1
|
Tan AH, Cornejo‐Olivas M, Okubadejo N, Pal PK, Saranza G, Saffie‐Awad P, Ahmad‐Annuar A, Schumacher‐Schuh AF, Okeng'o K, Mata IF, Gatto EM, Lim S. Genetic Testing for Parkinson's Disease and Movement Disorders in Less Privileged Areas: Barriers and Opportunities. Mov Disord Clin Pract 2024; 11:14-20. [PMID: 38291851 PMCID: PMC10828609 DOI: 10.1002/mdc3.13903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/14/2023] [Accepted: 07/30/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Mario Cornejo‐Olivas
- Neurogenetics Working GroupUniversidad Científica del SurLimaPeru
- Neurogenetics Research Center, Instituto Nacional de Ciencias NeurológicasLimaPeru
| | - Njideka Okubadejo
- Department of Medicine, College of MedicineUniversity of LagosLagosNigeria
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS)BengaluruIndia
| | - Gerard Saranza
- Movement Disorders Service, Section of Neurology, Department of Internal Medicine, Chong Hua Hospital and Vicente Sotto Memorial Medical CenterCebuPhilippines
| | - Paula Saffie‐Awad
- CETRAM‐Centro de Estudios de Transtornos del Movimiento, Clínica Santa MaríaSantiagoChile
| | - Azlina Ahmad‐Annuar
- Department of Biomedical Science, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Artur F. Schumacher‐Schuh
- Departamento de FarmacologiaUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Serviço de Neurologia, Hospital de Clínicas de Porto AlegrePorto AlegreBrazil
| | | | - Ignacio F. Mata
- Genomic Medicine Institute, Lerner Research Institute, Genomic Medicine, Cleveland Clinic FoundationClevelandOhioUSA
| | - Emilia M. Gatto
- Department of Neurology, Hospital Sanatorio de la Trinidad Mitre, Instituto de Neurociencias Buenos Aires, School of MedicineBuenos Aires UniversityBuenos AiresArgentina
| | - Shen‐Yang Lim
- Division of Neurology, Department of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| |
Collapse
|
2
|
Matuja SS, Ngimbwa J, Andrew L, Shindika J, Nchasi G, Kasala A, Paul IK, Ndalahwa M, Mawazo A, Kalokola F, Ngoya P, Rudovick L, Kilonzo S, Wajanga B, Massaga F, Kalluvya SE, Munseri P, Mnacho MA, Okeng'o K, Kimambo H, Manji M, Ruggajo P, Nagu T, Ahmed RA, Sheriff F, Mahawish K, Mangat H, Nguyen-Huynh MN, Saylor D, Peck R. Stroke characteristics and outcomes in urban Tanzania: Data from the Prospective Lake Zone Stroke Registry. Int J Stroke 2023:17474930231219584. [PMID: 38031727 DOI: 10.1177/17474930231219584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND Stroke is a second leading cause of death globally, with an estimated one in four adults suffering a stroke in their lifetime. We aimed to describe the clinical characteristics, quality of care, and outcomes in adults with stroke in urban Northwestern Tanzania. METHODS We analyzed de-identified data from a prospective stroke registry from Bugando Medical Centre in Mwanza, the second largest city in Tanzania, between March 2020 and October 2022. This registry included all adults ⩾18 years admitted to our hospital who met the World Health Organization clinical definition of stroke. Information collected included demographics, risk factors, stroke severity using the National Institutes of Health Stroke Scale, brain imaging, indicators for quality of care, discharge modified Rankin Scale, and in-hospital mortality. We examined independent factors associated with mortality using logistic regression. RESULTS The cohort included 566 adults, of which 52% (294) were female with a mean age of 65 ± 15 years. The majority had a first-ever stroke 88% (498). Premorbid hypertension was present in 86% (488) but only 41% (200) were taking antihypertensive medications before hospital admission; 6% (32) had HIV infection. Ischemic strokes accounted for 66% (371) but only 6% (22) arriving within 4.5 h of symptom onset. In-hospital mortality was 29% (127). Independent factors associated with mortality were severe stroke (adjusted odds ratio (aOR) = 1.81, 95% confidence interval (CI) = 1.47-2.24, p < 0.001), moderate to severe stroke (aOR = 1.49, 95% CI = 1.22-1.84, p < 0.001), moderate stroke (aOR = 1.80, 95% CI = 1.52-2.14, p < 0.001), leukocytosis (aOR = 1.19, 95% CI = 1.03-1.38, p = 0.022), lack of health insurance coverage (aOR = 1.15, 95% CI = 1.02-1.29, p = 0.025), and not receiving any form of venous thromboembolism prophylaxis (aOR = 1.18, 95% CI = 1.02-1.37, p = 0.027). CONCLUSION We report a stroke cohort with poor in-hospital outcomes in urban Northwestern Tanzania. Early diagnosis and treatment of hypertension could prevent stroke in this region. More work is needed to raise awareness about stroke symptoms and to ensure that people with stroke receive guidelines-directed therapy.
