scholarly journals Exploring the experiences of stroke survivors, informal caregivers and healthcare providers in Sierra Leone: a qualitative study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e051276
Author(s):  
Jessica O'Hara ◽  
Melvina Thompson ◽  
Gibrilla Deen ◽  
Andrew J M Leather ◽  
Daniel Youkee ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Sierra Leone ◽  
Informal Caregivers ◽  
Healthcare Providers ◽  
Stroke Care ◽  
Sub Saharan Africa ◽  
Stroke Survivors ◽  
Scientific Review ◽  
Cross Sectional ◽  
Stroke Research

IntroductionStroke is now the second leading cause of adult death in Sub-Saharan Africa. Developed in dialogue with stroke survivors and caregivers in Sierra Leone, this will be the first study to explore the experience of stroke as well as the perceptions of the barriers and facilitators to accessing stroke care among stroke survivors, informal caregivers and healthcare providers. Findings will inform future stroke research and care in Sierra Leone.Methods and analysisA cross-sectional qualitative study employing semistructured interviews that will be audiorecorded, translated, transcribed and coded.SettingFreetown, Sierra Leone.ParticipantsInterviews with a purposive sample of stroke survivors, informal caregivers and healthcare providers.AnalysisInterviews will be coded by two authors and inductively analysed using thematic analysis.Ethics and disseminationThis study has received ethical approval from the Sierra Leone Ethics and Scientific Review Committee (8 December 2020) and the KCL Biomedical & Health Sciences, Dentistry, Medicine and Natural & Mathematical Sciences Research Ethics Subcommittee (reference: HR-20/21-21050). The findings of the study and learning in terms of the process of coproduction and involvement of stroke survivors will be disseminated via peer-reviewed publications, conferences, media and lay reports.

scholarly journals Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mamuda Aminu ◽  
Sarah Bar-Zeev ◽  
Sarah White ◽  
Matthews Mathai ◽  
Nynke van den Broek
Keyword(s):  
Sierra Leone ◽  
Cause Of Death ◽  
Expert Panel ◽  
Healthcare Providers ◽  
Sub Saharan Africa ◽  
Primary Data ◽  
Middle Income ◽  
Computer Based ◽  
Sub Saharan ◽  
Low And Middle Income

Abstract Background Every year, an estimated 2.6 million stillbirths occur worldwide, with up to 98% occurring in low- and middle-income countries (LMIC). There is a paucity of primary data on cause of stillbirth from LMIC, and particularly from sub-Saharan Africa to inform effective interventions. This study aimed to identify the cause of stillbirths in low- and middle-income settings and compare methods of assessment. Methods This was a prospective, observational study in 12 hospitals in Kenya, Malawi, Sierra Leone and Zimbabwe. Stillbirths (28 weeks or more) were reviewed to assign the cause of death by healthcare providers, an expert panel and by using computer-based algorithms. Agreement between the three methods was compared using Kappa (κ) analysis. Cause of stillbirth and level of agreement between the methods used to assign cause of death. Results One thousand five hundred sixty-three stillbirths were studied. The stillbirth rate (per 1000 births) was 20.3 in Malawi, 34.7 in Zimbabwe, 38.8 in Kenya and 118.1 in Sierra Leone. Half (50.7%) of all stillbirths occurred during the intrapartum period. Cause of death (range) overall varied by method of assessment and included: asphyxia (18.5–37.4%), placental disorders (8.4–15.1%), maternal hypertensive disorders (5.1–13.6%), infections (4.3–9.0%), cord problems (3.3–6.5%), and ruptured uterus due to obstructed labour (2.6–6.1%). Cause of stillbirth was unknown in 17.9–26.0% of cases. Moderate agreement was observed for cause of stillbirth as assigned by the expert panel and by hospital-based healthcare providers who conducted perinatal death review (κ = 0.69; p < 0.0005). There was only minimal agreement between expert panel review or healthcare provider review and computer-based algorithms (κ = 0.34; 0.31 respectively p < 0.0005). Conclusions For the majority of stillbirths, an underlying likely cause of death could be determined despite limited diagnostic capacity. In these settings, more diagnostic information is, however, needed to establish a more specific cause of death for the majority of stillbirths. Existing computer-based algorithms used to assign cause of death require revision.

