Stroke-related stigma among West Africans: Patterns and predictors.
BACKGROUND
Disability-adjusted life-years lost after stroke in Low & Middle-Income Countries (LMICs) is almost seven times those lost in High-income countries. Although individuals living with chronic neurological and mental disorders are prone to stigma, there is a striking paucity of literature on stroke-related stigma particularly from LMICs.


OBJECTIVE
To assess the prevalence, severity, determinants and psycho-social consequences of stigma among LMIC stroke survivors.


METHODS
Between November 2015 and February 2016, we conducted a cross-sectional survey of 200 consecutive stroke survivors attending a neurology clinic in a tertiary medical center in Ghana. The validated 8-Item Stigma Scale for Chronic Illness (SSCI-8) questionnaire was administered to study participants to assess internalized and enacted domains of stigma at the personal dimension with further adaptation to capture family and community stigma experienced by stroke participants. Responses on the SSCI-8 were scored from 1 to 5 for each item, where 1=never, 2=rarely, 3=sometimes, 4=often and 5=always with a score range of 8-40. Demographic and clinical data on stroke type and severity as well as depression and Health-Related Quality of Life indicators were also collected. Predictors of stroke-related stigma were assessed using Linear Models (GLM) via Proc GENMOD in SAS 9.4.


RESULTS
105 (52.5%) subjects recruited were males and the mean±SD age of stroke survivors in this survey was 62.0±14.4years. Mean SSCI-8 score was highest for personal stigma (13.7±5.7), which was significantly higher than family stigma (11.9±4.6; p=0.0005) and social/community stigma (11.4±4.4; p<0.0001). Approximately 80% of the cohort reported experiencing mild-to-moderate degrees of stigma. A graded increase in scores on the Geriatric Depression Scale and Centre for Epidemiological Studies-Depression scale was observed across the three categories. Living in an urban setting was associated with higher SSCI-8 scores. Moreover, stroke subjects with more severe post-stroke residual symptom deficits reported a significantly higher frequency of stigma.


CONCLUSIONS
Four out of five stroke survivors in this Ghanaian cohort reported experiencing some form of stigma. Stigmatized individuals were also more likely to be depressed and have lower levels of quality of life. Further studies are required to assess the consequences of stigma from stroke in LMIC.
Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana. Electronic address: stephensarfo78@gmail.com.
Fred Stephen
FS
Sarfo
Medical University of South Carolina, USA.
Michelle
M
Nichols
Medical University of South Carolina, USA.
Suparna
S
Qanungo
Medical University of South Carolina, USA.
Abeba
A
Teklehaimanot
Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
Arti
A
Singh
Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Nathaniel
N
Mensah
Medical University of South Carolina, USA.
Raelle
R
Saulson
Medical University of South Carolina, USA.
Mulugeta
M
Gebregziabher
University of Ibadan, Ibadan, Nigeria.
Uvere
U
Ezinne
University of Ibadan, Ibadan, Nigeria.
Mayowa
M
Owolabi
Medical University of South Carolina, USA.
Carolyn
C
Jenkins
Medical University of South Carolina, USA.
Bruce
B
Ovbiagele
D000354:Africa, Western / Q000453:epidemiology; D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology; D012189:Retrospective Studies; D057545:Social Stigma; D020521:Stroke / Q000453:epidemiology* / Q000523:psychology*
Neglected; Quality-of-life; Rehabilitation; Stigma; Stroke; West Africa