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. CONCLUSION: 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.
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 strokeparticipants. 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. CONCLUSION: 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.
Authors: Mary Jo V Pugh; Laurel A Copeland; John E Zeber; Joyce A Cramer; Megan E Amuan; Jose E Cavazos; Lewis E Kazis Journal: Epilepsia Date: 2005-11 Impact factor: 5.864
Authors: Annet J Dallmeijer; Vincent de Groot; Leo D Roorda; Vera P M Schepers; Eline Lindeman; Leonard H van den Berg; Anita Beelen; Joost Dekker Journal: J Rehabil Med Date: 2007-03 Impact factor: 2.912
Authors: Sascha M C Rasquin; Jan Lodder; Rudolf W H M Ponds; Ieke Winkens; Jelle Jolles; Frans R J Verhey Journal: Dement Geriatr Cogn Disord Date: 2004-06-18 Impact factor: 2.959
Authors: Fred Stephen Sarfo; Manolo Agbenorku; Sheila Adamu; Vida Obese; Patrick Berchie; Bruce Ovbiagele Journal: J Neurol Sci Date: 2019-07-23 Impact factor: 3.181
Authors: Fred Stephen Sarfo; Ohene Opare-Sem; Martin Agyei; John Akassi; Dorcas Owusu; Mayowa Owolabi; Bruce Ovbiagele Journal: J Neurol Sci Date: 2018-09-20 Impact factor: 3.181
Authors: Michelle Nichols; Fred Stephen Sarfo; Arti Singh; Suparna Qanungo; Frank Treiber; Bruce Ovbiagele; Raelle Saulson; Sachin Patel; Carolyn Jenkins Journal: Am J Med Sci Date: 2017-08-12 Impact factor: 2.378
Authors: Altaf Saadi; Kigocha Okeng'o; Maijo R Biseko; Agness F Shayo; Theoflo N Mmbando; Sara J Grundy; Ai Xu; Robert A Parker; Leah Wibecan; Geetha Iyer; Peter M Onesmo; Boniphace N Kapina; Robert W Regenhardt; Farrah J Mateen Journal: Int J Stroke Date: 2018-04-20 Impact factor: 5.266
Authors: Fred S Sarfo; Patrick Berchie; Arti Singh; Michelle Nichols; Maria Agyei-Frimpong; Carolyn Jenkins; Bruce Ovbiagele Journal: J Stroke Cerebrovasc Dis Date: 2019-02-21 Impact factor: 2.136
Authors: Fred Stephen Sarfo; Linda Meta Mobula; Titus Adade; Yvonne Commodore-Mensah; Martin Agyei; Collins Kokuro; Rexford Adu-Gyamfi; Christiana Duah; Bruce Ovbiagele Journal: J Neurol Sci Date: 2020-03-04 Impact factor: 3.181