scholarly journals Prevalence and Mortality of Cryptococcal Disease in Adults with Advanced HIV in an Urban Tertiary Hospital in Sierra Leone: A Prospective Study

2019 ◽  
Author(s):  
Sulaiman Lakoh ◽  
Hannah Rickman ◽  
Momodu Sesay ◽  
Sartie Kenneh ◽  
Rachael M. Burke ◽  
...  
Keyword(s):  
Sierra Leone ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Cd4 Count ◽  
Sub Saharan Africa ◽  
World Health ◽  
Categorical Variables ◽  
Hiv Patients ◽  
Cross Sectional ◽  
Cryptococcal Disease

Abstract Background The global annual estimate for cryptococcal disease related deaths exceeds 180,000, with three fourth occurring in sub-Saharan Africa. The World Health Organization (WHO) recommends cryptococcal antigen (CrAg) screening in all HIV patients with CD4 count <100/µl. As there is no previous published study on the burden and impact of cryptococcal disease in Sierra Leone, research is needed to inform public health policies. We aimed to establish the seroprevalence and mortality of cryptococcal disease in adults with advanced HIV attending an urban tertiary hospital in Sierra Leone. MethodsA cross-sectional study design was used to screen consecutive adult (18 years or older) HIV patients at Connaught Hospital in Freetown, Sierra Leone with CD4 count below 100 cells/mm3 from January to April, 2018. Participants received a blood CrAg lateral flow assay (IMMY, Oklahoma, USA). All participants with a positive serum CrAg had lumbar puncture and cerebrospinal fluid (CSF) CrAg assay, and those with cryptococcal diseases had fluconazole monotherapy with eight weeks followed up. Data were entered into Excel and analysed in Stata version 13.0. Proportions, median and interquartile ranges were used to summarise the data. Fisher’s exact test was used to compare categorical variables. Results A total of 170 patients, with median age of 36 (IQR 30-43) and median CD4 count of 45 cells/mm3 (IQR 23-63) were screened. At the time of enrolment, 54% were inpatients, 51% were newly diagnosed with HIV, and 56% were either ART-naïve or newly initiated (≤ 30 days). Eight participants had a positive blood CrAg, giving a prevalence of 4.7% (95% CI: 2.4-9.2%). Of those with a positive CrAg, CSF CrAg was positive in five (62.5%). Five (62.5%) CrAg-positive participants died within the first month, while the remaining three were alive and established on ART at eight weeks. ConclusionA substantial prevalence of cryptococcal antigenaemia and poor outcome of cryptococcal disease were demonstrated in our study. The high mortality suggests a need for the HIV programme to formulate and implement policies on screening and pre-emptive fluconazole therapy for all adults with advanced HIV in Sierra Leone, and advocate for affordable access to effective antifungal therapies.

scholarly journals ‘We are very individual’: anticipated effects on stroke survivors of using their person-generated health data

2020 ◽  
Vol 27 (3) ◽  
pp. e100149
Author(s):  
Gerardo Luis Dimaguila ◽  
Frances Batchelor ◽  
Mark Merolli ◽  
Kathleen Gray
Keyword(s):  
Health Services ◽  
Information Technologies ◽  
Digital Health ◽  
Healthcare Providers ◽  
Health Behaviours ◽  
Stroke Care ◽  
Health Data ◽  
Care Process ◽  
Stroke Survivors ◽  
Patient Reported

