghana. METHODS Using a cluster randomized controlled pilot trial design, four hospitals in Kumasi, Ghana, were randomized to the intervention arm (2 hospitals) and enhanced usual care arm (2 hospitals). A total of 240 patients with uncontrolled hypertension defined as systolic blood pressure (BP) ≥140 mmHg on their most recent visit were included (60 patients per hospital). Patients in the intervention arm received an intervention that consisted of nurse-led task-shifting and a mobile health application (Medtronic® Labs' Empower Health), and home BP monitoring. The enhanced usual care arm received usual care as determined by their providers, plus short text messages on health. The intervention was administered for six months, after which it was withdrawn, and patients were followed for six more months to assess outcomes. Feasibility measures included recruitment and dropout rates of study participants, protocol adherence in both arms. Clinical outcomes included changes in BP control status and systolic BP levels from baseline. Secondary outcomes included change in glycemic control, rates of hypertensive urgencies/emergencies, cardiovascular disease events, and medication adherence. DISCUSSION Findings from this study will provide critical pilot data to inform the conduct of a larger scale trial and the development of scalable health system and policy interventions to improve hypertension control in low-resource settings. Trial registration NCT04010344. Registered on July 8, 2019 at ClinicalTrials.govhttps://clinicaltrials.gov/ct2/show/NCT04010344.
Collapse
|
4
|
Aboye GT, Vande Walle M, Simegn GL, Aerts JM. mHealth in sub-Saharan Africa and Europe: A systematic review comparing the use and availability of mHealth approaches in sub-Saharan Africa and Europe. Digit Health 2023; 9:20552076231180972. [PMID: 37377558 PMCID: PMC10291558 DOI: 10.1177/20552076231180972] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Background mHealth can help with healthcare service delivery for various health issues, but there's a significant gap in the availability and use of mHealth systems between sub-Saharan Africa and Europe, despite the ongoing digitalization of the global healthcare system. Objective This work aims to compare and investigate the use and availability of mHealth systems in sub-Saharan Africa and Europe, and identify gaps in current mHealth development and implementation in both regions. Methods The study adhered to the PRISMA 2020 guidelines for article search and selection to ensure an unbiased comparison between sub-Saharan Africa and Europe. Four databases (Scopus, Web of Science, IEEE Xplore, and PubMed) were used, and articles were evaluated based on predetermined criteria. Details on the mHealth system type, goal, patient type, health concern, and development stage were collected and recorded in a Microsoft Excel worksheet. Results The search query produced 1020 articles for sub-Saharan Africa and 2477 articles for Europe. After screening for eligibility, 86 articles for sub-Saharan Africa and 297 articles for Europe were included. To minimize bias, two reviewers conducted the article screening and data retrieval. Sub-Saharan Africa used SMS and call-based mHealth methods for consultation and diagnosis, mainly for young patients such as children and mothers, and for issues such as HIV, pregnancy, childbirth, and child care. Europe relied more on apps, sensors, and wearables for monitoring, with the elderly as the most common patient group, and the most common health issues being cardiovascular disease and heart failure. Conclusion Wearable technology and external sensors are heavily used in Europe, whereas they are seldom used in sub-Saharan Africa. More efforts should be made to use the mHealth system to improve health outcomes in both regions, incorporating more cutting-edge technologies like wearables internal and external sensors. Undertaking context-based studies, identifying determinants of mHealth systems use, and considering these determinants during mHealth system design could enhance mHealth availability and utilization.
Collapse
Affiliation(s)
- Genet Tadese Aboye
- M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
- School of Biomedical Engineering, Jimma University, Jimma, Ethiopia
| | - Martijn Vande Walle
- M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
| | | | - Jean-Marie Aerts
- M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
| |
Collapse
|
5
|
Amuasi J, Agbogbatey MK, Sarfo FS, Beyuo A, Duah K, Agasiya P, Arthur A, Appiah L, Nguah SB, Bockarie A, Ayisi-Boateng NK, Boateng KGA, Adusei-Mensah N, Akpalu A, Ovbiagele B. Feasibility, acceptability, and appropriateness of a mobile health stroke intervention among Ghanaian health workers. J Neurol Sci 2022; 439:120304. [DOI: 10.1016/j.jns.2022.120304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/18/2022] [Accepted: 05/28/2022] [Indexed: 02/08/2023]
|
6
|
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
|
7
|
Cernota M, Kroeber ES, Demeke T, Frese T, Getachew S, Kantelhardt EJ, Ngeh EN, Unverzagt S. Non-pharmacological interventions to achieve blood pressure control in African patients: a systematic review. BMJ Open 2022; 12:e048079. [PMID: 35228272 PMCID: PMC8886440 DOI: 10.1136/bmjopen-2020-048079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This systematic review aims to evaluate the evidence of non-pharmacological strategies to improve blood pressure (BP) control in patients with hypertension from African countries. DESIGN We performed a systematic review and searched Medline, Central, CINAHL and study registers until June 2020 for randomised studies on interventions to decrease BP of patients with hypertension in African countries. We assessed the study quality using the Cochrane risk of bias tool and narratively synthesised studies on non-pharmacological hypertension interventions. SETTING We included studies conducted in African countries. PARTICIPANTS Adult African patients with a hypertension diagnosis. INTERVENTIONS Studies on non-pharmacological interventions aiming to improve BP control and treatment adherence. OUTCOMES Main outcomes were BP and treatment adherence. RESULTS We identified 5564 references, included 23 with altogether 18 153 participants from six African countries. The studies investigated educational strategies to improve adherence (11 studies) and treatment by healthcare professionals (5 studies), individualised treatment strategies (2 studies), strategies on lifestyle including physical activity (4 studies) and modified nutrition (1 study). Nearly all studies on educational strategies stated improved adherence, but only three studies showed a clinically relevant improvement of BP control. All studies on individualised strategies and lifestyle changes resulted in clinically relevant effects on BP. Due to the type of interventions studied, risk of bias in domain blinding of staff/participants was frequent (83%). Though incomplete outcome data in 61% of the studies are critical, the general study quality was reasonable. CONCLUSIONS The identified studies offer diverse low-cost interventions including educative and task-shifting strategies, individualised treatment and lifestyle modifications to improve BP control. Especially trialled physical activity interventions show clinically relevant BP changes. All strategies were trialled in African countries and may be used for recommendations in evidence-based guidelines on hypertension in African settings. PROSPERO REGISTRATION NUMBER CRD42018075062.
