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.

Impact of physical activity and traumatic exposure on occurrence of gestational hypertension: a survey of pregnant women in an armed-conflict region in Nigeria.

OBJECTIVE: To compare physical activity level and traumatic exposure between normotensive and hypertensive pregnant women in an armed conflict region of Nigeria. METHODS: 130 normotensives and hypertensive pregnant women comprising of 65 participants per group participated in the study. Harvard Trauma Questionnaire and Pregnancy Physical Activity Questionnaire were used to assess traumatic events and physical activity respectively. RESULTS: Significant difference was observed on total traumatic event (p = 0.008) and all domains and intensities of physical activity except inactivity and sedentary (p > 0.05). Household activities (OR: 0.989; 95% CI: 0.981-0.996), occupational activities (OR: 0.936; 95%CI: 0.879-0.996) and sport/exercise activities (OR: 0.898; 95%CI: 0.832-0.969) were associated with a decrease hypertensive pregnancy. CONCLUSION: Despite exposed to traumatic events, physical activity is associated with normotensive pregnancy in an armed conflict region.