Background The potential of mobile-health (mHealth) technology for the management of hypertension among stroke survivors in Africa remains unexplored. We assessed whether an mHealth technology-enabled, nurse-guided intervention initiated among stroke patients within one month of symptom onset is effective in improving their blood pressure (BP) control. Methods A two-arm pilot cluster randomized controlled trial involving 60 stroke survivors, ≥18 years, with BP ≥140/90 mmHg at screening/enrollment visit at a medical center in Ghana. Participants in the intervention arm (n = 30) received a Blue-toothed BP device and smartphone with an App for monitoring BP measurements and medication intake under nurse guidance for three months after which intervention was withdrawn. Control arm (n = 30) received usual care. Primary outcome measure was proportion with clinic BP < 140/90 mmHg at month 9; secondary outcomes included medication adherence. Findings Mean ± SD age was 55 ± 13 years, 65% males. Two participants on intervention and three in control group were lost to follow-up. At month 9, proportion on the intervention versus controls with BP < 140/90 mmHg was 14/30 (46.7%) versus 12/30 (40.0%), p = 0.79 by intention-to-treat; systolic BP < 140 mmHg was 22/30 (73.3%) versus 13/30 (43.3%), p = 0.035. Mean ± SD medication possession ratio was 0.95 ± 0.16 on intervention versus 0.98 ± 0.24 in the control arm, p = 0.56. Interpretation We demonstrate feasibility and signal of improvement in BP control among stroke survivors in a resource-limited setting via an mHealth intervention. Larger scale studies are warranted. Trial registration NCT02568137. Registered on 13 July 2015 at ClinicalTrials.gov.
Background There are limited data on vascular cognitive impairment (VCI) from low- and middle income countries where the stroke burden is burgeoning. Objective To characterize the burden, determinants, and effects on health-related quality of life, of VCI in sub-Saharan Africa (SSA). Methods From January 2015 to February 2016, we collected information on 147 consecutive stroke survivors (>45 years) seen at a tertiary hospital in Ghana and 49 demographically matched stroke-free controls. Data collected included demographics, clinical factors, health-related quality of life and presence of depression. Cognitive status was evaluated using a standard vascular neuropsychological battery which assessed memory, executive function/mental speed, language, and visuospatial/ visuoconstructive functioning. Expert VCI guideline and DSM IV criteria were used to classify stroke patients into no VCI, VCI but no dementia, and vascular dementia (VD). Results Mean ± SD age of stroke survivors was 59.9 ± 13.7 years of which 47.6% were women. Among the cohort, 77/147 (52.3%) had no VCI, 50/147 (34.0%) had VCI no dementia and 20/147 (13.6%) had VD. Three factors remained significantly associated with VCI: increasing age for each successive 10 year rise (OR 1.44, 95% CI: 1.03–2.02); lack of formal education (OR 5.26, 95% CI: 1.01–27.52); and worse functional disability on the modified Rankin scale (OR 2.46, 1.61–3.75). Patients with VD had the poorest health related quality of life. Conclusion Half of the Ghanaian stroke survivors encountered in this cross-sectional study had evidence of cognitive dysfunction. Future studies in SSA will need to identify strategies to address this immense burden.
Background and Purpose The Questionnaire for Verifying Stroke-free Status (QVSFS), a method for verifying stroke-free status in participants of clinical, epidemiological and genetic studies, has not been validated in low-income settings where populations have limited knowledge of stroke symptoms. We aimed to validate QVSFS in 3 languages-Yoruba, Hausa and Akan- for ascertainment of stroke-free status of control subjects enrolled in an ongoing stroke epidemiological study in West Africa. Methods Data were collected using a cross-sectional study design where 384 participants were consecutively recruited from neurology and general medicine clinics of 5 tertiary referral hospitals in Nigeria and Ghana. Ascertainment of stroke status was by neurologists using structured neurological examination, review of case records and neuro-imaging (Gold standard). Relative performance of QVSFS without and with pictures of stroke symptoms (pictograms) was assessed using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results The overall median age of the study participants was 54 years and 48.4% were males. Of 165 stroke cases identified by Gold standard, 98% were determined to have had stroke while of 219 without stroke 87% were determined to be stroke-free by QVSFS. NPV of the QVSFS across the 3 languages was 0.97 (range, 0.93 – 1.00), sensitivity, specificity and PPV were 0.98, 0.82 and 0.80 respectively. Agreement between the questionnaire with and without the pictogram was excellent/strong with Cohen’s k=0.92. Conclusions QVSFS is a valid tool for verifying stroke-free status across culturally diverse populations in West Africa.
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