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|Title: ||Administration of a pictorial questionnaire to screen for stroke among patients with hypertension or diabetes in rural Ghana|
|Authors: ||Sarfo, Fred Stephen|
Gyamfi, Rexford Adu
|Keywords: ||Stroke symptoms|
|Issue Date: ||2017|
|Publisher: ||Journal of the Neurological Sciences|
|Citation: ||Journal of the Neurological Sciences, 373 (2017) 289–294|
|Abstract: ||Background: Stroke prevention is an important public health goal in low-and-middle income countries (LMIC)
due to its high mortality and morbidity in these settings. Epidemiological data from high-income countries
have demonstrated a potent predictive association between self-reported stroke symptoms and risks of future
strokes, incident cognitive impairment and all-cause mortality.
Objective: To utilize a pictographic version of the 8-itemQuestionnaire for Verifying Stroke Free Status (QVSFS) to
screen for stroke symptoms and determine its predictors among hypertensive and diabetic patients in a rural
hospital within a LMIC.
Methods: Between July and October 2016, 500 consecutive patients with hypertension and/or diabetes mellitus
encountered in clinic at the Agogo Presbyterian Hospital, a district level health institution in Ghana were enrolled.
A validated pictographic version of the QVSFS was administered by trained research assistants to all
study participants and demographic and clinical information on hypertension and diabetes controlwere collected.
The neurologist/specialist physician examined all patients neurologically using a structured questionnaire
and reviewed medical charts for objective documentary evidence of stroke. Predictors of stroke symptoms
were assessed using a multivariate logistic regression model.
Results: Among the cohort, median (IQR) age was 58 (51–66) years, 399 (79.8%) were women, 388 (77.6%) had
hypertension, 92 (18.4%) had diabetes and hypertension, and 20 (4.0%) had just diabetes. 30 (6.0%) patients had
confirmed stroke/TIA after physician evaluation, 151 (30.6%) had at least one symptom of stroke (SS) without
prior diagnosis of stroke/TIA and 319 (63.8%) reported no stroke symptoms. Independent predictors of reporting
stroke symptomswere increasing age - aOR: 1.38 (1.16–1.64) for each 10 years older andHBA1C–OR: 1.74 (1.16–
2.61) for each 2% increase. Subjects with previous stroke/TIA diagnosis had significantly higher mean± SD systolic
blood pressure (148.0± 21.2mmHg vs. 136.0 ± 17.3mmHg vs. 138.3 ± 19.7mmHg, p=0.009) and median
(IQR) HBA1C (8.8% (6.7–10.2) vs. 8.2 (6.4–10.6) vs. 7.2 (6.3–8.0), p = 0.05) compared with SS and
Conclusion: One in three patients with hypertension and/diabetes in rural Ghana report stroke-like symptoms.
Routine use of the pictographic version of the QVSFS could assist in identifying patients with or at high risk for
stroke who may benefit from appropriate prevention treatments.|
|Description: ||An article published in Journal of the Neurological Sciences, 373 (2017) 289–294|
|Appears in Collections:||College of Health Sciences|
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