Collapse
Affiliation(s)
- Monique Cernota
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin-Luther-Universität Halle-Wittenberg Medizinische Fakultät, Halle, Germany
| | - Eric Sven Kroeber
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin-Luther-Universität Halle-Wittenberg Medizinische Fakultät, Halle, Germany
| | - Tamiru Demeke
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin-Luther-Universität Halle-Wittenberg Medizinische Fakultät, Halle, Germany
| | - Sefonias Getachew
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva Johanna Kantelhardt
- Institute for Medical Epidemiology, Biostatistics and Informatics, Center of Health Sciences, Martin-Luther-Universität Halle-Wittenberg Medizinische Fakultät, Halle, Germany
| | - Etienne Ngeh Ngeh
- Physiotherapy Department, Regional Hospital Bamenda, Bamenda, Cameroon
- Research Organization for Health Education and Rehabilitation-Cameroon(ROHER-CAM), St. Louis University Bamenda, Bamenda, Cameroon
- African Regional Community, Guidelines International Network (G-I-N), Bamenda, Cameroon
| | - Susanne Unverzagt
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin-Luther-Universität Halle-Wittenberg Medizinische Fakultät, Halle, Germany
- Department of Primary Care, Universität Leipzig Medizinische Fakultät, Leipzig, Germany
| |
Collapse
|
8
|
Kalani Z, Ebrahimi S, Fallahzadeh H. Effects of the liaison nurse management on the infectious stroke complications: a randomized controlled trial. BMC Nurs 2022; 21:29. [PMID: 35057795 PMCID: PMC8772205 DOI: 10.1186/s12912-021-00802-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 12/29/2021] [Indexed: 11/26/2022] Open
Abstract
Background Two of the most serious complications after stroke are pneumonia, and urinary tract infection. Liaison nurse, from hospital admission to discharge and then at home helps patients with complicated caring issues stroke. This study investigates the effect of liaison nurse management on the incidence of pneumonia and urinary tract infection in patients with stroke after discharge from the hospital. Methods This randomized controlled trial was conducted on 80 patients in a hospital in Iran. The intervention group was assessed and developed a caring program by the liaison nurse and the control group received routine care. Two weeks and two months after discharge, the patients were evaluated for the incidence of pneumonia and urinary tract infection. Collected data were analyzed using the Chi-square test. P < 0.05 was considered statistically significant. Results The two groups were homogenous in terms of mean age; gender frequently distribution and having urinary catheter. The incidence of pneumonia in intervention and control groups (11.6% vs. 19.2%, P = 0.35) had no statistically significant differences, but there was a significant difference in the incidence of urinary tract infection (0% vs. 24.6%, P < 0.001). Conclusions With liaison nurse performance, there was a significant difference in the incidence of urinary tract infection, in two months after discharge from hospital, but the incidence of pneumonia had no statistically significant differences in two groups. Nurse’s evaluation each patient individually according to needs, developing and monitoring the home-based care program, beyond overall education to these patients, could reduce some of complications of a stroke. Trial registration This study is retrospectively registered by Iranian Registry of Clinical Trials with decree code: IRCT20170605034330N3 on April 4, 2018.
Collapse
|
9
|
"Lessons Learned" Preventing Recurrent Ischemic Strokes through Secondary Prevention Programs: A Systematic Review. J Clin Med 2021; 10:jcm10184209. [PMID: 34575320 PMCID: PMC8471819 DOI: 10.3390/jcm10184209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022] Open
Abstract
Recurrent ischemic strokes are a cause of significant healthcare burdens globally. Patients with uncontrolled vascular risk factors are more likely to develop recurrent ischemic strokes. This study aims to compile information gained from current secondary prevention programs. A pre-defined literature search strategy was applied to PubMed, SCOPUS, CINAHL, and Google Scholar databases, and studies from 1997 to 2020 were evaluated for quality, study aims, and outcomes. The search produced 1175 articles (1092 after duplicates were removed) and titles were screened; 55 titles were retained for the full-text analysis. Of the remaining studies, 31 were retained for assessment, five demonstrated long-term effectiveness, eight demonstrated short-term effectiveness, and 18 demonstrated no effectiveness. The successful studies utilized a variety of different techniques in the categories of physical fitness, education, and adherence to care plans to reduce the risk of recurrent strokes. The lessons we learned from the current prevention programs included (1) offer tailored care for underserved groups, (2) control blood pressure, (3) provide opportunities for medication dosage titration, (4) establish the care plan prior to discharge, (5) invest in supervised exercise programs, (6) remove barriers to accessing care in low resource settings, and (7) improve the transition of care.
Collapse
|
10
|
Kaddumukasa M, Najjuma J, Mbalinda SN, Kaddumukasa MN, Nakibuuka J, Burant C, Moore S, Blixen C, Katabira ET, Sajatovic M. Reducing stroke burden through a targeted self-management intervention for reducing stroke risk factors in high-risk Ugandans: A protocol for a randomized controlled trial. PLoS One 2021; 16:e0251662. [PMID: 34157024 PMCID: PMC8219138 DOI: 10.1371/journal.pone.0251662] [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: 03/23/2021] [Accepted: 04/09/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Stroke burden is rapidly increasing globally. Modifiable risk factors offer an opportunity to intervene, and targeting hypertension is a key actionable target for stroke risk reduction in sub-Saharan Africa. This 3-site planned randomized controlled trial builds on promising preliminary data. METHODS A total of 246 Ugandan adults will be recruited randomized to experimental intervention vs. enhanced treatment control. Intervention participants will receive six weekly group-format stroke risk reduction self-management training sessions, and the controls will receive information on cardiovascular risk. The primary study outcome is systolic B.P. measured at baseline, 13-week, 24 weeks (6 months). Secondary outcomes include other biological and behavioral stroke risk factors. DISCUSSION The curriculum-guided self-management TargetEd MAnageMent Intervention (TEAM) program is anticipated to reduce the stroke burden in Uganda. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04685408, registered on 28 December 2020.
Collapse
Affiliation(s)
- Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | - Josephine Najjuma
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Jane Nakibuuka
- Department of Medicine, Mulago Hospital, Kampala, Uganda
| | - Christopher Burant
- Louis Stokes VA Medical Center, Geriatric Research Education, and Clinical Center, Cleveland, OH, United States of America
| | - Shirley Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, United States of America
| | - Carol Blixen
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Elly T. Katabira
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| |
Collapse
|
11
|
Abstract
Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.
Collapse
|
12
|
Menyanu E, Baatiema L, Charlton K, Wilson M, Aikins ADG, Russell J. Towards Population Salt Reduction to Control High Blood Pressure in Ghana: A Policy Direction. Curr Dev Nutr 2020; 4:nzaa084. [PMID: 32851200 PMCID: PMC7438700 DOI: 10.1093/cdn/nzaa084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/16/2020] [Accepted: 05/13/2020] [Indexed: 01/29/2023] Open
Abstract
Although population salt reduction is considered a "best buy" in addressing hypertension and cardiovascular disease, Ghana shares a high hypertension burden with a seemingly high salt consumption. This article discusses best practices in reducing population salt intake and provides preliminary data on salt and potassium intake, as well as the process to develop a road map and identification of actions needed to support the development of a strategic national document towards salt reduction in Ghana. In February 2019, a 2-d stakeholder meeting was held with government agencies, researchers, nongovernmental organizations, civil society organizations, and international partners to deliberate on salt reduction strategies and interventions needed in the face of rising hypertension and other noncommunicable diseases (NCDs) in Ghana. Recommendations were developed from the stakeholder meeting and are being considered for inclusion in the revision of Ghana's national NCD policy.
