Experiences accessing and using rehabilitation services for people with physical disabilities in Sierra Leone

Aenishänslin, Justine; Amara, Abu; Magnusson, Lina

doi:10.1080/09638288.2020.1755375

Cited by 9 publications

(13 citation statements)

References 30 publications

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“…Intracerebral haemorrhages occurred in younger patients: 52.3 (12.0) years compared with 61.6 (13.8) years for ischaemic strokes (p < 0.001) (Figure 2). Intracerebral haemorrhages were more severe than ischaemic strokes, with NIHSS at admission 20 (12-26) and 13 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), respectively (p < 0.001). In a univariate analysis, haemorrhagic strokes had a higher in-hospital mortality 43.5% compared with 25.5% in ischaemic strokes (p = 0.002) (Supplementary Material).…”

Section: Resultsmentioning

confidence: 99%

“…There is no stroke unit or practising stroke specialist physician. There are only four trained physiotherapists in the country ( 19 ), no speech and language therapist and no occupational therapist. There is no functional CT scan or MRI in the government health system; the CT scans in our study were performed at a private facility and paid for by the project.…”

Section: Settingmentioning

confidence: 99%

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A Prospective Stroke Register in Sierra Leone: Demographics, Stroke Type, Stroke Care and Hospital Outcomes

et al. 2021

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Introduction: Stroke is the second most common cause of adult death in Africa. This study reports the demographics, stroke types, stroke care and hospital outcomes for stroke in Freetown, Sierra Leone.Methods: A prospective observational register recorded all patients 18 years and over with stroke between May 2019 and April 2020. Stroke was defined according to the WHO criteria. Pearson's chi-squared test was used to examine associations between categorical variables and unpaired t-tests for continuous variables. Multivariable logistic regression, to explain in-hospital death, was reported as odds ratios (ORs) and 95% confidence intervals.Results: Three hundred eighty-five strokes were registered, and 315 (81.8%) were first-in-a-lifetime events. Mean age was 59.2 (SD 13.8), and 187 (48.6%) were male. Of the strokes, 327 (84.9%) were confirmed by CT scan. Two hundred thirty-one (60.0%) were ischaemic, 85 (22.1%) intracerebral haemorrhage, 11 (2.9%) subarachnoid haemorrhage and 58 (15.1%) undetermined stroke type. The median National Institutes of Health Stroke Scale on presentation was 17 [interquartile range (IQR) 9–25]. Haemorrhagic strokes compared with ischaemic strokes were more severe, 20 (IQR 12–26) vs. 13 (IQR 7–22) (p < 0.001), and occurred in a younger population, mean age 52.3 (SD 12.0) vs. 61.6 (SD 13.8) (p < 0.001), with a lower level of educational attainment of 28.2 vs. 40.7% (p = 0.04). The median time from stroke onset to arrival at the principal referral hospital was 25 hours (IQR 6–73). Half of the patients (50.4%) sought care at another health provider prior to arrival. One hundred fifty-one patients died in the hospital (39.5%). Forty-three deaths occurred within 48 hours of arriving at the hospital, with median time to death of 4 days (IQR 0–7 days). Of the patients, 49.6% had ≥1 complication, 98 (25.5%) pneumonia and 33 (8.6%) urinary tract infection. Male gender (OR 3.33, 1.65–6.75), pneumonia (OR 3.75, 1.82–7.76), subarachnoid haemorrhage (OR 43.1, 6.70–277.4) and undetermined stroke types (OR 6.35, 2.17–18.60) were associated with higher risk of in-hospital death.Discussion: We observed severe strokes occurring in a young population with high in-hospital mortality. Further work to deliver evidence-based stroke care is essential to reduce stroke mortality in Sierra Leone.

