title: A cross-sectional study of quality of life in incident stroke survivors in rural northern Tanzania.
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.
authors.affiliation: South Tyneside NHS Foundation Trust, South Tyneside District Hospital, Harton Lane, South Shields, Tyne and Wear, NE34 0PL, UK.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Howitt
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Jones
authors.forename: Ahmed
authors.initials: A
authors.lastname: Jusabani
authors.forename: William K
authors.initials: WK
authors.lastname: Gray
authors.forename: Eric
authors.initials: E
authors.lastname: Aris
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mugusi
authors.forename: Mark
authors.initials: M
authors.lastname: Swai
authors.forename: Richard W
authors.initials: RW
authors.lastname: Walker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D020127:Recovery of Function / Q000502:physiology; D012959:Socioeconomic Factors; D020521:Stroke / Q000150:complications* / Q000523:psychology*; D017741:Survivors / Q000523:psychology*; D013636:Tanzania