Abstract
The aim of this study was to evaluate changes to, and predictors of, quality of life (QOL) in a community-based cohort of stroke survivors from an earlier stroke incidence study in rural northern Tanzania. Patients were assessed 1–5 years after their incident stroke. The study cohort was compared with an age- and sex-matched control group from the same rural district within a cross-sectional design. Patients and controls were asked a series of questions relating to their QOL [World Health Organization quality of life, abbreviated version (WHOQOL-BREF)], levels of anxiety and depression [hospital anxiety and depression (HAD) scale], cognitive function [community screening instrument for dementia (CSI-D) screening tool], socioeconomic status and demographic characteristics (e.g. age, sex, education and abode). Patients were further assessed for functional outcome and disability (Barthel index, modified Rankin scale), post-stroke care and psychosocial functioning. Patients (n = 58) were found to have significantly lower QOL than controls (n = 58) in all six domains of the WHOQOL-BREF. Gender, socioeconomic status, cognitive function and time elapsed since stroke were not associated with QOL. Older patients and those with more impaired motor function and disability (Barthel index, modified Rankin score) had significantly poorer physical health-related QOL. Greater anxiety and depression, reduced muscle power and less involvement in social events were significantly correlated with lower physical and psychological health-related QOL. To our knowledge, this is the first long-term study of QOL in survivors of incident stroke in Sub-Saharan Africa (SSA). Poorer QOL was associated with greater levels of physical disability, anxiety and depression and reduced social interaction. Demographic factors appear to be much less significant. Modifying these QOL predictors could be important in planning effective post-stroke care within a stretched healthcare system.
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Acknowledgments
We would like to thank all healthcare workers, officials, carers and family members who helped in the identification of patients, the inputting of data and in the examination and assessment process. We would also like to acknowledge Professor Nigel Unwin and Professor George Alberti, who were part of the TSIP study group, for their helpful advice. The Tanzanian stroke incidence study was funded by a grant from the Wellcome Trust, UK.
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Howitt, S.C., Jones, M.P., Jusabani, A. et al. A cross-sectional study of quality of life in incident stroke survivors in rural northern Tanzania. J Neurol 258, 1422–1430 (2011). https://doi.org/10.1007/s00415-011-5948-6
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DOI: https://doi.org/10.1007/s00415-011-5948-6