Collapse
Affiliation(s)
- Elias Menyanu
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Leonard Baatiema
- Noncommunicable Diseases Support Center for Africa, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Karen Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Michael Wilson
- Noncommunicable Diseases Support Center for Africa, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ama De-Graft Aikins
- Noncommunicable Diseases Support Center for Africa, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Joanna Russell
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
13
|
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
|
14
|
Tannor EK, Sarfo FS, Mobula LM, Sarfo‐Kantanka O, Adu‐Gyamfi R, Plange‐Rhule J. Prevalence and predictors of chronic kidney disease among Ghanaian patients with hypertension and diabetes mellitus: A multicenter cross-sectional study. J Clin Hypertens (Greenwich) 2019; 21:1542-1550. [PMID: 31465141 PMCID: PMC8030392 DOI: 10.1111/jch.13672] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/24/2019] [Accepted: 08/02/2019] [Indexed: 01/10/2023]
Abstract
The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astronomical increases in key risk factors including hypertension and diabetes. We sought to assess the burden and predictors of CKD among Ghanaians with hypertension and/or diabetes mellitus in a multicenter hospital-based study. We conducted a cross-sectional study in the Ghana Access and Affordability Program (GAAP) involving adults with hypertension only (HPT), hypertension with diabetes mellitus (HPT + DM), and diabetes mellitus only (DM) in 5 health facilities in Ghana. A structured questionnaire was administered to collect data on demographic variables, medical history, and clinical examination. Serum creatinine and proteinuria were measured, and estimated glomerular filtration rate derived using the CKD-EPI formula. A multivariable logistic regression model was used to identify factors associated with CKD. A total of 2781 (84.4%) of 3294 participants had serum creatinine and proteinuria data available for analysis. The prevalence of CKD was 242 (28.5%) among participants with both DM and HPT, 417 (26.3%) among participants with HPT, and 56 (16.1%) among those with DM alone. Predictors of CKD were increasing age aOR 1.26 (1.17-1.36), low educational level aOR 1.7 (1.23-2.35), duration of HPT OR, 1.02 (1.01-1.04), and use of herbal medications aOR 1.39 (1.10-1.75). Female gender was protective of CKD aOR 0.75 (0.62-0.92). Among patients with DM, increasing age and systolic blood pressure were associated with CKD. There is high prevalence of CKD among DM and hypertension patients in Ghana. Optimizing blood pressure control and limiting the use of herbal preparations may mitigate CKD occurrence in high cardiovascular risk populations in developing countries.
Collapse
Affiliation(s)
| | - Fred Stephen Sarfo
- Komfo Anokye Teaching HospitalKumasiGhana
- Kwame Nkrumah University of Science & TechnologyKumasiGhana
| | - Linda M. Mobula
- Johns Hopkins University School of MedicineBaltimoreMDUSA
- Johns Hopkins University Bloomberg School of Public HealthBaltimoreMDUSA
| | | | | | | |
Collapse
|
15
|
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
|
16
|
Akinyemi R, Ojagbemi A, Akinyemi J, Salami A, Olopade F, Farombi T, Nweke M, Uvere E, Aridegbe M, Balogun J, Ogbole G, Jegede A, Kalaria R, Ogunniyi A, Owolabi M, Arulogun O. Gender differential in inclination to donate brain for research among Nigerians: the IBADAN Brain Bank Project. Cell Tissue Bank 2019; 20:297-306. [PMID: 31028517 DOI: 10.1007/s10561-019-09769-4] [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: 12/14/2018] [Accepted: 04/17/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laboratory-based studies of neurological disease patterns and mechanisms are sparse in sub-Saharan Africa. However, availability of human brain tissue resource depends on willingness towards brain donation. This study evaluated the level of willingness among outpatient clinic attendees in a Nigerian teaching hospital. METHODS Under the auspices of the IBADAN Brain Bank Project, a 43-item semi-structured interviewer-administered questionnaire was designed to evaluate knowledge, attitude, and beliefs of individuals attending Neurology, Psychiatry and Geriatrics Outpatient clinics regarding willingness to donate brain for research. Association between participants characteristics and willingness towards brain donation was investigated using logistic regression models. Analysis was conducted using Stata SE version 12.0. RESULTS A total of 412 participants were interviewed. Their mean age was 46.3 (16.1) years. 229 (55.6%) were females and 92.5% had at least 6 years of formal education. Overall, 109 (26.7%) were willing to donate brains for research. In analyses adjusting for educational status, religion, ethnicity, marital status and family setting, male sex showed independent association with willingness towards brain donation OR (95% CI) 1.7 (1.08-2.69), p = 0.023. Participants suggested public engagement and education through mass media (including social media) and involvement of religious and community leaders as important interventions to improve awareness and willingness towards brain donation. CONCLUSION The survey revealed low willingness among outpatient clinic attendees to donate brain for research, although men were more inclined to donate. It is imperative to institute public engagement and educational interventions in order to improve consent for brain donation for research.
