Burden Of Stroke In Ghana: Prevalence, Experience And Caregiving

Background: Stroke has been named as one of the public health priorities in sub-Saharan Africa (SSA) because of its impact on mortality, morbidity and quality of life. Despite this, there is limited population-based information on prevalence and correlates of stroke, and there is limited information on knowledge and experience of stroke from the perspectives of the stroke survivors and their caregivers in SSA. Objectives: This thesis examined the prevalence, correlates, knowledge and experience of stroke in Ghana. It drew on three main concepts and theories: Health Related Quality of Life; explanatory models, and; biographical theories (biographical disruption, biographical transformation, biographical flow and biographical reinforcement). These concepts and theories were subsumed under social determinants of health. Methodology: This study adopted a triangulation mixed method approach using both quantitative and qualitative data. The wave 1 data of the World Health Organization (WHO) Survey on Global Ageing and Adult Health (SAGE) (Ghana) was used for the quantitative data and the sample size was 4,279 Ghanaian adults aged 50 years and above. The SAGE data was used to examine stroke prevalence and correlates as well as Health Related Quality of Life (HRQoL) of stroke survivors. While binary logistic regression was used to determine the correlates of stroke, multiple linear regression was used to determine the predictors of HRQoL of stroke survivors. For the qualitative data, a total of 22 stroke survivors and 29 caregivers were purposively selected from Ga Mashie and Korle-Bu Teaching Hospital (Physiotherapy and Stroke Units), Accra. Individual semi-structured interviews were used to explore the knowledge and experience of stroke from the perspectives of the stroke survivors and their caregivers. Data were analysed using thematic approach with the aid of Atlas ti. vi Results: Stroke prevalence was 4.6% and the correlates of stroke were being never married, unemployed, and living with hypertension and diabetes. This study showed that the HRQoL of stroke survivors was low in the physical health (body-self), functional, psychological, social and environment domains. The predictors of HRQoL of the stroke survivors were: unemployment, lower wealth status and living with hypertension. Particularly, the HRQoL was lower for stroke survivors who were unemployed; those in the poorest wealth quintiles, and; those living with hypertension. Further, participants’ knowledge on stroke causal theories, complications and prevention was eclectic and their sources of knowledge were mostly based on lived experiences of the stroke survivors and post-diagnosis information from health professionals. The impact of stroke on the stroke survivors centered on seven broad interrelated themes: body-self disruption; disruption to economic; disruption to social relationships; disruption to family relationships; cognitive disruption; nutrition disruption, and; lifestyle disruption. On the other hand, the impact of stroke on the caregivers centered on seven broad categories: disruption to physical body; disruption to economic circumstances; disruption to social relationships; nutrition disruption; psychological disruption; lifestyle disruption, and; disruption to life circumstances. Conclusion: This study showed high stroke prevalence among Ghanaian adults and the health of the stroke survivors affected that of their caregivers. The participants’ illness actions indicate that dual use of pharmaceutical and herbal treatments are adequate for stroke management. Further, the impact of stroke on stroke survivors and their caregivers was multifaceted. This indicates that interventions need to adopt a combined patient-and caregiver-focused approach in stroke survivor rehabilitation by adopting the Innovative Care for Chronic Conditions Framework, developed by World Health Organization

Social capital is associated with improved subjective well-being of older adults with chronic non-communicable disease in six low- and middle-income countries

Background: Non-communicable diseases (NCDs) are increasingly contributing to the morbidity and mortality burden of low and-middle income countries (LMIC). Social capital, particularly participation has been considered as a possible protective factor in the prevention and management of chronic conditions. It is also largely shown to have a negative effect on the well-being of patients. The current discourse on the well-being of individuals with NCDs is however focused more on a comparison with those with no NCDs without considering the difference between individuals with one chronic condition versus those with multiple chronic conditions (MCC). Method and objective: We employed a multinomial logit model to examine the effect of social capital, particularly social participation, on the subjective well-being (SWB) of older adults with single chronic condition and MCC in six LMIC. Findings: Social capital was associated with increased subjective well-being of adults in all the six countries. The positive association between social capital and subjective well-being was higher for those with a single chronic condition than those with multiple chronic conditions in India and South Africa. Conversely, an increase in the likelihood of having higher subjective well-being as social capital increased was greater for those with multiple chronic conditions compared to those with a single chronic condition in Ghana. Discussion: The findings suggest that improving the social capital of older adults with chronic diseases could potentially improve their subjective well-being. This study, therefore, provides valuable insights into potential social determinants of subjective well-being of older adults with chronic diseases in six different countries undergoing transition. Additional research is needed to determine if these factors do in fact have causal effects on SWB in these populations

