Knowledge, attitudes and practices related to stroke in Ghana and Nigeria: A SIREN call to action

Abstract

IntroductionStroke is a prominent cause of death, disability, and dementia in sub-Saharan Africa (SSA). The Stroke Investigative Research and Education Network works collaboratively with stroke survivors and individuals serving as community controls to comprehensively characterize the genomic, sociocultural, economic and behavioral risk factors for stroke in SSA.PurposeIn this paper, we aim to: i) explore the attitudes, beliefs, and practices related to stroke in Ghana and Nigeria using the process of qualitative description; and ii) propose actions for future research and community-based participation and education.MethodsStroke survivors, their caregivers, health care professionals, and community representatives and faith-based leaders participated in one of twenty-six focus groups, which qualitatively explored community beliefs, attitudes and practices related to stroke in Ghana and Nigeria. Arthur Kleinman’s Explanatory Model of Illness and the Social Ecological Model guided the questions and/or thematic analysis of the qualitative data. We hereby describe our focus group methods and analyses of qualitative data, as well as the findings and suggestions for improving stroke outcomes.Results and discussionThe major findings illustrate the fears, causes, chief problems, treatment, and recommendations related to stroke through the views of the participants, as well as recommendations for working effectively with the SIREN communities. Findings are compared to SIREN quantitative data and other qualitative studies in Africa. As far as we are aware, this is the first paper to qualitatively explore and contrast community beliefs, attitudes, and practices among stroke survivors and their caregivers, community and faith-based leaders, and health professionals in multiple communities within Nigeria and Ghana.

Risk factors, clinical outcomes and predictors of stroke mortality in Sierra Leoneans: A retrospective hospital cohort study

“…The mean age of 59.8 ± 14.0 years in this study, was slightly lower than the mean age of 62.9 years reported by Lisk et al in Sierra Leone [ 14 ] but in accordance with other underdeveloped countries stroke studies reporting the mean age range of 50–65 years [ 19 , 20 , 22 , 24 ]. In Africa, stroke occurs at an earlier age in comparison to industrialized countries because most reported stroke studies in Africa are hospital-based with age selection bias [ 4 , 5 , 26 ]. Hence community-based studies are needed to clearly establish the age distribution of stroke in our country.…”

Perceptions about the Therapeutic Itinerary after stroke: a qualitative research

“…The delay postpones decision making for the application of thrombolytic drugs, while the recommended time for this procedure is, at most, four hours and thirty minutes after stroke (22)(23) . Literature reports perceptions of delays in seeking treatment after the first symptoms as well as doubts about the diagnosis and quality of care in different countries (9,12,21) .…”

“…Thus, population surveys on the level of knowledge on the subject have been identified as important tools for preventive and educational programs (11) . However, such surveys, usually done through the application of closed questionnaires, end up producing results of questionable validity, evidencing the demand for qualitative studies (12) .…”

“…In this sense, it was evidenced, through closed questionnaires, that themes such as alternative or magical solutions to the stroke event, with the potential to delay the search for help, would be little shared by people in a given context. However, the qualitative deepening done with focus groups in the same population has shown that they are common attitudes (12) . In this sense, the gap to be filled has to do with the understanding of the therapeutic path based on patients' perceptions.…”

Assessing the Determinants of the Wish to Die among the Elderly Population in Ghana

“…These health conditions have detrimental effects on patients’ mental health (i.e., depression, cognitive impairment) [ 4 , 60 , 61 ], which might increase an individual’s susceptibility to developing the wish to die [ 61 ]. Also, as the elderly degenerate because of these chronic health conditions, their capacity to alleviate their health challenges declines, so may wish to die as a plausible solution to end their struggles [ 1 , 16 , 62 ].…”