Collapse
Affiliation(s)
- Sarah Shali Matuja
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Joshua Ngimbwa
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Lilian Andrew
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Jemima Shindika
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Goodluck Nchasi
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Anna Kasala
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Innocent Kitandu Paul
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mary Ndalahwa
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Akili Mawazo
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Patrick Ngoya
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Ladius Rudovick
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Semvua Kilonzo
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Bahati Wajanga
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Fabian Massaga
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Samuel E Kalluvya
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mohamed A Mnacho
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Kigocha Okeng'o
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Henrika Kimambo
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Mohamed Manji
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paschal Ruggajo
- Department of Curative Services, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Tumaini Nagu
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Rashid Ali Ahmed
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Faheem Sheriff
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Karim Mahawish
- Stroke Medicine Department, Counties Manukau Health, Auckland, New Zealand
| | - Halinder Mangat
- Division of Neurocritical Care, Department of Neurology, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Mai N Nguyen-Huynh
- Division of Research, The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Robert Peck
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
3
|
Rice DR, Vogel AC, Ismail SS, Okeng'o K, Lugemwa GK, Henry J, Kourkoulis C, Mateen FJ. Apolipoprotein E genotypes in stroke patients from urban Tanzania. J Neurol Sci 2022; 440:120331. [DOI: 10.1016/j.jns.2022.120331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022]
|
4
|
Rice DR, Okeng'o K, Massawe E, Ismail S, Mworia NA, Chiwanga F, Kapina B, Wasserman M, Mateen FJ. Efficacy of Fluoxetine for Post-Ischemic Stroke Depression in Tanzania. J Stroke Cerebrovasc Dis 2022; 31:106181. [PMID: 34740138 PMCID: PMC8766895 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Post-stroke fluoxetine trials are primarily conducted in high-income countries. We characterize post-ischemic stroke depression in fluoxetine-treated and -untreated study participants in urban Tanzania. METHODS Adults (>18 years old) within 14 days of CT-confirmed acute ischemic stroke onset were enrolled at Muhimbili National Hospital, Tanzania. The fluoxetine-treated group took 20mg fluoxetine daily for 90 days in a phase II trial and were compared to fluoxetine-untreated historical controls. The primary outcome was depression at 90 days, measured by the Patient Health Questionnaire-9 (PHQ-9). PHQ-9 scores were compared between fluoxetine-treated and -untreated groups. A score >=9 points was considered to reflect depression. A multivariable linear regression model assessed associations with post-stroke PHQ-9 scores. RESULTS Of the fluoxetine-treated (n=27) and -untreated (n=32) participants, the average age was 56.8 years old (39% women, 100% Black/African). The average presentation NIHSS score was 12.1 points and modified Rankin Scale (mRS) score was 3.5. The average mRS score at 90-day follow-up was 2.3. There was no significant difference between 90-day PHQ-9 scores in the fluoxetine-treated (mean=4.1 points, standard deviation=3.2; 11% depression) and untreated (mean=4.4, standard deviation=4.8; 19% depression) groups, p=.69. In the multivariable analysis, older age (β=0.08, p=.03) and higher NIHSS score (β=0.15, p=.04), but neither fluoxetine (β=0.57, p=.59) nor sex (β=-0.51, p=.63), were significantly associated with more depressive symptoms. CONCLUSIONS Our findings parallel results from trials from higher income settings that fluoxetine does not significantly improve post-ischemic stroke depression, although our sample size was small. More work is needed to depict the longitudinal nature and treatment of post-stroke depression in Sub-Saharan Africa.