Collapse
Affiliation(s)
- Rufus Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria. .,Neuroscience and Ageing Research Unit, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Akin Ojagbemi
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayodeji Salami
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Funmi Olopade
- Department of Anatomy, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Temitope Farombi
- Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan, Nigeria
| | - Michael Nweke
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ezinne Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Aridegbe
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - James Balogun
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Godwin Ogbole
- Department of Radiology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayodele Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Rajesh Kalaria
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
17
|
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
|
18
|
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
|
19
|
Mobula LM, Sarfo FS, Carson KA, Burnham G, Arthur L, Ansong D, Sarfo-Kantanka O, Plange-Rhule J, Ofori-Adjei D. Predictors of glycemic control in type-2 diabetes mellitus: Evidence from a multicenter study in Ghana. TRANSLATIONAL METABOLIC SYNDROME RESEARCH 2018. [DOI: 10.1016/j.tmsr.2018.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
20
|
Sarfo FS, Treiber F, Gebregziabher M, Adamu S, Nichols M, Singh A, Obese V, Sarfo-Kantanka O, Sakyi A, Adu-Darko N, Tagge R, Agyei-Frimpong M, Kwarteng N, Badu E, Mensah N, Ampofo M, Jenkins C, Ovbiagele B. Phone-based intervention for blood pressure control among Ghanaian stroke survivors: A pilot randomized controlled trial. Int J Stroke 2018; 14:630-638. [PMID: 30465630 DOI: 10.1177/1747493018816423] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The potential of mobile-health (mHealth) technology for the management of hypertension among stroke survivors in Africa remains unexplored. We assessed whether an mHealth technology-enabled, nurse-guided intervention initiated among stroke patients within one month of symptom onset is effective in improving their blood pressure (BP) control. METHODS A two-arm pilot cluster randomized controlled trial involving 60 stroke survivors, ≥18 years, with BP ≥140/90 mmHg at screening/enrollment visit at a medical center in Ghana. Participants in the intervention arm (n = 30) received a Blue-toothed BP device and smartphone with an App for monitoring BP measurements and medication intake under nurse guidance for three months after which intervention was withdrawn. Control arm (n = 30) received usual care. Primary outcome measure was proportion with clinic BP < 140/90 mmHg at month 9; secondary outcomes included medication adherence. FINDINGS Mean ± SD age was 55 ± 13 years, 65% males. Two participants on intervention and three in control group were lost to follow-up. At month 9, proportion on the intervention versus controls with BP < 140/90 mmHg was 14/30 (46.7%) versus 12/30 (40.0%), p = 0.79 by intention-to-treat; systolic BP < 140 mmHg was 22/30 (73.3%) versus 13/30 (43.3%), p = 0.035. Mean ± SD medication possession ratio was 0.95 ± 0.16 on intervention versus 0.98 ± 0.24 in the control arm, p = 0.56. INTERPRETATION We demonstrate feasibility and signal of improvement in BP control among stroke survivors in a resource-limited setting via an mHealth intervention. Larger scale studies are warranted. TRIAL REGISTRATION NCT02568137. Registered on 13 July 2015 at ClinicalTrials.gov.
Collapse
Affiliation(s)
- Fred Stephen Sarfo
- 1 Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.,2 Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Frank Treiber
- 3 Neurology Unit, Medical University of South Carolina, Charleston, SC, USA
| | | | - Sheila Adamu
- 2 Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Michelle Nichols
- 3 Neurology Unit, Medical University of South Carolina, Charleston, SC, USA
| | - Arti Singh
- 1 Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Vida Obese
- 2 Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Asumadu Sakyi
- 2 Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Raelle Tagge
- 3 Neurology Unit, Medical University of South Carolina, Charleston, SC, USA
| | | | - Naomi Kwarteng
- 2 Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Elizabeth Badu
- 2 Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Nathaniel Mensah
- 2 Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Michael Ampofo
- 2 Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Carolyn Jenkins
- 3 Neurology Unit, Medical University of South Carolina, Charleston, SC, USA
| | - Bruce Ovbiagele
- 3 Neurology Unit, Medical University of South Carolina, Charleston, SC, USA
| | | |
Collapse
|
21
|
Sarfo FS, Mobula LM, Plange-Rhule J, Ansong D, Ofori-Adjei D. Incident stroke among Ghanaians with hypertension and diabetes: A multicenter, prospective cohort study. J Neurol Sci 2018; 395:17-24. [PMID: 30268724 PMCID: PMC6227375 DOI: 10.1016/j.jns.2018.09.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/06/2018] [Accepted: 09/12/2018] [Indexed: 11/25/2022]
Abstract
Background The burden of stroke among hypertensive and diabetic population in sub-Saharan Africa remains high. We sought to identify the risk factors associated with stroke occurrence in these high-risk population groups. Methods A prospective cohort study involving adults with hypertension and or type II diabetes mellitus at 5 public hospitals in Ghana who were stroke-free at enrollment. Patients were followed every 2 months at clinic for 18 months and assessed clinically for first ever stroke by physicians. We calculated crude incidence rates for stroke and assessed the factors associated with stroke occurrence using a multivariate Cox Proportional Hazards regression models. Results Of 3220 eligible participants with 3805 person-years of follow-up, there were 54 clinically confirmed new strokes. Incidence rate of stroke was 14.19 events per 1000 person-years [95% CI: 10.77–18.38], with rates among diabetics with hypertension being 16.64 [10.58–25.00], hypertension of 13.77 [9.33–19.64] and diabetes was 9.81 [3.59–21.74]. Two factors independently associated with stroke occurrence were previous cigarette smoking with adjusted HR (95% CI) of 2.59 (1.18–5.67) and physical inactivity, 1.81 (1.06–3.10). In secondary analysis, stage II hypertension compared with optimal BP was associated with aHR of 3.04 (1.00–9.27), p = .05 for stroke occurrence. Conclusion Incident stroke among Ghanaians with hypertension and diabetes is quite high. Stricter control of blood pressure and engaging in regular physical activities are strongly recommended to reduce the risk of strokes. The first prospective cohort study to assess factors associated with incident strokes among Ghanaians 3220 participants stroke free adults with hypertension or diabetes were followed for an average of 14 months There were 54 strokes with incidence rate of 14.19 events per 1000 person-years Patients with both diabetes with hypertension had highest stroke rates Previous cigarette smoking and physical inactivity were independently associated with incident strokes
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.
| | - Linda M 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
| | - David Ofori-Adjei
- Department of Medicine & Therapeutics, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| |
Collapse
|
22
|
Sarfo FS, Ulasavets U, Opare-Sem OK, Ovbiagele B. Tele-Rehabilitation after Stroke: An Updated Systematic Review of the Literature. J Stroke Cerebrovasc Dis 2018; 27:2306-2318. [PMID: 29880211 PMCID: PMC6087671 DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.013] [Citation(s) in RCA: 182] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/20/2018] [Accepted: 05/09/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Tele-rehabilitation for stroke survivors has emerged as a promising intervention for remotely supervised administration of physical, occupational, speech, and other forms of therapies aimed at improving motor, cognitive, and neuropsychiatric deficits from stroke. OBJECTIVE We aimed to provide an updated systematic review on the efficacy of tele-rehabilitation interventions for recovery from motor, higher cortical dysfunction, and poststroke depression among stroke survivors. METHODS We searched PubMed and Cochrane library from January 1, 1980 to July 15, 2017 using the following keywords: "Telerehabilitation stroke," "Mobile health rehabilitation," "Telemedicine stroke rehabilitation," and "Telerehabilitation." Our inclusion criteria were randomized controlled trials, pilot trials, or feasibility trials that included an intervention group that received any tele-rehabilitation therapy for stroke survivors compared with a control group on usual or standard of care. RESULTS This search yielded 49 abstracts. By consensus between 2 investigators, 22 publications met the criteria for inclusion and further review. Tele-rehabilitation interventions focused on motor recovery (n = 18), depression, or caregiver strain (n = 2) and higher cortical dysfunction (n = 2). Overall, tele-rehabilitation interventions were associated with significant improvements in recovery from motor deficits, higher cortical dysfunction, and depression in the intervention groups in all studies assessed, but significant differences between intervention versus control groups were reported in 8 of 22 studies in favor of tele-rehabilitation group while the remaining studies reported nonsignificant differences. CONCLUSION This updated systematic review provides evidence to suggest that tele-rehabilitation interventions have either better or equal salutary effects on motor, higher cortical, and mood disorders compared with conventional face-to-face therapy.
