Browsing by Author "Chimatiro, George Lameck"

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    Barriers to reintegration experienced by stroke clients post discharge from a rehabilitation center in Malawi
    (University of the Western Cape, 2012) Chimatiro, George Lameck; Rhoda, Anthea
    Stroke is a worldwide medical emergency, and the trend in its incidence is rising. Stroke leads to activity limitation and participation restriction among stroke clients. However rehabilitation of stroke disability has been found as lacking emphasis on reintegration issues, resulting into stroke clients facing different barriers to reintegration in the community after discharge. There is limited information about experiences of stroke clients in the communities after discharge from rehabilitation centers in Malawi. The current study was conducted to explore the barriers to reintegration experienced by the clients post discharge from a rehabilitation center in Malawi. A qualitative research was adopted to explore the perceived barriers to reintegration at Malawi Against Physical Disabilities (MAP) Kachere rehabilitation centre in Blantyre. In-depth interviews were utilized to capture data from perspectives of eight stroke clients, eight caregivers and seven service providers. The data was analyzed by means of content analysis. The findings of this study show key barriers that challenge community reintegration at two levels: individual and environmental. At individual level the barriers include impairments mainly depression and anxiety and physical weakness; and personal characteristics such as denial, gender and comorbidity. At the environmental level stroke clients experience attitudinal barriers by people in different settings of the community, poor terrain, long distance to places of interest, inaccessible structures and poverty. From the findings, therefore, stroke client experience wide range of barriers in both the activity and participation domains of community reintegration.Based on the key findings, recommendations have been made along three broad lines. To decrease barriers to reintegration, service providers could use the findings to consider equally addressing the potential negative contextual factors to reintegration when managing stroke clients, a shift from purely medical model approach to management of stroke. To increase rehabilitation services the government of Malawi could address the problem of limited funding to rehabilitation organizations and put measures to increase number of rehabilitation personnel at community, district and national levels. Further research in the area of community reintegration and development of a model of stroke care and rehabilitation in the country has also been recommended with view to improving stroke care and enhanced community reintegration post stroke in the country.
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    Contextual model for in-patient stroke care and rehabilitation in Malawi
    (University of Western Cape, 2020) Chimatiro, George Lameck; Rhoda, Anthea J.
    Stroke is a known health challenge for the public as it is both incapacitating and fatal to many people world over. Malawi, one of the developing countries has stroke as the fourth leading cause of death, and is fast becoming even more significant due, primarily, to lifestyle changes and nature of healthcare practices. For these reasons, and particularly, the negative impact on quality of life, the management of people with stroke is a critical area of interest. While research activity throughout the world has advanced acute stroke-care interventions, patients in Low to Middle Income Countries (LMICs) benefit less from evidence-based stroke care practices due to less conventional applicability to the setting and continuing medical care and rehabilitation challenges. This doctoral project applied the results of a Diagnostic and Solution Phases to the development of a contextual model for in-patient stroke care and rehabilitation (MoC) in Malawi.
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    Scoping review of acute stroke care management and rehabilitation in low and middle-income countries
    (BMC, 2019) Chimatiro, George Lameck
    Stroke is a major public health concern, affecting millions of people worldwide. Care of the condition however, remain inconsistent in developing countries. The purpose of this scoping review was to document evidence of stroke care and service delivery in low and middle-income countries to better inform development of a context-fit stroke model of care.
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    Stroke patients’ outcomes and satisfaction with care at discharge from four referral hospitals in Malawi: A cross-sectional descriptive study in limited resource
    (The College of Medicine and the Medical Association of Malawi, 2018) Chimatiro, George Lameck; Rhoda, Anthea J.; De Wit, Liesbet
    BACKGROUND Stroke is the fourth leading cause of mortality and disability in Malawi. There is paucity of studies reporting on acute stroke functional outcomes, quality of life and satisfaction with care among patients with stroke. This study aimed to determine stroke outcomes and satisfaction with care in the country’s central hospitals. METHODS A descriptive cross-sectional study, recruiting 114 adult patients with stroke and their caregivers, was done. FIM, EQ-5D-5L, SASC and C-SASC were used to collect data. Univariate associations were assessed using the Kruskal-Wallis Test for categorical variables and the Wilcoxon Rank Sum Test for continuous variables. RESULTS With 79% of the original study sample taking part, there was improvement in patients’ functional status at discharge compared to on admission with notable improvement in self-care (p<0.001), sphincter control (p<0.001), locomotion (p<0.001), and social cognition (p<0.001), but no significant improvement in transfers (p=1.000), and communication (p=0.865). Satisfaction with care was high, with no significant differences between males and females (p=0.415), age in years (p=0.397), and distance to the clinic (p=0.615). Satisfaction ratings were also high from caregivers’ responses and their scores were not associated with age (p=0.663) or distance to the hospital (p=0.872). Quality of life was poor, most patients were either unable or had severe limitation in functional dimensions of mobility (22(28%), self-care (19(25%) and performance of usual activities (25(33%). Every additional year in age was associated with average of 0.36 decrease in quality of life score coefficient, -0.36 (95% CI: -0.63; -0.10); p=0.008. CONCLUSION Patients with stroke experience improvement in functional outcomes on discharge compared to on admission. Patients and caregivers were satisfied with care provision despite having poor quality of life post stroke treatment. There is need to focus proven interventions on areas of stroke care that can impact patients’ quality of life in resource limited settings.