Collapse
Affiliation(s)
- Dylan R Rice
- Massachusetts General Hospital, Boston, MA, United States
| | | | | | - Seif Ismail
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | | | | | | | | |
Collapse
|
5
|
Hamid E, Ayele BA, Massi DG, Ben Sassi S, Tibar H, Djonga EE, El-Sadig SM, Amer El Khedoud W, Razafimahefa J, Kouame-Assouan AE, Ben-Adji D, Lengané YTM, Musubire AK, Mohamed MH, Phiri TE, Nestor N, Alwahchi WA, Neshuku SN, Ocampo C, Sakadi F, Maidal MA, Ngwende GW, Hooker J, Okeng'o K, Charway-Felli A, Atadzhanov M, Carr J, Okubadejo NU, Shalash A. Availability of Therapies and Services for Parkinson's Disease in Africa: A Continent-Wide Survey. Mov Disord 2021; 36:2393-2407. [PMID: 34080713 DOI: 10.1002/mds.28669] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The growing burden of Parkinson's disease (PD) in Africa necessitates the identification of available therapies and services to improve patient care. OBJECTIVE To investigate the availability, affordability, frequency of usage, and insurance coverage of PD therapies (pharmacological, surgical, physical, and speech therapies) and services including specialized clinics, specialists, and nurses across Africa. METHODS A comprehensive web-based survey was constructed and distributed to neurologists/physicians with a special interest in PD across Africa. The survey instrument includes components that address availability, affordability, frequency of use, and insurance coverage of different therapies and services. RESULTS Responses were received from 28 (of 43 contacted) countries. Levodopa-based oral preparations were always available in 13 countries (46.4%) with variable affordability and "partial or no" insurance coverage in 60% of countries. Bromocriptine was the most available (50%) and affordable ergot dopamine agonists (DA), whereas non-ergot DA was always available in only six countries (21.4%). Trihexyphenidyl was the most available and affordable anticholinergic drug (46.4%). Tricyclic antidepressants and selective serotonin reuptake inhibitors were available in most countries (89.3% and 85.7% respectively), with variable affordability. Quetiapine and clozapine were less available. Specialized clinics and nurses were available in 25% and 7.1% of countries surveyed, respectively. Other services were largely unavailable in the countries surveyed. CONCLUSION PD-specific therapies and services are largely unavailable and unaffordable in most African countries. The data provide a platform for organizing strategies to initiate or scale up existing services and drive policies aimed at improving access to care and tailoring education programs in Africa. © 2021 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Eman Hamid
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Biniyam A Ayele
- Department of Neurology, Black Lion Specialized Hospital, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Gams Massi
- Douala General Hospital, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Samia Ben Sassi
- Mongi Ben Hamida National Institute of Neurology, Tunis, Tunisia
| | | | | | | | | | - Julien Razafimahefa
- Faculté Médecine Antananarivo, Hôpital Joseph Raseta Befelatanana, Antananarivo,, Madagascar
| | - Ange Eric Kouame-Assouan
- Department of Neurology, Faculty of Medicine, University and teaching hospital of Bouaké, Bouaké, Ivory Coast
| | | | | | | | | | | | | | | | - Saara Ndinelago Neshuku
- Department of Internal medicine, Division of Neurology, Intermediate Hospital Katutura, Windhoek, Namibia
| | | | - Foksouna Sakadi
- University Hospital Center of National Reference, N'djamena, Chad
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Vogel AC, Okeng'o K, Chiwanga F, Ismail SS, Buma D, Pothier L, Mateen FJ. MAMBO: Measuring ambulation, motor, and behavioral outcomes with post-stroke fluoxetine in Tanzania: Protocol of a phase II clinical trial. J Neurol Sci 2020; 408:116563. [PMID: 31731111 DOI: 10.1016/j.jns.2019.116563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND SSA has a high stroke incidence and post-stroke morbidity. An inexpensive pharmacological treatment for stroke recovery would be beneficial to patients in the region. Fluoxetine, currently on the World Health Organization Essential Medicines List, holds promise as a treatment for motor recovery after ischemic stroke, but its effectiveness is controversial and untested in this context in SSA. AIM To determine if fluoxetine 20 mg by mouth daily, given within 14 days of acute ischemic stroke, and taken for 90 days, is well-tolerated and safe with adequate adherence to justify a future randomized, controlled trial of fluoxetine in the United Republic of Tanzania. METHODS Open-label, phase II clinical trial enrolling up to 120 patients. Participants will be recruited from the Muhimbili National Hospital in Dar es Salaam, Tanzania, and followed for 90 days. The primary outcomes are: 1) safety, including serum sodium and hepatic enzyme levels; and 2) tolerability, as measured through study case report forms. The secondary outcomes are: 1) change in motor strength, as measured through the Fugl-Meyer Motor Scale; 2) adherence, as measured with electronic pill bottles; and 3) participant depressive symptom burden measured via standard questionnaires. CONCLUSIONS Expanding the evidence base for fluoxetine for Sub-Saharan African stroke survivors requires testing of its safety, tolerability, and adherence. Compared to prior studies in France and the United Kingdom, the patient characteristics, health infrastructure, and usual care for stroke recovery differ substantially in Tanzania. If fluoxetine reveals favorable endpoints, scale up of its use post-stroke is possible.