BackgroundPerson-generated health data (PGHD) are produced by people when they use health information technologies. People who use PGHD may experience changes in their health and care process, such as engagement with their own healthcare, and their sense of social support and connectedness. Research into evaluating those reported effects has not kept up; thus, a method for measuring PGHD outcomes was previously designed and applied to the exemplar case of Kinect-based stroke rehabilitation systems. A key step of the method ensures that the patient’s voice is included. Allowing stroke survivors to participate in the development and evaluation of health services and treatment can inform healthcare providers on decisions about stroke care, and thereby improve health outcomes.ObjectiveThis paper presents the perspectives of stroke survivors and clinicians on the anticipated effects of stroke survivors’ use of PGHD from a poststroke simulated rehabilitation technology.MethodsThis study gathered the perspectives of stroke survivors and clinicians through three focus groups and three interviews, recruited for convenience. Participants were also asked questions intended to encourage them to comment on the initial items of the patient-reported outcome measure-PGHD. Deductive thematic analysis was performed.ResultsThis paper has further demonstrated that outcomes of using PGHD can be measured. For instance, stroke survivors described that using PGHD could result in positive, negative and nil effects on their health behaviours. Survivors and clinicians had varying perspectives in three of the six themes presented, and emphasise the importance of allowing stroke survivors to participate in the evaluation of digital health services.

scholarly journals Factors affecting the acceptability of isoniazid preventive therapy among healthcare providers in selected HIV clinics in Nairobi County, Kenya: a qualitative study

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e024286 ◽  
Author(s):  
Elvis Omondi Achach Wambiya ◽  
Martin Atela ◽  
Ejemai Eboreime ◽  
Latifat Ibisomi
Keyword(s):  
Qualitative Study ◽  
Healthcare Providers ◽  
Preventive Therapy ◽  
Sub Saharan Africa ◽  
Isoniazid Preventive Therapy ◽  
Public Healthcare ◽  
People Living With Hiv ◽  
Policy Makers ◽  
Factors Affecting ◽  
High Level

ObjectiveDespite being globally recommended as an effective intervention in tuberculosis (TB) prevention among people living with HIV, isoniazid preventive therapy (IPT) implementation remains suboptimal, especially in sub-Saharan Africa. This study explored the factors influencing the acceptability of IPT among healthcare providers in selected HIV clinics in Nairobi County, Kenya, a high HIV/TB burden country.DesignA qualitative study was conducted using in-depth interviews with healthcare providers in selected HIV clinics. All conversations were audio recorded, transcribed verbatim and analysed using a thematic approach.SettingThe study was conducted in the HIV clinics of three purposefully selected public healthcare facilities in Nairobi County, Kenya between February 2017 and April 2017.ParticipantsEighteen purposefully selected healthcare providers (clinicians, nurses, pharmacists and counsellors) working in the HIV clinics participated in the study.ResultsProvider acceptability of IPT was influenced by factors relating to the organisational context, provider training on IPT and their perception on its efficacy, length and clarity of IPT guidelines and standard operation procedures, as well as structural factors (policy, physical and work environment). Inadequate high-level commitment and support for the IPT programme by programme managers and policy-makers were found to be the major barriers to successful IPT implementation in our study context.ConclusionThis study provides insight into the complexity of factors affecting the IPT implementation in Kenya. Ensuring optimal acceptability of IPT among healthcare providers will require an expanded depth of engagement by policy-makers and IPT programme managers with both providers and patients, as well as on-the-job design specific actions to support providers in implementation. Such high-level commitment and support are consequently essential for quality delivery of the intervention.

scholarly journals A Qualitative Study to Explore the Experience of Parents of Newborns Admitted to Neonatal Care Unit in Rural Rwanda

2020 ◽  
Author(s):  
Samuel Byiringiro ◽  
Rex Wong ◽  
Jenae Logan ◽  
Deogratias Kaneza ◽  
Joseph Gitera ◽  
...  
Keyword(s):  
Qualitative Study ◽  
District Hospital ◽  
Financial Burden ◽  
Healthcare Providers ◽  
Neonatal Care ◽  
Sub Saharan Africa ◽  
Clear Understanding ◽  
Limited Information ◽  
Experience Of Care ◽  
Neonatal Care Unit