How chronic conditions are understood, experienced and managed within African communities in Europe, North America and Australia: a synthesis of qualitative studies

This review focuses on the lived experiences of chronic conditions among African communities in the Global North, focusing on established immigrant communities as well as recent immigrant, refugee, and asylum-seeking communities. We conducted a systematic and narrative synthesis of qualitative studies published from inception to 2022, following a search from nine databases—MEDLINE, EMBASE, PsycINFO, Web of Science, Social Science Citation Index, Academic Search Complete, CINAHL, SCOPUS and AMED. 39 articles reporting 32 qualitative studies were included in the synthesis. The studies were conducted in 10 countries (Australia, Canada, Denmark, France, Netherlands, Norway, Sweden, Switzerland, United Kingdom, and the United States) and focused on 748 participants from 27 African countries living with eight conditions: type 2 diabetes, hypertension, prostate cancer, sickle cell disease, chronic hepatitis, chronic pain, musculoskeletal orders and mental health conditions. The majority of participants believed chronic conditions to be lifelong, requiring complex interventions. Chronic illness impacted several domains of everyday life—physical, sexual, psycho-emotional, social, and economic. Participants managed their illness using biomedical management, traditional medical treatment and faith-based coping, in isolation or combination. In a number of studies, participants took ‘therapeutic journeys’–which involved navigating illness action at home and abroad, with the support of transnational therapy networks. Multi-level barriers to healthcare were reported across the majority of studies: these included individual (changing food habits), social (stigma) and structural (healthcare disparities). We outline methodological and interpretive limitations, such as limited engagement with multi-ethnic and intergenerational differences. However, the studies provide an important insights on a much-ignored area that intersects healthcare for African communities in the Global North and medical pluralism on the continent; they also raise important conceptual, methodological and policy challenges for national health programmes on healthcare disparities

Stakeholder perspectives on the demand and supply factors driving substandard and falsified blood pressure lowering medications in Nigeria: A qualitative study

OBJECTIVES: Although substandard and falsified (SF) blood pressure (BP) lowering medications are a global problem, qualitative research exploring factors driving this in Nigeria has not been reported. This study provides information on factors driving demand for and supply of low-quality BP lowering medications in Nigeria and potential strategies to address these factors. METHODS: This was a cross-sectional qualitative study. Between August 2020 and September 2020, we conducted 11 in-depth interviews and 7 focus group discussions with administrators of health facilities, major manufacturers and distributors of BP lowering medications, pharmacists, drug regulators, patients and primary care physicians purposively sampled from the Federal Capital Territory, Nigeria. Data were analysed using directed content analysis, with the aid of Dedoose. RESULTS: We found that demand for SF BP lowering medications in Nigeria was driven by high out-of-pocket expenditure and stockouts of quality-assured BP lowering medications. Supply of low-quality BP lowering medications was driven by limited in-country manufacturing capacity, non-adherence to good manufacturing and distribution practices, under-resourced drug regulatory systems, ineffective healthcare facility operations, poor distribution practices, limited number of trained pharmacists and the COVID-19 pandemic which led to stockouts. Central medicine store procurement procedures, active pharmaceutical ingredient quality check and availability of trained pharmacists were existing strategies perceived to lower the risk of supply and demand of SF BP lowering medications. CONCLUSION: Our findings suggest that demand for and supply of SF BP lowering medications in Nigeria are driven by multi-level, interrelated factors. Multi-pronged strategies need to target stakeholders and systems involved in drug production, distribution, prescription, consumption, regulation and pricing

