title: Aphasia and swallowing problems in subjects with incident stroke in rural northern Tanzania: a case-control study.
abstract: OBJECTIVE
  This study was carried out to quantify the degree of cognitive impairment and the extent of speech, language, and swallowing problems in a representative cohort of Swahili-speaking people with stroke in Tanzania.
  
  
  METHODS
  A case-control design was used, comparing people with and without stroke on a screening test for aphasia (spoken comprehension and expression), a water swallow test, and the Community Screening Instrument for Dementia (CSI-D).
  
  
  RESULTS
  Fifty-eight persons between 6 and 60 months (median 36) post stroke and 58 age- and gender-matched control subjects were assessed. Twenty-eight strokes were left hemisphere; 25, right; 2, posterior circulation; and 3, undetermined. Forty-nine of 58 (84%) control subjects scored 19 to 20 (maximum) on the language screen compared with 26 of 56 (46%) persons with stroke who completed the assessment. Higher age and lower educational attainment, but not gender or time since stroke, were associated with poorer performance on language and swallow assessments. Poorer CSI-D score was significantly correlated with all items. Greater disability (Barthel Index score) was significantly correlated with poorer performance in all items except rate of drinking water. Those with a left hemisphere stroke performed less well on understanding and expression items but better than other subjects with stroke on the water swallow task.
  
  
  CONCLUSIONS
  This is the first attempt to describe aphasia incidence in a sub-Saharan African language. Further work on the psychometric properties of the screening instrument is warranted. Given that it delivers a relatively coarse indication of language disturbance, it is likely that incidence of aphasia in the current cohort is underestimated.
authors: Institute of Health and Society, Speech Language Sciences, Newcastle University, Newcastle upon Tyne, UK.
authors: Nick
authors: N
authors: Miller
authors: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Tyne and Wear, UK.
authors: William K
authors: WK
authors: Gray
authors: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Tyne and Wear, UK.
authors: Suzanne C
authors: SC
authors: Howitt
authors: Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro Region, Tanzania.
authors: Ahmed
authors: A
authors: Jusabani
authors: Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro Region, Tanzania.
authors: Mark
authors: M
authors: Swai
authors: Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.
authors: Ferdinand
authors: F
authors: Mugusi
authors: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Tyne and Wear, UK.
authors: Matthew P
authors: MP
authors: Jones
authors: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Tyne and Wear, UK.
authors: Richard W
authors: RW
authors: Walker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007806:Language Disorders / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D012424:Rural Population; D018709:Statistics, Nonparametric; D013281:Stomatitis, Aphthous / Q000209:etiology*; D020521:Stroke / Q000150:complications* / Q000453:epidemiology* / Q000523:psychology; D013636:Tanzania / Q000453:epidemiology
keywords: Swahili; Tanzania; aphasia; cognitive function; stroke