Quality of life of stroke survivors in Africa: a systematic review and meta-analysis.

PURPOSE: Functional impairments and socioeconomic constraints associated with stroke affect quality of life (QoL). With limited care and social support resources, there is a greater anticipated decline in QoL among stroke survivors in Africa. This study aims to examine post-stroke QoL, properties of outcome measures adopted and predictors of the QoL among African stroke survivors. METHODS: African Journals Online, CINAHL, PsychINFO, PubMed and Web of Science databases were searched from inception to February 2020. Methodological quality was assessed using the Agency for Healthcare Research and Quality (ARHQ) methodology checklist for observational studies. RESULTS: Twenty-eight studies recruiting 2572 (76.4%) stroke survivors and 795 (23.6%) healthy volunteers were included. Studies were conducted in eight African countries between 2007 and 2019. Methodological quality of studies was good. Overall, stroke survivors reported a low QoL. Six studies comparing QoL between stroke survivors and healthy controls were pooled for meta-analysis. Results showed a biased-adjusted standardised mean difference (Hedges's g) of 1.13 (95% CI 0.71 to 1.56; p < 0.001), indicating better QoL among healthy controls. Only 4 (14.3%) studies used translated or cross-culturally adapted QoL assessment tools. The most commonly reported predictor of QoL was post-stroke disability (35.8% of studies) which is followed by depression (28.6%) and stroke severity (28.6%). CONCLUSIONS: Overall, African stroke survivors reported comparatively lower QoL as compared to age-matched healthy controls. This highlights the need for cross-culturally validated assessment tools and more robust post-stroke QoL evaluation across the African continent. To improve QoL of stroke survivors in Africa, early interventions should focus on reducing disability and depression associated with stroke. PROSPERO registration number: CRD42019137653.

Community Integrated Management of Childhood Illnesses (C-IMCI) and Key Household Practices in Kano, Northwest Nigeria.

Introduction: Integrated Management of Childhood Illnesses (IMCI) is a holistic approach to reducing under-five morbidity and mortality and improving growth and development of children. This study compared key household and community practices in IMCI implementing and non-implementing communities in two local government areas (LGAs) of Kano State, Nigeria. Methodology: A cross sectional study was employed with multistage cluster sampling selection of caregivers of children 0-59 months of age and their index children (n=400).The study was conducted from February 2009 through January 2010. Data analysis was performed using EpiInfo™v6.0 and Minitab™ software. Results: The adoption of IMCI key household and community practices was generally better in IMCI-implementing communities than in non-IMCI communities. Exclusive breastfeeding (EBF) rate among children under six months was higher in IMCI communities than in non-IMCI communities (p=0.05). Non-IMCI communities also had a greater proportion of low weight-for-age children (42.5%) than IMCI communities. Mothers from IMCI communities (30.5%) were more likely to have antenatal care (ANC) during the first trimester than those from non-IMCI communities (p<0.05). There was no difference between the study communities with regard to use of insecticide treated nets during pregnancy (p=0.09), and having skilled attendance during last child birth (p=0.23). Conclusion: Mothers in communities implementing IMCI are more likely to adopt EBF and to attend ANC services than their counterparts in communities not implementing IMCI. Expanding IMCI activities to other LGAs in northwest Nigeria will have a positive impact on reducing morbidity from common childhood diseases.

Research profile of physiotherapy undergraduates in Nigeria.

OBJECTIVES: Physiotherapy training in Nigeria is almost 50 years old with no history of appraisal of research projects produced by the physiotherapy students. Physiotherapy students complete research projects in partial fulfilment of the requirements for graduation. An appraisal will reveal areas of strength and weakness in the research requirement for students, potentially leading to better research capacity and promoting evidence-based clinical practice among graduates. This study describes issues related to the study design, scope, statistical analysis and supervision of physiotherapy undergraduates in Nigerian universities. METHODS: This retrospective study analysed 864 projects undertaken by Nigerian physiotherapy students between years 2000 and 2010. A maximum of 20 projects per academic year were randomly selected from each of the seven physiotherapy institutions in Nigeria. Data were obtained using a self-designed data retrieval form and analysed using descriptive and inferential statistics. RESULTS: Cross-sectional surveys constituted 47.6% of the research projects with mainly non-probability sampling (57.7%) and lack of objective sample size determination in 91.6% of the projects. Most projects (56.4%) did not report any ethical approval. The particular university attended (χ2 = 109.5, P = 0.0001), type of degree offered (χ2 = 47.24, P = 0.00001) and the academic qualification of supervisors (χ2 = 21.99, P = 0.001) were significantly related to the strength of the research design executed by students. CONCLUSIONS: Most research projects carried out by Nigerian physiotherapy students were cross-sectional, characterised by arbitrary sample sizes, and were conducted on human subjects but most without report of ethical approval. Efforts to improve research methodology, documentation and exploration of a wider range of research areas are needed to strengthen this educational experience for students.