Self-motivation, functional ability and participation among stroke survivors’ resident in Ibadan Metropolis, Nigeria

Background: Stroke is a leading cause of death both globally, and in Africa. The attendant effect of the stroke is disability, loss of function and psychosocial issues. Studies have been carried out on different rehabilitation outcomes such as participation, self-motivation and functional ability related to stroke survivors. There is however a dearth of studies exploring the relationships among self-motivation, functional ability and participation of stroke survivors, particularly in our African community.Objectives: Relationship among participation, self-motivation and functional ability of stroke survivors residing in Ibadan was investigated.Methods: This was a cross-sectional survey which involved 44 consenting stroke survivors. Clinical and demographic information were documented. Self-motivation, functional ability and participation of the stroke survivors were assessed with the Self-Motivation Inventory, Fugl-Meyer Assessment of Motor Recovery after Stroke; and London Handicap Scale respectively. Data was analysed with descriptive statistics and inferential statistics of Spearman Rank Correlation at p= 0.05.Results: There was a statistically significant positive correlation between the time since onset of stroke scores and participation (p= 0.02) and between the stroke survivors‘ functional ability and participation scores (p=0.001). Conversely there was no significant relationship between the participants‘ functional ability and time since onset of stroke scores (p= 0.62), between stroke survivors‘ self-motivation and time since onset of stroke scores (p= 0.41), between self-motivation and participation (p=0.80) and between self-motivation and functional ability scores (p= 0.80)Conclusions: Whereas self-motivation appeared non-related to functional ability and participation, a more exploration of the subject matter is still necessary for a conclusive inference to be drawn, especially in view of the sample size involved in this present study. French title: Auto-motivation, capacite fonctionnelle et participation chez les survivants d'avc residant dans la metropole d’Ibadan au Nigeria &nbsp

Drivers of cost of treatment for traumatic spinal cord injury in Ibadan, Nigeria

Background: Traumatic Spinal Cord Injury (TSCI) is a costly condition in human and economic terms. Yet, studies on direct cost of treatment for TSCI in resource-constraint countries are sparse.Objective: To estimate the direct cost of treatment for patients with TSCI at the University College Hospital (UCH), Ibadan, Nigeria using an incidence-based costing approach.Methods: All new cases of TSCI admitted in the hospital from January, 2009 to December, 2013 were identified and reviewed. Direct costs of in-patient and out-patient treatments over the first year of injury were estimated.Results: 114 individuals with TSCI (73 males; 41 females) were admitted and discharged home alive from the hospital. The largest cost driver to the patients and the National Health Insurance Scheme was cost of consultations by neurosurgeons which constituted about a third (34.4%) of the total costs of treatment. Less than a fourth (24.2%) of the total cost of in-patient treatment was spent on therapeutic interventions (surgery, drugs and physiotherapy). There was a significant relationship between the direct cost of treatment and each of the severity of traumatic spinal cord injury and length of hospital stay (p = 0.01). Level of injury was not significantly associated with direct cost of treatment (p=0.89).Conclusion: Direct cost of treatment for individuals with TSCI in Ibadan, Nigeria is substantial. This high cost underscores the need for novel service models with potential for minimizing cost for patients with TSCI in Nigeria. French title: Determinants du cout de la prise en charge des traumatismes medullaires a Ibadan au Nigeria Contexte : Le traumatisme vertébro-médullaire (TVM) est une pathologie ayant un coût de prise en charge très élevé sur le plan humain, psychologique et économique. Néanmoins, les études sur le coût direct de prise en charge du TVM dans les pays à ressources limitées sont rares.Objectif : Mesurer le coût direct de prise en charge des malades avec TVM dans un Centre Hospitalier Universitaire (CHU) d‘Ibadan au Nigéria.Méthodes : Tous les nouveaux cas hospitalisés de janvier 2009 à décembre 2013 ont été recrutés et examinés. Les coûts directs de traitement de l‘hospitalisation et du suivi externe des patients au cours de la première année ont été évalués.Résultats : Au total, 114 personnes avec TVM (73 hommes ; 41 femmes) ont été admises, suivies et ont pu retourner à domicile. Le plus important inducteur de coût de prise en charge des malades dans le système de santé Nigérian était les frais de consultation des neurochirurgiens qui représentaient environ un tiers (34,4%) de l‘ensemble des coûts du traitement. Moins d‘un quart (24,2%) de  l‘ensemble des coûts du traitement du patient en hospitalisation a été dépensé sur les interventions thérapeutiques (chirurgie,  médicaments et physiothérapie). Il y avait un lien statistiquement significatif entre le coût du traitement et la gravité de la lésion de la moelle épinière traumatique ainsi que la durée d‘hospitalisation (p = 0,01). Le niveau médullaire de la lésion n‘était pas associé au coût direct de prise en charge (p = 0,89).Conclusion : Le coût direct de prise en charge des personnes avec TVM à Ibadan au Nigéria est élevé. Ce coût élevé souligne la nécessité d‘un modèle de service novateur avec la capacité d‘atténuer le coût pour les malades et leur famille au Nigéria

Clinical and demographic correlates of unilateral spatial neglect among community-dwelling Nigerian stroke survivors

