Supporting Survivors of Stroke in Low Resource Settings

Stroke occurs suddenly and has major impact on both the survivor and their caregiver. A third of stroke victims usually die from its direct effects or complications. The survivors usually have functional deficits resulting in the need for caregiver support. The caregivers may have inadequate knowledge of how to care for their affected relatives. The result is high caregiver burden and complications among the survivors. Once a person has stroke, it becomes important that their caregivers and their needs are determined so that they get the necessary support from the health professionals. Education of both the stroke survivors and the caregivers, and follow-up to determine if their needs are being met may be the support required. This is important in low resource settings where the survivors and caregivers may not always afford to go to stroke clinics for support visits and follow-up. Furthermore, stroke will result in reduced quality of life, poor functional outcomes, and poor community reintegration, which are important areas in life. Caregivers who look after the survivor for long periods may suffer burnout and have poor quality of life. Educating both the stroke survivor and their caregiver may result in better quality of life and survival rate

An evaluation of psychometric properties of caregiver burden outcome measures used in caregivers of children with cerebral palsy: a systematic review protocol

Background: Cerebral palsy (CP) is the most common, life-long paediatric disability. Taking care of a child with CP often results in caregiver burden/strain in the long run. As caregivers play an essential role in the rehabilitation of these children, it is therefore important to routinely screen for health outcomes in informal caregivers. Consequently, a plethora of caregiver burden outcome measures have been developed; however, there is a dearth of evidence of the most psychometrically sound tools. Therefore, the broad objective of this systematic review is to evaluate the psychometrical properties and clinical utility of tools used to measure caregiver burden in caregivers of children with CP. Methods/design: This is a systematic review for the evaluation of the psychometric properties of caregiver burden outcome tools. Two independent and blinded reviewers will search articles on PubMed, Scopus, Web of Science, CINAHL, PsychINFO and Africa-Wide Google Scholar. Information will be analysed using predefined criteria. Thereafter, three independent reviewers will then screen the retrieved articles. The methodological quality of studies on the development and validation of the identified tools will be evaluated using the four point COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Finally, the psychometric properties of the tools which were developed and validated from methodological sound studies will then be analysed using predefined criteria. Discussion: The proposed systematic review will give an extensive review of the psychometrical properties of tools used to measure caregiver burden in caregivers of children with CP. We hope to identify tools that can be used to accurately screen for caregiver burden both in clinical setting and for research purposes

Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)

Quality of life among adult patients living with HIV/AIDS taking antiretroviral drugs

Background: Zimbabwe’s response to the HIV/AIDS pandemic in terms of prevention, testing, counseling and treatment has been commendable but inadequate in terms of provision of rehabilitation services to HIV-infected individuals. Objectives: To determine the prevalence and extent of activity limitations and participation restrictions (disabilities) experienced by adults living with HIV/AIDS who are on Antiretroviral drugs (ARVs) and the factors associated with quality of life as assessed by the International Classification of Functioning, Disability and Health (ICF). Study variables: type of ARV, period on ARVs, last CD4 count, physical and mental health, previous injury, use of assistive devices, having an assistant, and demographic characteristics. Outcome variables: quality of life (total score), domain total scores, reduction and stopping of usual activities. Methods: A cross sectional analytical study was done with 59 consenting HIV positive adults on antiretroviral drugs attending an opportunistic infection clinic. An ICF-based interview questionnaire was administered on consecutive patients. Ethical clearance was granted. Data Analysis: Descriptive statistics were used to describe the distributions of participants according to demographic characteristics, clinical profile and prevalence of activity limitations and participation restrictions. Multivariate analysis was done to determine the factors that predicted quality of life. Level of significance was set at 5%. Results: The mean age of participants was 41 years (+/- 9.3), 56% were female, 54% were married and 30.5% were widowed. Median period on ARVs was 13 months (I.Q.R 3-29) and median last CD4 count was 189.5 (I.Q.R 114-278). Thirty-two (54%) were on Stalanev. About 36% and 61% had stopped or reduced their usual activities due to the illness respectively. Most affected aspects were walking (71%), fine hand use (41%), lifting & carrying objects (71%), shopping (55%), housework (55%), remunerative employment (56%) and economic self-sufficiency (79%). The support and relationships and attitudes of health professionals (86% and 88%) and immediate family (75% and 78%) were the cited major environmental facilitators. Factors statistically significantly associated with quality of life were physical health (p= 0.01), mental & emotional health (p= 0.04), and use of assistive devices (p= 0.02). Period on ARVs and last CD4 count were not statistically significantly associated with quality of life. Conclusion: HIV-related disabilities are prevalent even among those on antiretroviral drugs and their quality of life is reduced, hence the need to scale up rehabilitation services for them

The Need for Occupational Therapy (OT) Services in Zimbabwean Urban Mainstream Schools in the Context of Inclusive Education: A Cross Sectional Descriptive Pilot Study