Abstract ABSTRACT (310/350 words) Background: Neonatal Care Units (NCUs) provide special care for sick and small newborns and can help reduce neonatal mortality. For parents, the experience of having a hospitalized newborn can be traumatic. In LMIC, especially sub-Saharan Africa, there is limited information about the parents’ experience of care in NCUs. Objective: Our study aimed to explore the experience of parents in the NCU of a rural district hospital in Rwanda. Methods: A qualitative study was conducted with parents whose newborns were hospitalized in the Ruli District Hospital NCU from September 2018 to January 2019. In-depth interviews were conducted using a semi-structured guide in the participants homes by trained data collectors. Data were transcribed, translated, and then coded using a structured code book. All data analyses were conducted using Dedoose software. Results: Twenty-one interviews were conducted primarily with mothers (90.5%, n=19) among newborns who were most often discharged home alive (90.5%, n=19). Parents reported stressful and emotional responses to having their newborns admitted particularly when they lacked clear understanding of their newborn’s condition, generally positive communication and interactions with healthcare providers and other parents, policies and procedures in the NCU that contributed to stress and limited access to newborns by fathers and other family members, and stress due to the high financial burden of NCU care. Conclusion: The admission of a newborn into the NCU alone was a source of stress for parents and caregivers in rural Rwanda. However, there were several positive factors of the NCU including involvement of mothers and support from healthcare providers. The experience in the NCU can be improved when healthcare providers communicate and explain the newborn’s status to the parents and actively involve them in the care of their newborn. Expanding the NCU access for families, encouraging peer support, and ensuring financial accessibility for neonatal care services could contribute to improved experiences for families. KEYWORDS: prematurity, neonatology, family-centered care, neonatal care unit, nurses, patient satisfaction, patient experience

scholarly journals The psychological burden in survivors of stroke and caregivers dyads in Kinshasa (Democratic Republic of Congo): a cross-sectional study

2021 ◽  
Author(s):  
Germain Manzekele Bin Kitoko ◽  
Bives Mutume. Vivalya ◽  
Martial Mumbere Vagheni ◽  
Thierry Matonda Ma Nzuzi ◽  
Sam Mampunza Lusambulu ◽  
...  
Keyword(s):  
Democratic Republic Of Congo ◽  
Healthcare Providers ◽  
Depression Scale ◽  
Cross Sectional Study ◽  
Anxiety And Depression ◽  
Stroke Survivors ◽  
Sectional Study ◽  
Cross Sectional ◽  
Psychological Burden ◽  
Zarit Burden Inventory

Abstract Background: Stroke exposes the patients and the caregivers to the development of burden in terms of health, economic and social costs. Few studies have focused on the relationship between the psychological burden and the level of disability in stroke survivors and caregiver dyads. Methods: This cross-sectional study aimed at determining the psychological burden of stroke in patients and caregivers in Kinshasa. 85 stroke survivors and caregivers dyads were screened using the Hospital Anxiety and Depression Scale, the Zarit Burden Inventory, and the Rankin’s modified Scale to determine respectively the depression, the anxiety in stroke survivors as well as the caregivers’ psychological burden. Results: Up to fifty percent of survivors of stroke had a severe disability, associated with a high risk of the occurrence of the psychological burden. Nearly eighty-five percent of caregivers showed a moderate psychological burden. The stroke survivors developed more depression than anxiety. Caregivers developed more likely anxiety and depression than stroke survivors. Conclusions: There is a positive relationship between the psychological burden in caregivers and the level of disability in stroke survivors far from the acute phase of the stroke. Healthcare providers working with the survivors of stroke should assess for anxiety and depression in caregivers.