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Section: Resultsmentioning

confidence: 99%

Section: Settingmentioning

confidence: 99%

A Prospective Stroke Register in Sierra Leone: Demographics, Stroke Type, Stroke Care and Hospital Outcomes

et al. 2021

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“…Two content areas were discussed in the FGDs: access to healthcare and rehabilitation, which is covered in this paper, and coordination of health and rehabilitation, which is presented in a separate paper [ 14 ]. Persons with physical disabilities were interviewed about their experiences accessing and using rehabilitation and healthcare services in another part of the project [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

“…Most PWD in Sierra Leone live in poverty [ 2 ], have poor access to healthcare services, rehabilitation or mobility devices such as prostheses and orthoses [ 10 , 11 ]. PWD also have less access to education and employment than those without disabilities [ 2 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Access to health and rehabilitation services for persons with disabilities in Sierra Leone – focus group discussions with stakeholders

Magnusson

Kebbie

Jerwanska

2022

BMC Health Serv Res

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Background In Sierra Leone persons with disabilities are at higher risk of living in poverty and have poor access to a fragile healthcare and rehabilitation services. The aim was to explore stakeholders’ perceptions of access to health and rehabilitation services for persons with disabilities in Sierra Leone. Methods Seven focus group discussions, including stakeholders working within the field of disability was conducted. Results The subthemes were: continuous stigmatisation of persons with disabilities throughout life; long distances and transportation issues to access health and rehabilitation facilities; financial constraints; infrastructural barriers to healthcare and rehabilitation services and healthcare personnel’s negative attitudes and inadequate knowledge towards persons with disabilities; rehabilitation and healthcare facilities lacking materials to provide quality services; lack of specialised services and rehabilitation personnel for complex rehabilitation and the need for continuous education of new and current rehabilitation personnel. Conclusion Local actors need to take charge and renew efforts made by international organisations by providing trained rehabilitation staff and quality rehabilitation services. Rehabilitation services need to be affordable and transportation costs covered for persons with disabilities to access healthcare and rehabilitation services. Continuous education of the public and health personnel about disability is necessary to reduce negative attitudes towards persons with disabilities.

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“…In many remote and resource-constrained settings, physiotherapy options are limited [48]. However, physiotherapy is a very important and crucial element of the learning process of walking with a prosthesis.…”

Section: Physiotherapy In Remote and Resource-constrained Settingsmentioning

confidence: 99%

Pioneering low-cost 3D-printed transtibial prosthetics to serve a rural population in Sierra Leone – an observational cohort study

et al. 2021

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Background: There is a huge unmet global need for affordable prostheses. Amputations often happen in Sierra Leone due to serious infections, complex wounds, traffic accidents and delayed patient presentation to the hospital. However, purchasing a prosthesis is still beyond reach for most Sierra Leonean amputees. Method: We applied computer-aided design (CAD) and computer-aided manufacturing (CAM) to produce low-cost transtibial prosthetic sockets. In February and March 2020, eight participants received a 3D printed transtibial prosthesis in the village of Masanga in Tonkolili district, Sierra Leone. Research was performed using questionnaires to investigate the use, participants' satisfaction, and possible complications related to the prostheses. Questionnaires were conducted prior to production of the prosthesis and five to six weeks after fitting the prosthesis. A personal short-term goal was set by the participants. Findings: Competitively priced and fully functional prostheses were produced locally. After six weeks, all participants were still wearing the prosthesis and six of the eight participants reached their personal rehabilitation goals. Using their prostheses, all participants were no longer in need of their crutches. Interpretation: We have come a step closer to the production of low-cost prostheses for low-and middleincome countries (LMICs). The goal of our project is to perform long-term follow-up and to refine our concept of 3D printed prostheses for LMICs to provide practical solutions for a global health need unmet to date. Funding: € 15,000 was collected during a crowdfunding campaign in collaboration with the Dutch Albert Schweitzer Fund. Internship allowance for MvdS was obtained from the University of Twente. 3D-scanner, 3D-printer, and printing material were donated by Ultimaker BV and Shining 3D.

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Experiences accessing and using rehabilitation services for people with physical disabilities in Sierra Leone

Cited by 9 publications

References 30 publications

A Prospective Stroke Register in Sierra Leone: Demographics, Stroke Type, Stroke Care and Hospital Outcomes

A Prospective Stroke Register in Sierra Leone: Demographics, Stroke Type, Stroke Care and Hospital Outcomes

Access to health and rehabilitation services for persons with disabilities in Sierra Leone – focus group discussions with stakeholders

Pioneering low-cost 3D-printed transtibial prosthetics to serve a rural population in Sierra Leone – an observational cohort study

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