Collapse
Affiliation(s)
- Andre C Vogel
- Massachusetts General Hospital, Department of Neurology, 165 Cambridge St. #627, Boston, MA 02114, USA.
| | - Kigocha Okeng'o
- Muhimbili National Hospital, Neurology Unit, Dar es Salaam, Tanzania
| | - Faraja Chiwanga
- Muhimbili National Hospital, Department of Pharmacy, Dar es Salaam, Tanzania.
| | | | - Deus Buma
- Muhimbili National Hospital, Department of Pharmacy, Dar es Salaam, Tanzania.
| | - Lindsay Pothier
- Massachusetts General Hospital, Department of Neurology, 165 Cambridge St. #627, Boston, MA 02114, USA.
| | - Farrah J Mateen
- Massachusetts General Hospital, Department of Neurology, 165 Cambridge St. #627, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
| |
Collapse
|
7
|
Regenhardt RW, Biseko MR, Shayo AF, Mmbando TN, Grundy SJ, Xu A, Saadi A, Wibecan L, Kharal GA, Parker R, Klein JP, Mateen FJ, Okeng'o K. Opportunities for intervention: stroke treatments, disability and mortality in urban Tanzania. Int J Qual Health Care 2019; 31:385-392. [PMID: 30165650 DOI: 10.1093/intqhc/mzy188] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/15/2018] [Accepted: 08/16/2018] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Given the high post-stroke mortality and disability and paucity of data on the quality of stroke care in Sub-Saharan Africa, we sought to characterize the implementation of stroke-focused treatments and 90-day outcomes of neuroimaging-confirmed stroke patients at the largest referral hospital in Tanzania. DESIGN Prospective cohort study. SETTING Muhimbili National Hospital (MNH) in Dar es Salaam, July 2016-March 2017. PARTICIPANTS Adults with new-onset stroke (<14 days), confirmed by head CT, admitted to MNH. MAIN OUTCOMES MEASURES Modified Rankin scale (mRS) and vital status. RESULTS Of 149 subjects (mean age 57; 48% female; median NIH stroke scale (NIHSS) 19; 46% ischemic stroke; 54% hemorrhagic), implementation of treatments included: dysphagia screening (80%), deep venous thrombosis prophylaxis (0%), aspirin (83%), antihypertensives (89%) and statins (95%). There was limited ability to detect atrial fibrillation and carotid artery disease and no acute thrombolysis or thrombectomy. Of ischemic subjects, 19% died and 56% had severe disability (mRS 4-5) at discharge; 49% died by 90 days. Of hemorrhagic subjects, 33% died and 49% had severe disability at discharge; 50% died by 90 days. In a multivariable model, higher NIHSS score but not dysphagia, unconsciousness, or patient age was predictive of death by 90 days. CONCLUSIONS The 90-day mortality of stroke presenting at MNH is 50%, much higher than in higher income settings. Although severe stroke presentations are a major factor, efforts to improve the quality of care and prevent complications of stroke are urgently needed. Acute stroke interventions with low number needed to treat represent challenging long-term goals.