scholarly journals 1289Decline in duration, satisfaction and sleep quality among informal caregivers of stroke survivors, 18-months post-stroke

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Phd Filipa Teixeira ◽  
Ana Moura ◽  
Elisabete Alves
Keyword(s):  
Sleep Quality ◽  
Informal Caregivers ◽  
Stroke Care ◽  
Stroke Survivors ◽  
Care Provision ◽  
Post Stroke ◽  
Adverse Health Outcomes ◽  
Care Services ◽  
The North ◽  
Falling Asleep

Abstract Background Data on stroke caregivers’ sleep is scarce. We aimed to assess changes in duration, satisfaction and sleep quality among informal caregivers of stroke survivors. Methods Informal caregivers (n = 126) of stroke survivors hospitalized between September 2018 and August 2019 in the 12 Stroke Units of the North of Portugal were invited to participate in the study, 18 months’ post-stroke. Sociodemographic and sleep characteristics (duration, satisfaction and quality) were collected through structured questionnaires. Odds ratios and 95% confidence intervals (95%CI) were estimated through logistic regression, adjusted for age and sex. Answers to open-ended questions were synthetized using content analysis. Results Due to care provision, informal caregivers reported sleeping, on average (SD), significantly less hours (7.0 (1.7) vs. 6.4 (1.8); p &lt; 0.001). Since its beginning, caregivers’ satisfaction with their sleep decreased approximately 30%. Changes in sleep quality, namely difficulties in falling asleep and constant interruptions during sleep, were reported by almost 70% of caregivers. Only 6.4% described the prescription of medication to sleep after beginning care provision. Participants who returned to work (adjusted OR = 0.34; 95%CI:0.16-0.76) and with a monthly income above 1000€ (adjusted OR = 0.29; 95%CI:0.13-0.66) were less likely to report changes in sleep quality. Conclusions A decline in duration, satisfaction and sleep quality of informal caregivers of stroke survivors, 18 months’ post-stroke, was observed. Changes in sleep quality revealed socioeconomic inequalities, highlighting the need to prevent adverse health outcomes related to sleep disturbance. Key messages Sleep health dimensions of stroke caregivers should be considered an additional dimension of the post-stroke care services.

scholarly journals Stroke Epidemiology, Care, and Outcomes in Kenya: A Scoping Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Peter Waweru ◽  
Samwel Maina Gatimu
Keyword(s):  
Policy Development ◽  
Case Reports ◽  
Stroke Care ◽  
Sub Saharan Africa ◽  
Urgent Care ◽  
Current Evidence ◽  
Systemic Hypertension ◽  
Cross Sectional ◽  
Sub Saharan ◽  
Stroke Epidemiology

Background: Stroke is a leading cause of death and disability in sub-Saharan Africa with increasing incidence. In Kenya, it is a neglected condition with a paucity of evidence despite its need for urgent care and hefty economic burden. Therefore, we reviewed studies on stroke epidemiology, care, and outcomes in Kenya to highlight existing evidence and gaps on stroke in Kenya.Methods: We reviewed all published studies on epidemiology, care, and outcomes of stroke in Kenya between 1 January 1990 to 31 December 2020 from PubMed, Web of Science, EBSCOhost, Scopus, and African journal online. We excluded case reports, reviews, and commentaries. We used the Newcastle-Ottawa scale adapted for cross-sectional studies to assess the quality of included studies.Results: Twelve articles were reviewed after excluding 111 duplicates and 94 articles that did not meet the inclusion criteria. Five studies were of low quality, two of medium quality, and five of high quality. All studies were hospital-based and conducted between 2003 and 2017. Of the included studies, six were prospective and five were single-center. Stroke patients in the studies were predominantly female, in their seventh decade with systemic hypertension. The mortality rate ranged from 5 to 27% in-hospital and 23.4 to 26.7% in 1 month.Conclusions: Our study highlights that stroke is a significant problem in Kenya, but current evidence is of low quality and limited in guiding policy development and improving stroke care. There is thus a need for increased investment in hospital- and community-based stroke care and research.