Collapse
Affiliation(s)
- Fred S Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | | | - Ohene K Opare-Sem
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bruce Ovbiagele
- Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
23
|
Bridgwood B, Lager KE, Mistri AK, Khunti K, Wilson AD, Modi P. Interventions for improving modifiable risk factor control in the secondary prevention of stroke. Cochrane Database Syst Rev 2018; 5:CD009103. [PMID: 29734470 PMCID: PMC6494626 DOI: 10.1002/14651858.cd009103.pub3] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND People with stroke or transient ischaemic attack (TIA) are at increased risk of future stroke and other cardiovascular events. Stroke services need to be configured to maximise the adoption of evidence-based strategies for secondary stroke prevention. Smoking-related interventions were examined in a separate review so were not considered in this review. This is an update of our 2014 review. OBJECTIVES To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control, including patient adherence to prescribed medications, and the occurrence of secondary cardiovascular events. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (April 2017), the Cochrane Effective Practice and Organisation of Care Group Trials Register (April 2017), CENTRAL (the Cochrane Library 2017, issue 3), MEDLINE (1950 to April 2017), Embase (1981 to April 2017) and 10 additional databases including clinical trials registers. We located further studies by searching reference lists of articles and contacting authors of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated the effects of organisational or educational and behavioural interventions (compared with usual care) on modifiable risk factor control for secondary stroke prevention. DATA COLLECTION AND ANALYSIS Four review authors selected studies for inclusion and independently extracted data. The quality of the evidence as 'high', 'moderate', 'low' or 'very low' according to the GRADE approach (GRADEpro GDT).Three review authors assessed the risk of bias for the included studies. We sought missing data from trialists.The results are presented in 'Summary of findings' tables. MAIN RESULTS The updated review included 16 new studies involving 25,819 participants, resulting in a total of 42 studies including 33,840 participants. We used the Cochrane risk of bias tool and assessed three studies at high risk of bias; the remainder were considered to have a low risk of bias. We included 26 studies that predominantly evaluated organisational interventions and 16 that evaluated educational and behavioural interventions for participants. We pooled results where appropriate, although some clinical and methodological heterogeneity was present.Educational and behavioural interventions showed no clear differences on any of the review outcomes, which include mean systolic and diastolic blood pressure, mean body mass index, achievement of HbA1c target, lipid profile, mean HbA1c level, medication adherence, or recurrent cardiovascular events. There was moderate-quality evidence that organisational interventions resulted in improved blood pressure control, in particular an improvement in achieving target blood pressure (odds ratio (OR) 1.44, 95% confidence interval (CI) 1.09 to1.90; 13 studies; 23,631 participants). However, there were no significant changes in mean systolic blood pressure (mean difference (MD), -1.58 mmHg 95% CI -4.66 to 1.51; 16 studies; 17,490 participants) and mean diastolic blood pressure (MD -0.91 mmHg 95% CI -2.75 to 0.93; 14 studies; 17,178 participants). There were no significant changes in the remaining review outcomes. AUTHORS' CONCLUSIONS We found that organisational interventions may be associated with an improvement in achieving blood pressure target but we did not find any clear evidence that these interventions improve other modifiable risk factors (lipid profile, HbA1c, medication adherence) or reduce the incidence of recurrent cardiovascular events. Interventions, including patient education alone, did not lead to improvements in modifiable risk factor control or the prevention of recurrent cardiovascular events.
Collapse
Affiliation(s)
- Bernadeta Bridgwood
- Department of Health Sciences, University of Leicester, University Road, Leicester, UK, LE1 7RH
| | | | | | | | | | | |
Collapse
|
24
|
Sarfo FS, Sarfo-Kantanka O, Adamu S, Obese V, Voeks J, Tagge R, Sethi V, Ovbiagele B. Stroke Minimization through Additive Anti-atherosclerotic Agents in Routine Treatment (SMAART): study protocol for a randomized controlled trial. Trials 2018. [PMID: 29540234 PMCID: PMC5853072 DOI: 10.1186/s13063-018-2564-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background There is an unprecedented rise in the prevalence of stroke in sub-Saharan Africa (SSA). Secondary prevention guidelines recommend that antihypertensive, statin and antiplatelet therapy be initiated promptly after ischemic stroke and adhered to in a persistent fashion to achieve optimal vascular-risk reduction. However, these goals are seldom realized in routine clinical care settings in SSA due to logistical challenges. We seek to assess whether a polypill containing fixed doses of three antihypertensive agents, a statin and antiplatelet therapy taken once daily per os for 12 months among recent stroke survivors would result in carotid intimal thickness regression compared with usual care (UC). Methods The Stroke Minimization through Additive Anti-atherosclerotic Agents in Routine Treatment (SMAART) trial is a phase 2, open-label, evaluator-blinded trial involving 120 Ghanaian recent-ischemic-stroke survivors. Using a computer-generated sequence, patients will be randomly allocated 1:1 into either the intervention arm or UC. Patients in the intervention arm will receive Polycap DS® (containing aspirin, 100 mg; atenolol, 50 mg; ramipril, 5 mg; thiazide, 12.5 mg; simvastatin, 20 mg) taken as two capsules once daily. Patients in the UC will receive separate, individual secondary preventive medications prescribed at the physician’s discretion. Both groups will be followed for 12 months to assess changes in carotid intimal thickness regression – a surrogate marker of atherosclerosis – as primary outcome measure. Secondary outcome measures include adherence to therapy, safety and tolerability, health-related quality of life, patient satisfaction, functional status, depression and cognitive dysfunction. Discussion An efficacy-suggesting SMAART trial could inform the future design of a multi-center, double-blinded, placebo-controlled, parallel-group, randomized controlled trial comparing the clinical efficacy of the polypill strategy for vascular risk moderation among stroke survivors in SSA. Trial registration ClinicalTrials.gov, ID: NCT03329599. Registered on 11 February 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2564-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Fred Stephen Sarfo
- Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science and Technology, P.M. B, Kumasi, Ghana. .,Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | | | | | - Vida Obese
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Jennifer Voeks
- Department of Neurology, Medical University of South Carolina, South Carolina, USA
| | - Raelle Tagge
- Department of Neurology, Medical University of South Carolina, South Carolina, USA
| | | | - Bruce Ovbiagele
- Department of Neurology, Medical University of South Carolina, South Carolina, USA
| |
Collapse
|
25
|
Sarfo FS, Adusei N, Ampofo M, Kpeme FK, Ovbiagele B. Pilot trial of a tele-rehab intervention to improve outcomes after stroke in Ghana: A feasibility and user satisfaction study. J Neurol Sci 2018; 387:94-97. [PMID: 29571880 DOI: 10.1016/j.jns.2018.01.039] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/27/2018] [Accepted: 01/30/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Tele-rehabilitation after stroke holds promise for under-resourced settings, especially sub-Saharan Africa (SSA), with its immense stroke burden and severely limited physical therapy services. OBJECTIVE To preliminarily assess the feasibility and outcomes of mobile technology-assisted physical therapy exercises for stroke survivors in Ghana. METHODS We conducted a prospective, single arm, pre-post study involving 20 stroke survivors recruited from a tertiary medical center, who received a Smartphone with the 9zest Stroke App® to deliver individualized, goal-targeted 5-days-a-week exercise program that was remotely supervised by a tele-therapist for 12 weeks. Outcome measures included changes in stroke levity scale scores (SLS), Modified Rankin score (MRS), Montreal Cognitive Assessment (MOCA), and feasibility indicators. RESULTS Among study participants, mean ± SD age was 54.6 ± 10.2 years, 11 (55%) were men, average time from stroke onset was 6 months. No participants dropped out. Compared with baseline status, mean ± SD scores on SLS improved from 7.5 ± 3.1 to 11.8 ± 2.2 at month 1 (p < 0.0001) and 12.2 ± 2.4 at month 3 (p < 0.0001), MOCA scores improved from 18.2 ± 4.3 to 20.4 ± 4.7 at month 1 (p = 0.14), and 22.2 ± 7.6 at month 3 (p = 0.047). Mean ± SD weekly sessions performed by participants per month was 5.7 ± 5.8 and duration of sessions was 25.5 ± 16.2 min. Erratic internet connectivity negatively affected full compliance with the intervention, although satisfaction ratings by study participants were excellent. CONCLUSION It is feasible to administer an m-health delivered physical therapy intervention in SSA, with high user satisfaction. Randomized trials to assess the efficacy and cost-effectiveness of this intervention are warranted.
Collapse
Affiliation(s)
- Fred S Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | | | | | | | | |
Collapse
|
26
|
Long-Term Outcomes of Stroke in a Ghanaian Outpatient Clinic. J Stroke Cerebrovasc Dis 2017; 27:1090-1099. [PMID: 29275059 DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/11/2017] [Accepted: 11/16/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Compared with high-income countries, sub-Saharan African (SSA) countries experience a comparatively higher early mortality from stroke. However, data on long-term mortality from stroke in SSA are lacking. OBJECTIVE Our aim is to assess long-term outcomes of stroke in an SSA setting. METHODS We conducted a retrospective analysis of longitudinal data involving 607 consecutive stroke survivor encountered at an outpatient clinic in Kumasi, Ghana, between January 2012 and June 2014. Data were closed for analysis in June 2016. Data on demography, presence of vascular risk factors, stroke type, and functional status were evaluated. We followed up subjects who were no longer attending clinic by phone to assess their vital status. Primary outcome was death after initiation of clinic care, and its predictors were determined using a Cox proportional hazards regression model. RESULTS Mean ± standard deviation (SD) age of cohort was 59.9 ± 13.9 years and 50.3% were female. Of the 607 stroke survivors, 377 (62.1%) were still alive, 59 (9.7%) were confirmed to have died, whereas 171 (28.2%) were lost to follow-up at the clinic. Mean ± SD observation time for the cohort was 32 ± 30 months. Upon adjustment for confounders, the independent predictors of mortality were age (adjusted hazard ratio [aHR] of 1.41 [95% confidence interval 1.15-1.73] for a 10-year increase in age) and diabetes mellitus (aHR of 2.24 [1.32-3.80]). CONCLUSIONS Diabetes mellitus, a modifiable risk factor for stroke, is associated with an increased risk of mortality among West African stroke survivors over the long term.
Collapse
|
27
|
Sarfo F, Treiber F, Gebregziabher M, Adamu S, Patel S, Nichols M, Awuah D, Sakyi A, Adu-Darko N, Singh A, Tagge R, Carolyn J, Ovbiagele B. PINGS (Phone-Based Intervention Under Nurse Guidance After Stroke): Interim Results of a Pilot Randomized Controlled Trial. Stroke 2017; 49:236-239. [PMID: 29222227 DOI: 10.1161/strokeaha.117.019591] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 10/23/2017] [Accepted: 11/13/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke exacts an immense toll in sub-Saharan Africa where there are few resources, and stroke prevention research is limited. The aim of this study is to test the feasibility and preliminary efficacy of an m-Health technology-enabled, nurse-guided intervention in improving blood pressure (BP) control among Ghanaian stroke patients within 1 month of symptom onset. METHODS We conducted a 2-arm cluster pilot randomized controlled trial involving 60 recent stroke survivors encountered within a single tertiary medical system in Ghana. Subjects in the intervention arm (n=30) received a Blue-toothed UA-767Plus BT BP device and smartphone for monitoring and reporting BP measurements and medication intake for 3 months compared with standard of care (n=30). Primary outcome measure was systolic BP <140 mm Hg at month 3; secondary outcomes included medication adherence and autonomous self-regulation. Analysis accounting for clustering was made using generalized linear mixed model by intention to treat. RESULTS Mean±SD age was 55±13 years, 65% male. Systolic BP <140 mm Hg at month 3 was found in 20/30 subjects (66.7%) in the intervention arm versus 14/30 subjects (46.7%) in the control arm (P=0.12). Medication possession ratio scores at month 3 were better in the intervention (0.88±0.40) versus control (0.64±0.45) arm (P=0.03). One subject in control arm died from a recurrent hemorrhagic stroke. CONCLUSIONS It is feasible to conduct an m-Health-based, nurse-guided BP control intervention among recent stroke patients in sub-Saharan Africa. We observed a potential signal of efficacy with the intervention, which will need to be tested in a future large definitive study. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02568137.