The Zimbabwean government endorsed inclusive education in all mainstream learning institutions in the country. This pilot study sought to determine if they are challenges encountered by mainstream primary school teachers in their interaction with their pupils, teachers’ perspective of the challenges, in any, that can be addressed by occupational therapy (OT) services, and whether there are significant differences between private and public schools with regards to the encountered challenges. A cross sectional descriptive study was conducted with primary school teachers stratified by school type and grade. Data was collected using a pre-tested, self-administered questionnaire. Permission was granted by the Ministry of Primary and Secondary Education and school heads. Ethical clearance was granted (JREC: 292/16 and MRCZ (MRCZ/B/1160). Thirty-two teachers participated in the study with the majority being female (84.4%). The mean age of participants was 44.6 years (SD 9.8) and mean years of teaching experience was 19.5 years (SD 10.6). A high proportion of teachers reported encountering children with gross motor, fine motor, visual perception, auditory language, tactile sensation and emotional problems. These were 75 - 100% in private schools, and 43.8 - 93.8% in public schools. Teachers from both settings encountered problems in similar magnitudes except for fine motor and auditory language where a higher proportion was reported in private schools (p< 0.05). The majority of teachers indicated that the problems could be addressed by OT services. A high and similar proportion of teachers from private and public mainstream primary schools reported encountering problems that could benefit from OT services. The study therefore recommends that services should be availed in these settings in order to maximise the benefits of inclusive education

Caring for a child with Cerebral Palsy: The experience of Zimbabwean mothers

Background: The needs of caregivers of children with disability may not be recognized despite evidence to suggest that they experience increased strain because of their care-giving role. This strain may be exacerbated if they live in under-resourced areas. Objectives: We set out to establish the well-being of caregivers of children with Cerebral Palsy (CP) living in high-density areas of Harare, Zimbabwe. In addition, we wished to identify factors that might be predictive of caregivers’ well-being. Finally, we examined the psychometric properties of the Caregiver Strain Index (CSI) within the context of the study. Method: Caregivers of 46 children with CP were assessed twice, at baseline, and after three months, for perceived burden of care and health-related quality of life (HRQoL) using CSI and EQ-5D respectively. The psychometric properties of the CSI were assessed post hoc. Results: The caregivers reported considerable caregiver burden with half of the caregivers reporting CSI scores in the ‘clinical distress’ range. Many of the caregivers experienced some form of pain, depression and expressed that they were overwhelmed by the care-giving role. No variable was found to be associated with clinical distress. The CSI demonstrated good overall internal consistency (Cronbach’s Alpha = 0.8), stability over time (Z = 0.87, p = 0.381) and was significantly and negatively correlated with the EQ-5D VAS (Spearman’s rho = −0.33, p = 0.027), demonstrating concurrent validity. Conclusion: Caregivers must be monitored routinely for their level of distress and there is an urgent need to provide them with support. The CSI is likely to be a valid measure of distress in this population

Perspectives of adults living with HIV attending the opportunistic infections clinic at Chitungwiza central hospital in Zimbabwe towards physical activity: a cross-sectional survey

Abstract Background Regular physical activity and exercise have been shown to be of benefit in managing the HIV disease, its complications and the side effects of HAART. The perceptions of those living with HIV toward physical activity and exercises is a key factor in advocating for participation of rehabilitation personnel in the management of this disease. However, this domain remains underexplored in Zimbabwe. Methods A descriptive cross-sectional quantitative study was conducted with 327 people living with HIV. Participants were consecutively sampled from Chitungwiza Central Hospital Opportunistic Clinic. The International Physical Activity Questionnaire (IPAQ) and the Exercise Benefits/Barriers Scale (EBBS) were respectively used to measure the physical activity level and perceived benefits/barriers of physical exercise among adults living with HIV. The tools were self-administered. The analyses were done for 323 participants using the Statistical Package for the Social Sciences (SPSS). Results The mean age was 41.1 ± 11.0. Females constituted 69.7% (n = 225) of the sample. The majority of participants (n = 184; 57%) described themselves as being highly physically active (3204;IQR = 2139–4441 MET-minutes/week). Most of the participants agreed that physical activity prevented heart attacks with a mean value of 3.34 ± 0.65. The majority perceived psychological outlook as the greatest benefit from physical activity among the benefit sub-scales. Furthermore, most of the participants agreed that it cost too much for them to exercise which had a mean of 3.00 ± 0.88. Family discouragement was the most agreed perceived barrier to physical activity with a mean of 2.91 ± 0.67. Those who perceived physical activity as being beneficial reported less barriers. A statistically significant association was found between level of physical activity and CD4 cell count (p = 0.035) as well as with employment status (p < 0.05). No statistically significant association was reported between the perceived benefits and the level of physical activity (p = 0.214). A statistically significant association was reported between the perceived barriers and age (p < 0.05) as well as with employment status (p = 0.006). Conclusion Adults living with HIV receiving HAART at Chitungwiza Central Hospital are highly active when compared to other studies done in Sub-Saharan Africa. It is also important to create interventions that promote physical activity considering what this population considers as perceived benefits and barriers to physical activity

