Improving stroke care in Ghana: a roundtable discussion with communities, healthcare providers, policymakers and civil society organisations

Even though there have been advances in medical research and technology for acute stroke care treatment and management globally, stroke mortality has remained high, with a higher burden in low- and middle-income countries (LMICs) such as Ghana. In Ghana, stroke mortality and disability rates are high, and research on post-stroke survival care is scarce. The available evidence suggests that Ghanaian stroke survivors and their caregivers seek treatment from pluralistic health care providers. However, no previous attempt has been made to bring them together to discuss issues around stroke care and rehabilitation. To address this challenge, researchers from the Institute of Advanced Studies, University College London, in collaboration with researchers from the African Centre of Excellence for Non-communicable diseases (ACE-NCDs), University of Ghana, organised a one-day roundtable to discuss issues around stroke care. The purpose of the roundtable was fourfold. First, to initiate discussion/collaborations among biomedical, ethnomedical and faith-based healthcare providers and stroke patients and their caregivers around stroke care. Second, to facilitate discussion on experiences with stroke care. Third, to understand the healthcare providers’, health systems’, and stroke survivors’ needs to enhance stroke care in Ghana. Finally, to define practical ways to improve stroke care in Ghana.

Towards Population Salt Reduction to Control High Blood Pressure in Ghana: A Policy Direction

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.

Cross-sectional study of association between socioeconomic indicators and chronic kidney disease in rural-urban Ghana: the RODAM study

OBJECTIVES

Studies from high-income countries suggest higher prevalence of chronic kidney disease (CKD) among individuals in low socioeconomic groups. However, some studies from low/middle-income countries show the reverse pattern among those in high socioeconomic groups. It is unknown which pattern applies to individuals living in rural and urban Ghana. We assessed the association between socioeconomic status (SES) indicators and CKD in rural and urban Ghana and to what extent the higher SES of people in urban areas of Ghana could account for differences in CKD between rural and urban populations.

SETTING

The study was conducted in Ghana (Ashanti region). We used baseline data from a multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study.

PARTICIPANTS

The sample consisted of 2492 adults (Rural Ghana, 1043, Urban Ghana, 1449) aged 25-70 years living in Ghana.

EXPOSURE

Educational level, occupational level and wealth index.

OUTCOME

Three CKD outcomes were considered using the 2012 Kidney Disease: Improving Global Outcomes severity of CKD classification: albuminuria, reduced glomerular filtration rate and high to very high CKD risk based on the combination of these two.

RESULTS

All three SES indicators were not associated with CKD in both rural and urban Ghana after age and sex adjustment except for rural Ghana where high wealth index was significantly associated with higher odds of reduced estimated glomerular filtration rate (eGFR) (adjusted OR, 2.38; 95% CI 1.03 to 5.47). The higher rate of CKD observed in urban Ghana was not explained by the higher SES of that population.

CONCLUSION

SES indicators were not associated with prevalence of CKD except for wealth index and reduced eGFR in rural Ghana. Consequently, the higher SES of urban Ghana did not account for the increased rate of CKD among urban dwellers suggesting the need to identify other factors that may be driving this.

Towards best practice in acute stroke care in Ghana: a survey of hospital services

Background

Stroke and other non-communicable diseases are important emerging public health concerns in sub-Saharan Africa where stroke-related mortality and morbidity are higher compared to other parts of the world. Despite the availability of evidence-based acute stroke interventions globally, uptake in low-middle income countries (LMIC) such as Ghana is uncertain. This study aimed to identify and evaluate available acute stroke services in Ghana and the extent to which these services align with global best practice.

Methods

A multi-site, hospital-based survey was conducted in 11 major referral hospitals (regional and tertiary - teaching hospitals) in Ghana from November 2015 to April 2016. Respondents included neurologists, physician specialists and medical officers (general physicians). A pre-tested, structured questionnaire was used to gather data on available hospital-based acute stroke services in the study sites, using The World Stroke Organisation Global Stroke Services Guideline as a reference for global standards.

Results

Availability of evidence-based services for acute stroke care in the study hospitals were varied and limited. The results showed one tertiary-teaching hospital had a stroke unit. However, thrombolytic therapy (thrombolysis) using recombinant tissue plasminogen activator for acute ischemic stroke care was not available in any of the study hospitals. Aspirin therapy was administered in all the 11 study hospitals. Although eight study sites reported having a brain computed tomographic (CT) scan, only 7 (63.6%) were functional at the time of the study. Magnetic resonance imaging (MRI scan) services were also limited to only 4 (36.4%) hospitals (only functional in three). Acute stroke care by specialists, especially neurologists, was found in 36.4% (4) of the study hospitals whilst none of the study hospitals had an occupational or a speech pathologist to support in the provision of acute stroke care.

Conclusion

This study confirms previous reports of limited and variable provision of evidence based stroke services and the low priority for stroke care in resource poor settings. Health policy initiatives to enhance uptake of evidence-based acute stroke services is required to reduce stroke-related mortality and morbidity in countries such as Ghana.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-2061-2) contains supplementary material, which is available to authorized users.

Health, Disease and Healthcare in Africa

This editorial introduction to `Health, disease and healthcare in Africa' addresses some of the key issues for health psychology in the continent. African populations face a health crisis driven by a double burden of disease, a nutrition transition, war and conflict, and poverty. Health systems are under-funded and underresourced. Research suggests that the most prevalent diseases in Africa are preventable and treatable, and that most deaths are avoidable. Health practices and systems that may aid equitable, cost-effective and sustainable healthcare exist but remain untapped. We advocate a reflective, action-oriented health psychology that challenges social injustice and racism, and develops strategies that promote more just and healthy societies.

Living with diabetes in rural and urban Ghana: a critical social psychological examination of illness action and scope for intervention

Current chronic illness research in Africa neglects the social psychological dimensions of illness experiences that present more appropriate frameworks for intervention. Informed by social representations theory, links between social knowledge of diabetes, illness experience and illness action were examined through semistructured individual interviews with rural and urban Ghanaians with diabetes. All respondents drew interchangeably from commonsense, scientized, and religious knowledge modalities in defining health, illness and diabetes. Diabetes caused disruption to: body-self, social identity, family/social relationships, economic circumstance and nutrition. Commonsense and scientized notions of health, illness and diabetes framed illness action goals that merged with biomedical goals, specifically drug and diet management. These goals were compromised by the nature, severity and duration of disruption(s) and emotional responses evoked. The paper dicusses implications of the findings and outlines recommendations for interventions that span individual/group, community and structural dimensions.