Collapse
Affiliation(s)
- Fred Sarfo
- From the Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S., A.S.); Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., D.A., A.S., N.A.-D.); and Department of Neurology, Medical University of South Carolina, Charleston (F.T., M.G., S.P., M.N., R.T., J.C., B.O.).
| | - Frank Treiber
- From the Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S., A.S.); Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., D.A., A.S., N.A.-D.); and Department of Neurology, Medical University of South Carolina, Charleston (F.T., M.G., S.P., M.N., R.T., J.C., B.O.)
| | - Mulugeta Gebregziabher
- From the Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S., A.S.); Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., D.A., A.S., N.A.-D.); and Department of Neurology, Medical University of South Carolina, Charleston (F.T., M.G., S.P., M.N., R.T., J.C., B.O.)
| | - Sheila Adamu
- From the Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S., A.S.); Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., D.A., A.S., N.A.-D.); and Department of Neurology, Medical University of South Carolina, Charleston (F.T., M.G., S.P., M.N., R.T., J.C., B.O.)
| | - Sachin Patel
- From the Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S., A.S.); Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., D.A., A.S., N.A.-D.); and Department of Neurology, Medical University of South Carolina, Charleston (F.T., M.G., S.P., M.N., R.T., J.C., B.O.)
| | - Michelle Nichols
- From the Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S., A.S.); Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., D.A., A.S., N.A.-D.); and Department of Neurology, Medical University of South Carolina, Charleston (F.T., M.G., S.P., M.N., R.T., J.C., B.O.)
| | - Dominic Awuah
- From the Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S., A.S.); Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., D.A., A.S., N.A.-D.); and Department of Neurology, Medical University of South Carolina, Charleston (F.T., M.G., S.P., M.N., R.T., J.C., B.O.)
| | - Asumadu Sakyi
- From the Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S., A.S.); Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., D.A., A.S., N.A.-D.); and Department of Neurology, Medical University of South Carolina, Charleston (F.T., M.G., S.P., M.N., R.T., J.C., B.O.)
| | - Nyantakyi Adu-Darko
- From the Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S., A.S.); Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., D.A., A.S., N.A.-D.); and Department of Neurology, Medical University of South Carolina, Charleston (F.T., M.G., S.P., M.N., R.T., J.C., B.O.)
| | - Arti Singh
- From the Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S., A.S.); Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., D.A., A.S., N.A.-D.); and Department of Neurology, Medical University of South Carolina, Charleston (F.T., M.G., S.P., M.N., R.T., J.C., B.O.)
| | - Raelle Tagge
- From the Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S., A.S.); Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., D.A., A.S., N.A.-D.); and Department of Neurology, Medical University of South Carolina, Charleston (F.T., M.G., S.P., M.N., R.T., J.C., B.O.)
| | - Jenkins Carolyn
- From the Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S., A.S.); Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., D.A., A.S., N.A.-D.); and Department of Neurology, Medical University of South Carolina, Charleston (F.T., M.G., S.P., M.N., R.T., J.C., B.O.)
| | - Bruce Ovbiagele
- From the Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S., A.S.); Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S., S.A., D.A., A.S., N.A.-D.); and Department of Neurology, Medical University of South Carolina, Charleston (F.T., M.G., S.P., M.N., R.T., J.C., B.O.)
| |
Collapse
|
28
|
Sarfo FS, Adamu S, Awuah D, Sarfo-Kantanka O, Ovbiagele B. Potential role of tele-rehabilitation to address barriers to implementation of physical therapy among West African stroke survivors: A cross-sectional survey. J Neurol Sci 2017; 381:203-208. [PMID: 28991682 DOI: 10.1016/j.jns.2017.08.3265] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 08/26/2017] [Accepted: 08/30/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The greatest burden from stroke-related disability is borne by Low-and-Middle Income countries (LMICs) where access to rehabilitation after stroke is severely challenged. Tele-rehabilitation could be a viable avenue to address unmet rehabilitation needs in LMICs. OBJECTIVES To assess the burden of post-stroke physical deficits, rates of utilization of physiotherapy services, and perceptions of tele-rehabilitation among recent Ghanaian stroke survivors. METHODS Using a consecutive sampling strategy, 100 stroke survivors attending an outpatient Neurology clinic in a Ghanaian tertiary medical center were enrolled into this cross-sectional study. After collecting basic demographic data, clinical history on stroke type, severity and level of disability, we administered the validated 20-item Functional Independence Measure questionnaire to evaluate functional status of study participants and an 8-item questionnaire to assess participants' attitudes towards telemedicine administered rehabilitation intervention. RESULTS Mean±SD age of study participants was 57.2±13.3years of which 51.0% were males with a mean duration of stroke of 1.3±2.2years. 53% had Modified Rankin scores of ≥3, 57% were fully independent and only 27% reported utilizing any physiotherapy services. Barriers to access to physiotherapy included financial constraints due to cost of physiotherapy services and transportation as well as premature discharge from physiotherapy to avoid overburdening of available physiotherapy services. These factors led to the limited provision of rehabilitative therapy. Participants held positive views of the potential for tele-rehabilitation interventions (80-93%). However, while 85% owned mobile phones, only 35% had smart phones. CONCLUSION Despite, a high burden of residual disability, only about 1 out of 4 stroke patients in this Ghanaian cohort was exposed to post-stroke physiotherapy services, largely due to relatively high costs and limited health system resources. These Ghanaian stroke patients viewed the potential role of Tele-rehabilitation as positive, but this promising intervention needs to be formally tested for feasibility, efficacy and cost-effectiveness.
Collapse
Affiliation(s)
- Fred S Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | | | | | | | | |
Collapse
|
29
|
Nichols M, Sarfo FS, Singh A, Qanungo S, Treiber F, Ovbiagele B, Saulson R, Patel S, Jenkins C. Assessing Mobile Health Capacity and Task Shifting Strategies to Improve Hypertension Among Ghanaian Stroke Survivors. Am J Med Sci 2017; 354:573-580. [PMID: 29208254 DOI: 10.1016/j.amjms.2017.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/02/2017] [Accepted: 08/09/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND There has been a tremendous surge in stroke prevalence in sub-Saharan Africa. Hypertension (HTN), the most potent, modifiable risk factor for stroke, is a particular challenge in sub-Saharan Africa. Culturally sensitive, efficacious HTN control programs that are timely and sustainable are needed, especially among stroke survivors. Mobile health (mHealth) technology and task-shifting offer promising approaches to address this need. METHODS Using a concurrent triangulation design, we collected data from stroke survivors, caregivers, community leaders, clinicians and hospital personnel to explore the barriers, facilitators and perceptions toward mHealth related to HTN management among poststroke survivors in Ghana. Exploration included perceptions of a nurse-led navigational model to facilitate care delivery and willingness of stroke survivors and caregivers to use mHealth technology. RESULTS Two hundred stroke survivors completed study surveys while focus groups (n = 4) were conducted with stroke survivors, caregivers and community leaders (n = 28). Key informant interviews were completed with clinicians and hospital personnel (n = 10). A total of 93% of survey respondents had HTN (60% uncontrolled). Findings support mHealth strategies for poststroke care delivery and HTN management and for task-shifting through a nurse-led model. Of survey and focus group participants, 76% and 78.6%, respectively, have access to mobile phones and 90% express comfort in using mobile phones and conveyed assurance that task-shifting through a nurse-led model could facilitate management of HTN. Findings also identified barriers to care delivery and medication adherence across all levels of the social ecological model. CONCLUSIONS Participants strongly supported enhanced care delivery through mobile health and were receptive toward a nurse-led navigational model.