scholarly journals African Physician Migration to High-Income Nations: Diverse Motives to Emigrate ("We Are not Florence Nightingale") or Stay in Africa ("There Is No Place Like Home") Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle"

2020 ◽  
Author(s):  
Akhenaten Siankam Tankwanchi ◽  
Amy Hagopian ◽  
Sten H. Vermund
Keyword(s):  
Large Scale ◽  
Health Workers ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Right To Health ◽  
Sub Saharan Africa ◽  
Global Public Health ◽  
Cross Sectional ◽  
Medical Migration ◽  
The Right

Research in assessing the global and asymmetric flows of health workers in general, and international medical graduates in particular, is fraught with controversy. The complex goal of improving health status of the citizens of home nations while ensuring the right of health workers to migrate generates policy discussions and decisions that often are not adequately informed by evidence. In times of global public health crises like the current coronavirus disease 2019 (COVID-19) global pandemic, the need for equitable distribution and adequate training of health workers globally becomes even more pressing. Brugha et al report suboptimal training and working conditions among Irish and foreign medical doctors practicing in Ireland, while predicting large-scale outward migration. We comment on health personnel migration and retention based on our own experience in this area of research. Drawing from our examination of medical migration dynamics from sub-Saharan Africa, we argue for greater consideration of health workforce retention in research and policy related to resource-limited settings. The right to health suggests the need to retain healthcare providers whose education was typically subsidized by the home nation. The right to migrate may conflict with the right to health. Hence, a deeper understanding is needed as to healthcare worker motives based on interactions of psychosocial processes, economic and material determinants, and quality of work environments.

scholarly journals Prevalence and Correlates of Herbal Medicine Use among Women Seeking Care for Infertility in Freetown, Sierra Leone

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Peter Bai James ◽  
Lexina Taidy-Leigh ◽  
Abdulai Jawo Bah ◽  
Joseph Sam Kanu ◽  
Jia Bainga Kangbai ◽  
...  
Keyword(s):  
Herbal Medicine ◽  
Traditional Medicine ◽  
Sierra Leone ◽  
Healthcare Providers ◽  
Herbal Medicines ◽  
Cross Sectional Study ◽  
Herbal Remedies ◽  
Medicine Use ◽  
Chi Square ◽  
Cross Sectional

In resource-poor countries where access to infertility care is limited, women may turn to traditional medicine to achieve motherhood. It is unknown whether Sierra Leonean women with such condition use herbal medicine. This study investigates the prevalence and factors associated with herbal medicine use among women seeking care for infertility. This was a questionnaire-based cross-sectional study conducted among women seeking care for infertility at various clinics within Freetown, Sierra Leone. Data analysis included Chi-square tests and logistic regression. Out of the 167 women that participated, 36.5% used herbal medicine for infertility treatment. Women with no formal (AOR 4.03, CL: 1.38–11.76, p=0.011), primary education (AOR: 6.23, CL: 2.02–19.23, p=0.001) and those that visited a traditional medicine practitioner (AOR: 20.05, CL: 2.10–192.28, p=0.009) as well as women suffering from other reproductive health problems (AOR: 2.57, CL: 1.13–5.83, p=0.024) were more likely to use herbal medicines. Friends and family (n=57, 96.7%) were the main influencers of herbal medicine use. Only (n=12) 19.7% of users disclosed their status to their healthcare provider. Over half (n=32, 52.5%) could not remember the name of the herb they used. Luffa acutangula (n=29, 100%) was the herbal medicinal plant users could recall. Herbal medicine use among women seeking care for infertility in Freetown is common. Healthcare providers should be aware of the potential dyadic use of herbal and allopathic medicines by their patients and be knowledgeable about commonly used herbal remedies as well as being proactive in communicating the potential risks and benefits associated with their use.

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