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Background: Stroke is a leading cause of mortality and negatively affects health-related quality of life (HRQoL). HRQoL after stroke is understudied in Africa and there are no reports of quality-adjusted life years after stroke (QALYs) in African countries. We determined the impact of stroke on HRQoL after stroke in Sierra Leone. We calculated QALYs at 1 year post-stroke and determined sociodemographic and clinical variables associated with HRQoL and QALYs in this population. Methods: A prospective stroke register was established at the two-principal adult tertiary government hospitals in Freetown, Sierra Leone. Participants were followed up at 7, 90 days, and 1 year post-stroke to capture all-cause mortality and EQ-5D-3L data. QALYs were calculated at the patient level using EQ-5D-3L utility values and survival data from the register, following the area under the curve method. Utilities were based on the UK and Zimbabwe (as a sensitivity analysis) EQ-5D value sets, as there is no Sierra Leonean or West African value set. Explanatory models were developed based on previous literature to assess variables associated with HRQoL and QALYs at 1 year after stroke. To address missing values, Multiple Imputation by Chained Equations (MICE), with linear and logistic regression models for continuous and binary variables, respectively, were used. Results: EQ-5D-3L data were available for 373/460 (81.1%), 360/367 (98.1%), and 299/308 (97.1%) participants at 7, 90 days, and 1 year after stroke. For stroke survivors, median EQ-5D-3L utility increased from 0.20 (95% CI: −0.16 to 0.59) at 7 days post-stroke to 0.76 (0.47 to 1.0) at 90 days and remained stable at 1 year 0.76 (0.49 to 1.0). Mean QALYs at 1 year after stroke were 0.28 (SD: 0.35) and closely associated with stroke severity. Older age, lower educational attainment, patients with subarachnoid hemorrhage and undetermined stroke types all had lower QALYs and lower HRQoL, while being the primary breadwinner was associated with higher HRQoL. Sensitivity analysis with the Zimbabwe value set did not significantly change regression results but did influence the absolute values with Zimbabwe utility values being higher, with fewer utility values less than 0. Conclusion: We generated QALYs after stroke for the first time in an African country. QALYs were significantly lower than studies from outside Africa, partially explained by the high mortality rate in our cohort. Further research is needed to develop appropriate value sets for West African countries and to examine QALYs lost due to stroke over longer time periods. Data availability: The Stroke in Sierra Leone anonymized dataset is available on request to researchers, see data access section. [ABSTRACT FROM AUTHOR]

The 2014-2016 West Africa Ebola virus disease (EVD) epidemic resulted in an estimated 3,956 deaths and 10,168 survivors in Sierra Leone (1). The use of high quality specialty services by [...]

We describe a case series of 35 Ebola virus disease (EVD) survivors during the epidemic in West Africa who had neurologic and accompanying psychiatric sequelae. Survivors meeting neurologic criteria were invited from a cohort of 361 EVD survivors to attend a preliminary clinic. Those whose severe neurologic features were documented in the preliminary clinic were referred for specialist neurologic evaluation, ophthalmologic examination, and psychiatric assessment. Of 35 survivors with neurologic sequelae, 13 had migraine headache, 2 stroke, 2 peripheral sensory neuropathy, and 2 peripheral nerve lesions. Of brain computed tomography scans of 17 patients, 3 showed cerebral and/or cerebellar atrophy and 2 confirmed strokes. Sixteen patients required mental health followup; psychiatric disorders were diagnosed in 5. The 10 patients who experienced greatest disability had co-existing physical and mental health conditions. EVD survivors may have ongoing central and peripheral nervous system disorders, including previously unrecognized migraine headaches and stroke. [ABSTRACT FROM AUTHOR]

Background: Epilepsy is one of the world's most common neurological disorders with about eighty percent of cases living in low and middle-income countries. Due to superstitious cultural and traditional beliefs in Sub-Saharan Africa, the stigma associated with epilepsy is particularly disabling. Stigma negatively affects the psychosocial wellbeing of people with epilepsy (PWE) and their acceptance of medical treatment. Very limited studies have been done on the types and extent of stigma in PWE in Sierra Leone., Objective: This study will assess the extent and correlates of perceived and enacted stigma among patients attending the epilepsy clinic at Connaught hospital in Freetown, Sierra Leone., Methods: Using a semi-structured questionnaire to identify both perceived and enacted stigma, a cross-sectional descriptive study was conducted among patients attending the epilepsy clinic at Connaught hospital aged ten years and above with no major psychiatric co-morbidity. Frequency of stigma and socio-demographic and clinical correlates of stigma were determined., Results: Of the 128 patients, (9 below 18 years) 57.8% were males. Participants had a mean age of 32.9 years. 53.9% and 79.9% of participants reported experiencing perceived and enacted stigma, respectively. Longer duration of illness and being single correlated with perceived stigma, while lower educational achievement and early age of onset of seizure correlated with enacted stigma. A seizure frequency of more than two attacks a month was significantly related to both forms of stigma., Conclusion: The level of epilepsy-related social stigma is high in Sierra Leone. This is likely due to poor community education, leading to misconceptions and biases. An appropriate educational intervention coupled with effective clinical management of cases is needed to mitigate epilepsy-related stigma., Contexte: L'épilepsie est l'un des troubles neurologiques les plus courants dans le monde, avec environ quatre-vingts pour cent des cas vivant dans des pays à revenu faible et intermédiaire. En raison des croyances culturelles et traditionnelles superstitieuses en Afrique subsaharienne, la stigmatisation associée à l'épilepsie est particulièrement handicapante. La stigmatisation affecte négativement le bien-être psychosocial des personnes épileptiques (PWE) et leur acceptation du traitement médical. Très peu d'études ont été menées sur les types et l'étendue de la stigmatisation chez les PWE en Sierra Leone., Objectif: Cette étude évaluera l'étendue et les corrélats de la stigmatisation perçue et manifeste chez les patients fréquentant la clinique de l'épilepsie à l'hôpital Connaught à Freetown, Sierra Leone., Méthodes: À l'aide d'un questionnaire semi-structuré pour identifier la stigmatisation perçue et manifeste, une étude descriptive transversale a été menée chez des patients fréquentant la clinique de l'épilepsie à l'hôpital Connaught, âgés de dix ans et plus, sans co-morbidité psychiatrique majeure. La fréquence de la stigmatisation et les corrélats socio-démographiques et cliniques de la stigmatisation ont été déterminés., Résultats: Sur les 128 patients (9 de moins de 18 ans), 57,8% étaient des hommes. Les participants avaient un âge moyen de 32,9 ans. 53,9% et 79,9% des participants ont signalé avoir éprouvé une stigmatisation perçue et manifeste, respectivement. Une durée plus longue de la maladie et le fait d'être célibataire étaient corrélés à la stigmatisation perçue, tandis qu'un niveau d'éducation inférieur et un jeune âge de début des crises étaient corrélés à la stigmatisation manifeste. Une fréquence de crises de plus de deux attaques par mois était significativement liée aux deux formes de stigmatisation., Conclusion: Le niveau de stigmatisation sociale liée à l'épilepsie est élevé en Sierra Leone. Cela est probablement dû à une éducation communautaire insuffisante, conduisant à des idées fausses et des préjugés.Une intervention éducative appropriée couplée à une gestion clinique efficace des cas est nécessaire pour atténuer la stigmatisation liée à l'épilepsie., Mots-Clés: Épilepsie, Manifeste, Perçue, Stigmatisation, Sierra Leone., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2023 by West African Journal of Medicine.)