Background: Unilateral Spatial Neglect (USN) is important sequelae of stroke which has been linked with poor clinical recovery. Its prevalence among post hospital discharge stroke survivors and clinical and demographic correlates of the USN have not been well documented. This study explored the occurrence of USN and its associated factors among Nigerian community-dwelling stroke survivors.Method: A descriptive research approach was employed in this study carried out at a Physiotherapy outpatient facility. Forty post-stroke individuals receiving physiotherapy on out-patient basis were screened for the existence of USN using the bells and star cancellation tests. Information on age, gender, stroke laterality, time after stroke and motor function assessed using modified motor assessment scale were also documented. Prevalence of USN was determined while differences in prevalence by demographic and clinical variables were analyzed using Chi-square and Mann Whitney U tests at P=0.05.Results: Neglect was observed in 15 (37.0%) stroke patients, with an almost equal proportion in both right and left hemispheric stroke. Among the demographic and clinical variables investigated, only gender and motor function were found to have significant association with USN. Conclusions: A considerable proportion of community-dwelling stroke survivors receiving physiotherapy as part of their rehabilitation program were observed to experience neglect, a disorder identified with prolonged rehabilitation efforts and poor outcome. Routine screening for existence or persistence of USN should be carried out for individuals who have suffered a stroke considering that its presence is associated with poor motor performance

The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis

Background A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. Methods In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. Findings Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity (I 2 of > 75%) between estimates for almost half of the outcomes. Interpretation To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. Funding Public Health Wales. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licens

Pattern of Presentation and Physiotherapy Approach to Management of Children with Cerebral Palsy at Public Hospitals in Ibadan, Nigeria

IntroductionChildren with Cerebral Palsy (CP) require physiotherapy as part of their habilitation programme. Given scarcity of physiotherapy clinical guidelines for managing CP in Nigeria, it is probable that physiotherapists would adopt management approaches based on individual preferences. The commonly used management approaches by physiotherapists at two purposively selected public-funded hospitals in Ibadan, Nigeria were documented in this retrospective study.MethodsInformation was methodically extracted from the clinic records of children with CP managed over a 5-year period. They include: information concerning the clinical diagnosis; physiotherapy management approach such as techniques, assessment and discharge practice. Data were analysed using descriptive statistics.ResultsSix hundred and ten (610) case files were retrieved. The spastic type of CP was the most prevalent (n = 214; 35.1%;); conventional physiotherapy treatment (n = 344; 56.4%); neurodevelopmental technique (n=185; 30.3%); and the proprioceptive neuromuscular facilitation (n=81; 13.3%) were the treatment approaches. Home programmes were prescribed for the majority (n =520; 85.2%); 555 (90.0%) were not formally discharged; many (n=409; 67.0%) were not reassessed in the course of receiving physiotherapy and those reassessed were done without the use of a standardized outcome measure.ConclusionImportance of physiotherapy practice guideline in CP is underscored by this report. Rwanda J Med Health Sci 2022;5(2):141-15

Challenges and barriers for implementation of the World Health Organization Global Disability Action Plan in low- and middle- income countries

Objective: To identify potential barriers and facilitators for implementation of the World Health Organization Global Disability Action Plan (GDAP) in Nigeria and compare these with other low- and middle-income countries. Methods: A rehabilitation team from the Royal Melbourne Hospital, Parkville, Australia, conducted intensive workshops at medical/academic institutions in Nigeria for healthcare professionals from various local Physical Medicine and Rehabilitation facilities. A modified Delphi method identified challenges for person with disability, using 3 GDAP objectives. Findings were compared with similar exercises in Madagascar, Pakistan and Mongolia. Results: Despite differences in the healthcare system and practice, the challenges reported in Nigeria were similar to those in other 3 low- and middle-income countries, at both macro (governmental/policymakers) and micro levels (community/social/individual). Common challenges identified were: limited knowledge of disability services, limited Physical Medicine and Rehabilitation workforce, guidelines and accreditation standards; coordination amongst healthcare sectors; social issues; data and research; legislation and political commitment. Common potential facilitators included: need for strong leadership; advocacy of disability-inclusive development; investment in infrastructure/human resources; coordination/partnerships in healthcare sector; and research. Conclusion: Disability care is an emerging priority in low- and middle-income countries to address the needs of people with disability. The challenges identified in Nigeria are common to most low- and middle-income countries. The GDAP framework can facilitate access and strengthen Physical Medicine and Rehabilitation services

Conceptual framework for establishing the African Stroke Organization

Africa is the world’s most genetically diverse, second largest, and second most populous continent, with over one billion people distributed across 54 countries. With a 23% lifetime risk of stroke, Africa has some of the highest rates of stroke worldwide and many occur in the prime of life with huge economic losses and grave implications for the individual, family, and the society in terms of mental capital, productivity, and socioeconomic progress. Tackling the escalating burden of stroke in Africa requires prioritized, multipronged, and inter-sectoral strategies tailored to the unique African epidemiological, cultural, socioeconomic, and lifestyle landscape. The African Stroke Organization (ASO) is a new pan-African coalition that brings together stroke researchers, clinicians, and other health-care professionals with participation of national and regional stroke societies and stroke support organizations. With a vision to reduce the rapidly increasing burden of stroke in Africa, the ASO has a four-pronged focus on (1) research, (2) capacity building, (3) development of stroke services, and (4) collaboration with all stakeholders. This will be delivered through advocacy, awareness, and empowerment initiatives to bring about people-focused changes in policy, clinical practice, and public education. In the spirit of the African philosophy of Ubuntu “I am because we are,” the ASO will harness the power of diversity, inclusiveness, togetherness, and team work to build a strong, enduring, and impactful platform for tackling stroke in Africa