Stroke is a neurological condition with rapidly increasing burden in many low- and middle-income countries. Africa is particularly hard-hit by stroke burden due to rapid population growth, increased lifespan, patterns of industrialization, adoption of harmful western diets, and increased prevalence of risk factors such as hypertension and obesity. In spite of the daunting projections, stroke is often a preventable brain disorder. Early identification and management of risk factors can greatly reduce stroke burden. Written in response to PAR-14-331 Global Brain and Nervous System Disorders Across the Lifespan, the proposed project will develop a person- centered stroke burden reduction approach that will be practical and effective in Uganda, generalizable to other countries in Sub-Saharan Africa, and will develop research capacity for future efforts in stroke burden reduction. The proposed study includes investigators from Makerere University in Kampala, Uganda, and from Case Western Reserve University, Ohio, U.S.A, who have a successful and established track-record of previous collaboration, including a NINDS-funded Medical Education Partnership Initiative (MEPI) focused on neurological conditions. This proposed 3-phase/3-aim project will; 1.) Conduct a mixed-methods (quantitative + qualitative) assessment of barriers and facilitators to stroke risk reduction in Uganda; 2) Develop a manualized self-management approach (SMA) to reduce primary and secondary stroke risk in Ugandans with multiple risk factors, and 3.) Lay groundwork that establishes a clinical trial infrastructure, adequately trained staff, and data tools/procedures preparatory to implementation of an interventional stroke burden reduction trial. In Phase 1/Aim 1, the investigators will conduct an epidemiological survey in 440 individuals to better understand stroke knowledge and attitudes. A sub-sample qualitative assessment will be conducted, using individual and group- format methodologies. In Phase 2/Aim 2, the study team will adapt a successful SMA initially developed for African-Americans. In Phase 3/Aim 3, the study team will select appropriate measures, train staff in measure implementation, and finalize the SMA for delivery using nurses and Peer Dyads (individuals who have had success in managing stroke risk factors). Finally, in a training/proof-of-concept exercise, the nurses and Peer Dyads will conduct the SMA with the 2 SMA targets (one group of up to 8 individuals at risk for stroke and one group of up to 8 individuals who have had stroke).
Stroke is a neurological condition associated with high fatality rates, years of suffering and disability for stroke survivors and families, as well as escalating costs. Africa is particularly hard-hit by stroke burden due to rapid population growth, increased lifespan, patterns of industrialization, adoption of harmful western diets, and spreading prevalence of risk factors such as hypertension, obesity, and diabetes. In spite of the daunting projections, stroke is often a preventable brain disorder, and developing ways to reduce stroke burden is a public health priority. The proposed project will develop a person-centered stroke burden reduction approach that will be practical and effective in Uganda, generalizable to other countries in Sub-Saharan Africa, and will develop the necessary research capacity and infrastructure needed for a future interventional trial.
| Kaddumukasa, Mark; Nakibuuka, Jane; Mugenyi, Levicatus et al. (2018) Feasibility study of a targeted self-management intervention for reducing stroke risk factors in a high-risk population in Uganda. J Neurol Sci 386:23-28 |
| Kaddumukasa, Mark; Kayima, James; Nakibuuka, Jane et al. (2017) Modifiable lifestyle risk factors for stroke among a high risk hypertensive population in Greater Kampala, Uganda; a cross-sectional study. BMC Res Notes 10:675 |
