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The long-term complications of stroke interfere with function, and the level of disability varies based on the type of stroke, location, and the extent of damage. Rehabilitation services are important in the recovery of stroke patients, but not all survivors have access to the services especially in low resourced settings where accessibility and economic challenges are the major barriers. Inadequate fulfilment of stroke survivors’ rehabilitation needs contribute to poor functional outcomes and slow recovery. The objectives of this chapter is therefore to give an overview of stroke and stroke rehabilitation with specific emphasis on occupational therapy, discuss the activities and areas of participation considered important by stroke patients, stroke patients’ needs and perceived fulfilment of these needs in order to provide targeted interventions. Data to inform the chapter is based on research done in a low resource setting. The perceived important activities and participation areas, and the needs of stroke patients are discussed in light of literature on the subject and findings from the studies done in Zimbabwe.

Background: Epidemiological data on stroke in Zimbabwe are scarce and few clinical studies have been performed to date. Methods: A retrospective review of the medical records of patients admitted for stroke during the year 2012 was performed at three tertiary hospitals. Sociodemographic data were recorded alongside with comorbidities and outcomes. Scoping over a period of one year using records of patients admitted for stroke helped to quantify and qualify the stroke problem. Descriptive analysis was done using STATA version 13.0. Results: A total of 450 stroke cases, (63% women) were included in the final analysis. The proportion of stroke cases among the admissions was 0.61%. Mean age of the stroke patients was 61.6±16.8 years (95% CI=60.1; 63.2). Risk factors were hypertension (58.5%), diabetes (18%) and HIV, (14%)). Diagnosis was clinical and 39.4% had a CT scan. Mean length of hospital stay was 8.1±5.6 days with a significance difference noted among hospitals (p

Background: The burden of HIV/AIDS in Sub-Saharan Africa has presented unusual and challenging acute surgical problems across all specialties. Thoraco-abdominal surgery cuts through muscle and thereby disrupts the normal anatomy and activity of the respiratory muscles leading to reduced lung volumes and putting the patients at greater risk of developing post-operative pulmonary complications (PPCs). PPCs remain an important cause of post-operative morbidity, mortality, and impacts on the long-term outcomes of patients post hospital discharge. The objective of the study was to determine the pulmonary complications developing after abdominal and thoracic surgery and the associated risks factors. Methods: A retrospective records review of all abdominal and thoracic surgery patients admitted at a central hospital from January 2014 to October 2014 was done. Data collected included demographic data, surgical history, comorbidities and the PPCs present. Results: Out of the 92 patients whose records were reviewed, 55 (59.8%) were males and 84 (91.3%) had abdominal surgery. The mean age of the patients was 42.6 years (SD = 18.4). The common comorbidities were HIV infection noted in 14(15.2%) of the patients and hypertension in 10 (13.0%). Thirty nine (42.4%) developed PPCs and the most common complications were nosocomial pneumonia in 21 (22.8%) patients, ventilator associated pneumonia in 11 (12.0%), and atelectasis in 6 (6.5%) patients. Logistic regression showed that a history of alcohol consumption, prolonged surgery, prolonged stay in hospital or critical care unit, incision type, and comorbidities were significant risk factors for PPCs (p < 0.05). The mortality rate was 10.9%. Conclusion: PPCs like nosocomial and ventilator associated pneumonia were common and were associated with increased morbidity and adversely affected clinical outcomes of patients. HIV and hypertension presented significant comorbidities which the health team needed to recognize and address. Strategies to reduce the occurrence of PPCs have to be implemented through coordinated efforts by the health practitioners as a team during the entire perioperative period.

Introduction: Village health workers (VHW)/Lay workers have been used effectively in HIV programmes in Zimbabwe and may potentially be useful in supporting caregivers of people with mental illness, if they are adequately trained and supervised by health professionals. Objective: To explore the training needs of VHW in supporting caregivers of persons with mental illness. Methods: Fifty two VHWs were conveniently selected from 5 out of 9 provinces in Zimbabwe and participated in focus group discussions (FGD) using a standardized study guide. Forty six health professionals completed a self-administered open ended questionnaire. Interviews were audio recorded and transcribed verbatim in Shona and translated into English. Data were analyzed thematically using Atlas Ti. Statistical Package for Social Sciences version 16 was used for sociodemographic data analysis. Results: The overall perceived training needs for VHW included training on counseling skills, psycho- education for caregivers, stress management, education on mental health conditions in order for them to effectively support caregivers of patients with mental illness in their communities in Zimbabwe. Conclusion: The needs analysis demonstrates perceived gaps in the knowledge of VHW in training caregivers of patients with mental illness. Designing a curriculum and assessing its impact on patient care and caregiver perceptions may go a long way in reducing caregiver burden in Zimbabwe.

Background: Cerebral Vascular Accident (CVA), or stroke, has become an epidemic in Zimbabwe with the incidence rising significantly over the past two decades. Most patients in Zimbabwe who have had a CVA are initially admitted into a hospital for the acute phase of care and later discharged back to the community and into the care of their family. Although caregivers are forced to suddenly take on a critical role in the daily care and rehabilitation of the person who has had a stroke and continues to have disabilities, there is little to prepare someone for these responsibilities at the time the patient returns home or even in the weeks and months following. Caregiver support, which can be extended through education in how to assist the patient with daily routines and mobility, has been shown to improve the quality of life of patients and caregivers. The need to develop a standardized curriculum for use with family and other primary caregivers was identified by faculty involved in health professions education at the University of Zimbabwe College of Health Sciences. The primary purpose of the curriculum was to meet the needs of caregivers responsible for individuals who had a CVA and returned to live in their local communities in Zimbabwe. Purpose: Thus, the purpose of this paper is to describe the process of curriculum development, from needs assessment through curricular design and evaluation, as an opportunity to demonstrate how physical therapists and other allied health professionals can address community need through curriculum design. Methods: A questionnaire was developed to ascertain curricular content from the people who had a stroke and designated caregivers. Results: Intended outcomes of the curriculum included evidence of (1) decreased caregiver burden among caregivers responsible for people who have survived a stroke and returned to live in their local communities in Zimbabwe; and (2) increased function and health related quality of life of the patient who has had a stroke and of their caregiver over a period of one year. Conclusion: Although this curriculum was designed specifically to meet the needs of caregivers in Zimbabwe, the process for curriculum development and the curriculum content can be adapted in many other countries and for other rehabilitation related situations.