Stroke Rehabilitation and Occupational Therapy in Low Resource Settings

The long-term complications of stroke interfere with function, and the level of disability varies based on the type of stroke, location, and the extent of damage. Rehabilitation services are important in the recovery of stroke patients, but not all survivors have access to the services especially in low resourced settings where accessibility and economic challenges are the major barriers. Inadequate fulfilment of stroke survivors’ rehabilitation needs contribute to poor functional outcomes and slow recovery. The objectives of this chapter is therefore to give an overview of stroke and stroke rehabilitation with specific emphasis on occupational therapy, discuss the activities and areas of participation considered important by stroke patients, stroke patients’ needs and perceived fulfilment of these needs in order to provide targeted interventions. Data to inform the chapter is based on research done in a low resource setting. The perceived important activities and participation areas, and the needs of stroke patients are discussed in light of literature on the subject and findings from the studies done in Zimbabwe

A systematic review of the psychometric properties of the cross-cultural translations and adaptations of the Multidimensional Perceived Social Support Scale (MSPSS)

Background: Social support (SS) has been identified as an essential buffer to stressful life events. Consequently, there has been a surge in the evaluation of SS as a wellbeing indicator. The Multidimensional Perceived Social Support Scale (MSPSS) has evolved as one of the most extensively translated and validated social support outcome measures. Due to linguistic and cultural differences, there is need to test the psychometrics of the adapted versions. However, there is a paucity of systematic evidence of the psychometrics of adapted and translated versions of the MSPSS across settings. Objectives: To understand the psychometric properties of the MSPSS for non-English speaking populations by conducting a systematic review of studies that examine the psychometric properties of non-English versions of the MSPSS. Methods: We searched Africa-Wide Information, CINAHL, Medline and PsycINFO, for articles published in English on the translation and or validation of the MSPSS. Methodological quality and quality of psychometric properties of the retrieved translations were assessed using the COSMIN checklist and a validated quality assessment criterion, respectively. The two assessments were combined to produce the best level of evidence per language/translation. Results: Seventy articles evaluating the MSPSS in 22 languages were retrieved. Most translations [16/22] were not rigorously translated (only solitary backward-forward translations were performed, reconciliation was poorly described, or were not pretested). There was poor evidence for structural validity, as confirmatory factor analysis was performed in only nine studies. Internal consistency was reported in all studies. Most attained a Cronbach’s alpha of at least 0.70 against a backdrop of fair methodological quality. There was poor evidence for construct validity. Conclusion: There is limited evidence supporting the psychometric robustness of the translated versions of the MSPSS, and given the variability, the individual psychometrics of a translation must be considered prior to use. Responsiveness, measurement error and cut-off values should also be assessed to increase the clinical utility and psychometric robustness of the translated versions of the MSPSS. Trial registration PROSPERO - CRD42016052394. Electronic supplementary material The online version of this article (10.1186/s12955-018-0912-0) contains supplementary material, which is available to authorized users

Is any wheelchair better than no wheelchair? a Zimbabwean perspective

CITATION: Visagie, S., et al. 2015. Is any wheelchair better than no wheelchair ? a Zimbabwean perspective. African Journal of Disability, 4(1):1-10, doi:10.4102/ajod.v4i1.201.The original publication is available at http://www.ajod.orgBackground: Within a rights-based paradigm, wheelchairs are essential in the promotion of user autonomy, dignity, freedom, inclusion and participation. Objectives: This paper aimed to describe a group of Zimbabwean wheelchair users’ satisfaction with wheelchairs, wheelchair services and wheelchair function. Method: A mixed method, descriptive study was done. Quantitative data was collected from 94 consecutively sampled wheelchair users, who accessed wheelchair services at 16 clinics in five Zimbabwean provinces between October 2013 and February 2014, using the Quebec User Evaluation of Satisfaction with Assistive Technology for adults and children and Functioning Every day with a Wheelchair questionnaire. Qualitative data were collected through two focus group discussions (22 participants) and two case studies with participants purposively sampled from those who participated in the quantitative phase. Results: More than 60% of participants were dissatisfied with the following wheelchair features: durability (78.6%), weight (75.6%), ease of adjustment (69.1%), effectiveness (69.0%), safety (66.7%), reliability (66.7%), and meeting user needs (60.6%). Similarly, more than 66% of participants were dissatisfied with various services aspects: professional services (69.0%), follow-up (67.0%), and service delivery (68.3%). Although 60% of participants agreed that the wheelchair contributed to specific functions, more than 50% of participants indicated that the features of the wheelchair did not allow in- (53.2%) and outdoor (52.7%) mobility. Conclusion: Findings indicate high levels of dissatisfaction with wheelchair features and services, as well as mobility. It is recommended that policy and minimum service standards which incorporate evidence and good practice guidelines for wheelchair services and management of wheelchair donations are developed for Zimbabwe.http://www.ajod.org/index.php/ajod/article/view/201Publisher's versio