Collapse
Affiliation(s)
- Michelle Nichols
- Medical University of South Carolina, College of Nursing, Charleston, South Carolina.
| | - Fred Stephen Sarfo
- Department of Medicine, Neurology Unit, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Arti Singh
- KNUST Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Suparna Qanungo
- Medical University of South Carolina, College of Nursing, Charleston, South Carolina
| | - Frank Treiber
- Medical University of South Carolina, College of Nursing, Charleston, South Carolina
| | - Bruce Ovbiagele
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Raelle Saulson
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Sachin Patel
- Medical University of South Carolina, College of Nursing, Charleston, South Carolina
| | - Carolyn Jenkins
- Medical University of South Carolina, College of Nursing, Charleston, South Carolina
| |
Collapse
|
30
|
Ehrenstein V, Nielsen H, Pedersen AB, Johnsen SP, Pedersen L. Clinical epidemiology in the era of big data: new opportunities, familiar challenges. Clin Epidemiol 2017; 9:245-250. [PMID: 28490904 PMCID: PMC5413488 DOI: 10.2147/clep.s129779] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Routinely recorded health data have evolved from mere by-products of health care delivery or billing into a powerful research tool for studying and improving patient care through clinical epidemiologic research. Big data in the context of epidemiologic research means large interlinkable data sets within a single country or networks of multinational databases. Several Nordic, European, and other multinational collaborations are now well established. Advantages of big data for clinical epidemiology include improved precision of estimates, which is especially important for reassuring (“null”) findings; ability to conduct meaningful analyses in subgroup of patients; and rapid detection of safety signals. Big data will also provide new possibilities for research by enabling access to linked information from biobanks, electronic medical records, patient-reported outcome measures, automatic and semiautomatic electronic monitoring devices, and social media. The sheer amount of data, however, does not eliminate and may even amplify systematic error. Therefore, methodologies addressing systematic error, clinical knowledge, and underlying hypotheses are more important than ever to ensure that the signal is discernable behind the noise.
Collapse
Affiliation(s)
- Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Henrik Nielsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Søren P Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| |
Collapse
|
31
|
Miranda JJ, Moscoso MG, Yan LL, Diez-Canseco F, Málaga G, Garcia HH, Ovbiagele B. Addressing post-stroke care in rural areas with Peru as a case study. Placing emphasis on evidence-based pragmatism. J Neurol Sci 2017; 375:309-315. [PMID: 28320158 PMCID: PMC6995500 DOI: 10.1016/j.jns.2017.02.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/13/2017] [Indexed: 02/08/2023]
Abstract
Stroke is a major cause of death and disability, with most of its burden now affecting low- and middle-income countries (LMIC). People in rural areas of LMIC who have a stroke receive very little acute stroke care and local healthcare workers and family caregivers in these regions lack the necessary knowledge to assist them. Intriguingly, a recent rapid growth in cell-phone use and digital technology in rural areas has not yet been appropriately exploited for health care training and delivery purposes. What should be done in rural areas, at the community setting-level, where access to healthcare is limited remains a challenge. We review the evidence on improving post-stroke outcomes including lowering the risks of functional disability, stroke recurrence, and mortality, and propose some approaches, to target post-stroke care and rehabilitation, noting key challenges in designing suitable interventions and emphasizing the advantages mHealth and communication technologies can offer. In the article, we present the prevailing stroke care situation and technological opportunities in rural Peru as a case study. As such, by addressing major limitations in rural healthcare systems, we investigate the potential of task-shifting complemented with technology to utilize and strengthen both community-based informal caregivers and community healthcare workers.
Collapse
Affiliation(s)
- J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Miguel G Moscoso
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China; Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Germán Málaga
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Hector H Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru; Cysticercosis Unit, National Institute of Neurological Sciences, Lima, Peru.
| | | |
Collapse
|
32
|
Sarfo FS, Ovbiagele B, Akassi J, Kyem G. Baseline Prescription and One-Year Persistence of Secondary Prevention Drugs after an index Stroke in Central Ghana. eNeurologicalSci 2017; 6:68-73. [PMID: 28920085 PMCID: PMC5597054 DOI: 10.1016/j.ensci.2016.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 12/17/2016] [Accepted: 12/26/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE There is a paucity of data on persistence of secondary prevention medications among stroke survivors in resource-limited settings where stroke is on a rapid upward trajectory and its management severely challenged. To avert new cardiovascular events after stroke, preventive medications should be promptly instituted and used continuously. We report 1-year rates and determinants of persistent utilization of secondary prevention therapies after stroke in Ghana. METHODS A retrospective observational study involving 418 stroke survivors enrolled into a Neurology clinic in a tertiary institution in central Ghana between January 2011 and December 2013. Data on demography, stroke type, risk factor profile and five secondary risk prevention medication classes namely antihypertensive, antiplatelet, statins, antidiabetic and anticoagulants were collected from patient charts. Persistence within first year after stroke was defined as continuation of all secondary preventive medications prescribed at enrollment to the Neurology clinic and it excluded 126 (≈30%) patients who could not complete 12 month follow up. Data was closed for analysis in June 2015 to allow for at least 12 months of follow-up. RESULTS Rates of utilization of secondary preventive medications and its intensity were influenced by stroke type and prevailing vascular risk factors. In decreasing order, antihypertensive, lipid-modifying, anti-platelet, anti-diabetic medications and anti-coagulants were prescribed at frequencies (%) of 394 (94.3%), 303 (72.5%), 274 (65.6%), 61 (14.6%) and 2 (0.5%) respectively at enrollment into the Neurology clinic (n=418). Overall, 92.1% of subjects (n=292) under follow-up for 1 year were persistent on secondary prevention medications initiated at enrollment into the neurology clinic with medication class specific rates of 97.5% for antihypertensive, 94.8% for anti-platelets, 94.1% for statins, 85.7% for anti-diabetic and 50% for anticoagulants. Abuse of alcohol was significantly associated with non-persistence, adjusted OR (95% CI) of 3.08 (1.13-8.38). CONCLUSION Persistence of secondary preventive medications among stroke survivors in this resource-limited setting is excellent and comparable to those in resource-replete countries. There is however the need to investigate the causes of high attrition rates from care.
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
| | - Gloria Kyem
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| |
Collapse
|
33
|
Sarfo FS, Ovbiagele B. Mobile health for stroke: a promising concept for research and practice. Mhealth 2017; 3:4. [PMID: 28300225 PMCID: PMC5344107 DOI: 10.21037/mhealth.2017.02.01] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/04/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
- Fred Stephen Sarfo
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | |
Collapse
|