Background: Rugby is a popular sport played in many countries worldwide. There has been recent growing interest for the sport in Zimbabwe especially among adolescents. However, no study has been done to documentthe profile of rugby-related injuries among Zimbabwean adolescents between the ages of 10 and 19 years. The goal of the present study is to describe the injuries sustained by adolescent males during the 2014 high school rugby season. Methods: A cross-sectional survey was conducted involving 275 male adolescents’ rugby players who competed in the Super Eight School Rugby League in Harare, Zimbabwe. Results: The mean age of the sample was 16 years (SD = 1.4). 58.2% of participants sustained at least one rugby-related injury. There were 561 injuries reported in total, of which 63.3% (n = 355) were new injuries and the remainder were recurrent cases. 7.7% (n = 43) of the injuries were graded as severe with participants missing rugby activities for more than 28 days. Of the 561 injuries that occurred, 59.4% (n = 333) occurred during competitive matches in the second half (59.5%). Injuries due to tackles were the most frequent accounting for 48.3% (n = 271) of all injuries sustained. The lower limbs were the most frequent body region affected (38.6%, n = 217). When comparing position of play, flankers sustained the most injuries (14.1%) and there were no differences in incidence of injury between forward and backline players. Conclusion: Our findings on the profile of rugby injuries among male Zimbabwean adolescents were similar to those of other studies in certain aspects but differed in others. Most injuries occurred in competition during the second half of the game mainly from tackles. Both junior and senior players were equally affected. The lower limbs were frequently injured especially the knee region.

Background: Late presentation to hospital after onset of stroke affects management and outcomes of the patients. This study aimed to determine the factors associated with time taken to present to hospital after the onset of acute stroke symptoms. Methods: A descriptive cross sectional study was conducted at two teaching hospitals in Zimbabwe. Participants included patients admitted with stroke and their relatives. A self-administered questionnaire was used to collect information on history of stroke occurrence and time taken to present to hospital. Data was analysed for means, frequencies, percentages and Odds ratios. Results: Less than half (33%) of the participants were able to recognize symptoms of stroke. Not having money to pay for hospital bills was a predictor of late hospital presentation (OR =6.64; 95% CI, (2.05-21.53); p=0.002). The other factors, though not statistically significant included not perceiving stroke as a serious illness (OR = 2.43; 95% CI (0.78-5.51); p=0.083) and unavailability of transport (OR=2.33; 95% CI (0.71-7.56); p=0.161). Predictors for early presentation included receiving knowledge about stroke from the community (OR=0.46; 95% CI (0.15-1.39); p=0.170); seeking help at the hospital (OR=0.50; 95% CI (0.18-1.37); p=0.177) and having a stroke while at the workplace (OR =0.46; 95% CI (0.08-2.72); p=0.389). Conclusions: Regarding stroke as an emergency that does not require prerequisite payment for services at hospitals and improved community awareness on stroke may improve time taken to present to hospital after the onset of stroke symptoms.

Background Physiotherapy is an integral part of treatment for paediatric burns. In Zimbabwe, children are admitted in paediatric burn unit with their caregivers, who play important roles such as providing explanation and obtaining cooperation of the child during physiotherapy, which is often uncomfortable or painful to the patient. The aim of this study was to determine the perspectives of caregivers towards physiotherapy interventions administered to hospitalized children at central hospitals in Harare, Zimbabwe. Methods A descriptive cross-sectional study was conducted using self-administered questionnaires. The study was carried out at two large central hospitals (Parirenyatwa Hospital and Harare Central Hospital). The study targeted all the caregivers of children below the age of 12 years with a diagnosis of burns, irrespective of severity or area affected, who were admitted in the two paediatric burn units. Of the 34 caregivers eligible to participate, 31 (91.1 %) questionnaires had complete data and were analysed. The analyses were done using Statistica version 12.0. Results The median age of the caregivers was 28 years (IQR = 24–33 years). Female caregivers constituted 90.3 % of the sample. The majority of the caregivers (n = 26, 83.9 %) were biological mothers to the hospitalised child. The majority of children (n = 20, 64.5 %) hospitalised were between 0 and 4 years. The commonest cause of burns was scalding (n = 19, 61.2 %). The burns were mainly in the upper extremities (n = 11, 35.5 %). Physiotherapy for the burns was mainly active and passive joint range of motion exercises (n = 30, 96.8 %). The caregivers’ perceptions towards physiotherapy were mainly positive (n = 20, 64.5 %) indicating that physiotherapy plays an important role in burn management. Of the 21 caregivers given a ward exercise programme, 13 (61.9 %) were not compliant. Conclusions Caregivers’ perspectives towards physiotherapy were largely positive and are similar to those found in other studies. The majority of the caregivers indicated that physiotherapy was important in the overall management of burns leading to proper healing of the wounds without complications.