Scoping review of community health participatory research projects in Ghana

BACKGROUND: Community health participation is an essential tool in health research and management where community members, researchers and other relevant stakeholders contribute to the decision-making processes. Though community participation processes can be complex and challenging, evidence from previous studies have reported significant value of engaging with community in community health projects. OBJECTIVE: To identify the nature and extent of community involvement in community health participatory research (CHPR) projects in Ghana and draw lessons for participatory design of a new project on diabetes intervention in Accra called the Contextual Awareness Response and Evaluation (CARE) diabetes project. METHODS: A scoping review of relevant publications on CHPR projects in Ghana which had a participatory component was undertaken. PubMed, PsycINFO, African Journal Online, Health Source: Nursing/Academic Edition, Humanities International Complete and Google Scholar were searched for articles published between January 1950 and October 2021. Levac et al.'s (2010) methodological framework for scoping reviews was used to select, collate and characterise the data. RESULTS: Fifteen studies were included in this review of CHPR projects from multiple disciplines. Participants included community health workers, patients, caregivers, policymakers, community groups, service users and providers. Based on Pretty's participation typology, several themes were identified in relation to the involvement of participants in the identified studies. The highest levels of participation were found in two studies in the diagnosis, four in the development, five in the implementation and three in the evaluation phases of projects. Community participation across all studies was assessed as low overall. CONCLUSION: This review showed that community participation is essential in the acceptability and feasibility of research projects in Ghana and highlighted community participation's role in the diagnosis, development, implementation and evaluation stages of projects. Lessons from this review will be considered in the development, implementation, and future evaluation of the CARE diabetes project

The contextual awareness, response and evaluation (CARE) diabetes project: study design for a quantitative survey of diabetes prevalence and non-communicable disease risk in Ga Mashie, Accra, Ghana

Diabetes is estimated to affect between 3.3% and 8.3% of adults in Ghana, and prevalence is expected to rise. The lack of cost-effective diabetes prevention programmes designed specifically for the Ghanaian population warrants urgent attention. The Contextual Awareness, Response and Evaluation (CARE): Diabetes Project in Ghana is a mixed methods study that aims to understand diabetes in the Ga Mashie area of Accra, identify opportunities for community-based intervention and inform future diabetes prevention and control strategies. This paper presents the study design for the quantitative survey within the CARE project. This survey will take place in the densely populated Ga Mashie area of Accra, Ghana. A household survey will be conducted using simple random sampling to select households from 80 enumeration areas identified in the 2021 Ghana Population and Housing Census. Trained enumerators will interview and collect data from permanent residents aged ≥ 25 years. Pregnant women and those who have given birth in the last six months will be excluded. Data analysis will use a combination of descriptive and inferential statistics, and all analyses will account for the cluster sampling design. Analyses will describe the prevalence of diabetes, other morbidities, and associated risk factors and identify the relationship between diabetes and physical, social, and behavioural parameters. This survey will generate evidence on drivers and consequences of diabetes and facilitate efforts to prevent and control diabetes and other NCDs in urban Ghana, with relevance for other low-income communities

Trends Of Cardiovascular Disease Mortality In Ghana: A Case Study Of Mortality Cases At Korle Bu Teaching Hospital

Globally, more people die from cardiovascular diseases (CVDs) annually than from any other cause (WHO, 2011). In Ghana, CVDs accounted for one of the top three causes of death in 2010 after diarrhoeal and HIV/AIDS. Despite this, Ghana has no effective surveillance system in place to monitor the disease. Although hospital data may partly help in monitoring the mortality from the disease, most of these data are not analysed and interpreted. The goal of the study was to examine the trend in CVD mortality among autopsy cases from Korle Bu Teaching Hospital (KBTH), from 2006 to 2010. All cardiovascular deaths diagnosed at autopsy in the 5-year period from the beginning of January 2006 to the end of December 2010 located in the autopsy logbooks of the Department of Pathology, KBTH, were analysed for this study. The study showed that a total of 20,706 autopsy cases were done at KBTH within the five-year period. Out of this, 1,417 cases were incomplete and hence, a total of 19,289 cases were used in the analysis. The results showed that CVDs constituted about one-fifth of all causes of deaths from autopsy cases at KBTH within the 5-year period. Also, the findings show that females had higher odds of death from CVDs compared to males. Congestive heart failure was a major cause of CVDs deaths and it had the highest contribution to the years of potential life lost (YPLL) to CVDs. Therefore, there is need for population-based surveillance system put in place to monitor CVDs mortality and effort should be made at ensuring that developing policies for the disease is not based on mere extrapolations but on actual data

Hypertension prevalence, awareness, treatment and control in Ghanaian population: Evidence from the Ghana demographic and health survey.

