Burden Of Stroke In Ghana: Prevalence, Experience And Caregiving

ABSTRACT

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.

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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.