Collapse
Affiliation(s)
- Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Maijo R Biseko
- Department of Neurology, Muhimbili National Hospital, University of Medicine and Allied Health, Dar es Salaam, Tanzania
| | - Agness F Shayo
- Department of Neurology, Muhimbili National Hospital, University of Medicine and Allied Health, Dar es Salaam, Tanzania
| | - Theoflo N Mmbando
- Department of Neurology, Muhimbili National Hospital, University of Medicine and Allied Health, Dar es Salaam, Tanzania
| | - Sara J Grundy
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Ai Xu
- Center for AIDS Research, Massachusetts General Hospital, Boston, MA, USA
| | - Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Leah Wibecan
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - G Abbas Kharal
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Robert Parker
- Center for AIDS Research, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua P Klein
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Kigocha Okeng'o
- Department of Neurology, Muhimbili National Hospital, University of Medicine and Allied Health, Dar es Salaam, Tanzania
| |
Collapse
|
8
|
Saadi A, Okeng'o K, Biseko MR, Shayo AF, Mmbando TN, Grundy SJ, Xu A, Parker RA, Wibecan L, Iyer G, Onesmo PM, Kapina BN, Regenhardt RW, Mateen FJ. Post-stroke social networks, depressive symptoms, and disability in Tanzania: A prospective study. Int J Stroke 2018; 13:840-848. [PMID: 29676225 DOI: 10.1177/1747493018772788] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Evidence suggests that social networks improve functional recovery after stroke, but this work has not been extended to low- and middle-income countries (LMICs). Post-stroke depression interferes with functional outcome but is understudied in LMICs. Aims To determine the relationships between social networks, disability, and depressive symptoms in patients surviving 90-days post-stroke in Dar es Salaam, Tanzania. Methods Participants ≥ 18 years, admitted ≤ 14 days of stroke onset, were enrolled. Disability was measured using the modified Rankin Scale, social networks by the Berkman-Syme social network index, and depressive symptoms by the Patient Health Questionnaire-9 (PHQ-9) by telephone interview at 90 days. A Kruskal-Wallis test or Spearman's correlation coefficient was used to assess the associations between social networks, depressive symptoms, and disability. Results Of 176 participants, 43% (n = 75) died, with an additional 11% (n = 20) lost to follow-up by 90 days. Among 81 survivors, 94% (n = 76, 57% male, average age 54 years) had complete information on all scales (mean and median follow-up time of 101 and 88 days). Thirty percent (n = 23, 41.9%, 95% confidence interval 20.2) had at least mild depressive symptoms (PHQ-9 ≥ 5 points). Nearly two-thirds (n = 46, 61%) reported ≥ 3 close friends. A higher social network index score was associated with fewer depressive symptoms (p < 0.0001) and showed a trend towards significance with lower disability (p = 0.061). Higher depressive symptom burden was correlated with higher disability (r = 0.52, p < 0.0001). Conclusion Post-stroke social isolation is associated with more depressive symptoms in Tanzania. Understanding social networks and the associated mechanisms of recovery in stroke is especially relevant in the context of limited resources.
Collapse
Affiliation(s)
- Altaf Saadi
- 1 National Clinical Scholars Program, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | | | | | - Sara J Grundy
- 3 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Ai Xu
- 4 Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Robert A Parker
- 4 Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.,5 Harvard Medical School, Boston, USA
| | - Leah Wibecan
- 6 Massachusetts General Hospital, Boston, MA, USA
| | - Geetha Iyer
- 7 Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Robert W Regenhardt
- 8 Partners Neurology Residency, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA, USA
| | - Farrah J Mateen
- 5 Harvard Medical School, Boston, USA.,6 Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
9
|
Okeng'o K, Chillo P, Gray WK, Walker RW, Matuja W. Early Mortality and Associated Factors among Patients with Stroke Admitted to a Large Teaching Hospital in Tanzania. J Stroke Cerebrovasc Dis 2016; 26:871-878. [PMID: 27913201 DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/17/2016] [Accepted: 10/28/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Stroke is a major cause of death worldwide and 85.5% of stroke deaths occur in low- and middle-income countries due to stroke. The aim of this study was to investigate correlates and predictors of 30-day mortality in stroke patients in urban Tanzania. METHODS A prospective 30-day follow-up study was conducted at the Muhimbili National Hospital, Dar es Salaam, Tanzania. We recruited all patients with stroke seen at the Emergency Medicine Department and medical wards. Patients underwent medical history and physical examination including full neurological examination. For those who met the criteria for the diagnosis of stroke according to the World Health Organization, further data were collected, including cholesterol, creatinine, fasting blood glucose, full blood picture, human immunodeficiency virus serology, and electrocardiogram. Patients were followed up at 30 days from the date of stroke onset. The date and the cause of death of those participants who died within 30 days of stroke onset were recorded. RESULTS A total of 224 patients were recruited into the study, with follow-up data available on 186 (83.0%). At 30 days post stroke, 124 patients (66.7%) were still alive. Mortality was significantly higher among stroke patients who were over 65 years of age. Of the 62 who died, 54% died of aspiration pneumonia and 21% of septicemia. Patients with infection were 4.4 times more likely to die than thosewithout (P = .001). CONCLUSIONS Poststroke mortality rates were high. Many deaths were potentially preventable.
Collapse
Affiliation(s)
- Kigocha Okeng'o
- Internal Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
| | - Pilly Chillo
- Internal Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom
| | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - William Matuja
- Internal Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| |
Collapse
|