Hypertension is a major cause of cardiovascular disease morbidity and mortality in Ghana. This study examines the prevalence, awareness, treatment and control of hypertension among Ghanaian aged 15-49 years. This cross-sectional study retrieved data from the 2014 Ghana Demographic and Health Survey (GDHS). The sample, comprising of 13,247 respondents aged 15-49 years, was analysed using descriptive statistics, Chi-Square tests, independent sample t-tests and binary logistic regressions. The overall prevalence of hypertension was 13.0% (12.1% for males and 13.4% for females). Among respondents who had hypertension, 45.6% were aware of their hypertension status; 40.5% were treating the condition while 23.8% had their blood pressure controlled (BP <140/90 mmHg). Socio-economic and demographic factors, health insurance coverage and recent visit to health facilities played significant roles in hypertension prevalence and awareness. While region of residence and health facility visits were predictors of hypertension treatment, age and region of residence predicted hypertension control in this population. This study suggests that in order to address the increasing burden of hypertension in Ghana, there should be an expansion of the National Health Insurance Scheme and development of measures to reduce health inequities. Also, some of the determining factors such as age, gender, marital status are similar to other cultures; therefore, existing interventions from those cultures could be adapted in addressing hypertension prevalence, awareness, treatment and control in Ghana

Lay knowledge of cardiovascular disease and risk factors in three communities in Accra, Ghana: A cross-sectional survey

Objectives Cardiovascular disease is a major cause of morbidity and mortality in Ghana, and urban poor communities are disproportionately affected. Research has shown that knowledge of cardiovascular disease (CVD) is the first step to risk reduction. This study examines knowledge of CVD and risk factors and determinants of CVD knowledge in three urban poor communities in Accra, Ghana. Methods Using the Cardiovascular Disease Risk Factors Knowledge Level Scale, which has been validated in Ghana, we conducted a cross-sectional survey with 775 respondents aged 15-59 years. CVD knowledge was computed as a continuous variable based on correct answers to 27 questions, and each correct response was assigned one point. Linear regression was used to determine the factors associated with CVD knowledge. Results The mean age of the participants was 30.3±10.8 years and the mean knowledge score was 19.3±4.8. About one-fifth of participants were living with chronic diseases. Overall, 71.1% had good CVD knowledge, and 28.9% had moderate or poor CVD knowledge. CVD knowledge was low in the symptoms and risk factor domains. A larger proportion received CVD knowledge from radio and television. The determinants of CVD knowledge included ethnicity, alcohol consumption, self-reported health and sources of CVD knowledge. CVD knowledge was highest among a minority Akan ethnic group, those who were current alcohol consumers and those who rated their health as very good/excellent, compared with their respective counterparts. CVD knowledge was significantly lower among those who received information from health workers and multiple sources. Conclusion This study underscores the need for health education programmes to promote practical knowledge on CVD symptoms, risks and treatment. We outline health systems and community-level barriers to good CVD knowledge and discuss the implications for developing context-specific and culturally congruent CVD primary prevention interventions

Metabolic syndrome among individuals living with hypertension in Accra, Ghana

Metabolic syndrome (MetS) is a major risk factor to cardiovascular diseases. In this study, we investigate the prevalence and associated risky behaviour of MetS in resource-poor urban communities in Accra, Ghana. We analysed data on 111 persons with hypertension, screened and recruited for a therapeutic lifestyle intervention program in August 2015. MetS was measured using the International Diabetes Federation (IDF) and the World Health Organization definitions. The prevalence of MetS was 58.4% and 16.8% by the IDF and WHO definitions respectively. More women (61.8%) compared to men (31.8%) had MetS (p = 0.011). Approximately 31% of the hypertensive patients were engaged in moderate-intensity physical activity; 9.0% were current smokers, 42.0% consumed excess alcohol over the past month prior to the interview and 41.0% discontinued taking their antihypertensive medications without consulting with a doctor. About 42.0% and 37.0% of respondents always consumed fruits and vegetables respectively at least two times a day. The binary logistic regression showed that compared to women, men had lower odds of consuming two or more servings of vegetable in a day (OR: 0.2; 95% CI; 0.1, 0.8). Increase in age was associated with higher odds of consuming fruits at least twice a day (1.0; 1.0, 1.1) but with lower odds of engaging in moderate intensity physical activity (0.9; 0.8, 1.0). Being married was associated with higher odds of engaging in moderate physical activity (2.8; 1.0, 8.2). Therapeutic methods essential for the management of patients with hypertension and MetS should include non-pharmacological remedies targeting the promotion of medication adherence, Dietary Approaches to Stop Hypertension (DASH) and physical activities; these are vital to changing unhealthy lifestyle which worsens the underlying pathology