Browsing by Author "Koltai, Deborah"

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    Depression Following Small Vessel Stroke is Common and More Prevalent in Women.
    (Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2024-02) Dymm, Braydon; Goldstein, Larry B; Unnithan, Shakthi; Al-Khalidi, Hussein R; Koltai, Deborah; Bushnell, Cheryl; Husseini, Nada El

    Objectives

    We sought to examine the frequency of depression after small vessel-type stroke (SVS) and associated risk factors.

    Materials and methods

    We conducted a retrospective analysis of a prospective cohort of patients enrolled in the American Stroke Association-Bugher SVS Study, which included 200 participants within 2-years of SVS and 79 controls without a history of stroke from 2007 to 2012 at four sites. The primary outcome was PHQ-8, with scores ≥10 consistent with post-stroke depression (PSD). A logistic regression adjusted for age, race, sex, history of diabetes and Short-Form Montreal Cognitive Assessment score (SF-MoCA) was used to compare the risk of having depression after SVS compared to controls. Another logistic regression, adjusted for age, sex, race, level of education, SF-MoCA, white matter disease (WMD) burden, stroke severity (NIHSS), time between stroke and depression screen, history of diabetes, and history of hypertension was used to identify factors independently associated with depression in participants with SVS.

    Results

    The cohort included 161 participants with SVS (39 excluded due to missing data) and 79 controls. The mean interval between stroke and depression screening was 74 days. Among participants with SVS, 31.7% (n=51) had PSD compared to 6.3% (n=5) of controls (RR= 5.44, 95% CI=2.21-13.38, p=0.0002). The only two variables independently associated with PSD in participants with SVS were female sex (RR=1.84, 95% CI=1.09-3.09, p=0.020) and diabetes (RR 1.69, 95% CI 1.03-2.79).

    Conclusions

    After adjusting for several demographic and clinical variables, having a SVS was associated with an approximate 5-fold increased risk of depression and was more frequent in women and in those with diabetes. The extent of WMD was not independently associated with PSD, suggesting that small vessel disease in the setting of an overt SVS may not account for the increased prevalence of depression.
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    Health System Capacity for Epilepsy Care in Uganda: A Survey of Health Facilities In Western Uganda
    (2023) Njeru, Paula Njoki

    Background

    Epilepsy is a chronic neurological disorder characterized by recurrent seizure activity caused by abnormal electrical activity in the brain. Over 80% of all cases globally occur in Low- and Middle-Income countries. A high treatment gap exists in LMICs, including Uganda, with 80% of people with epilepsy never receiving treatment. Studies have shown that even with existing medical services, a lack of skilled workforce, medication stock-outs, and long distances to health facilities contribute to the high treatment gap. This study describes the capacity, distribution of health facilities, and referral patterns between facilities that care for epilepsy patients in Uganda.

    Methods

    We conducted a cross-sectional survey adapted from the WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. It was modified to include WHO Mental Health Gap Action Program (mhGAP) resources for epilepsy and the Tool for Situational Analysis to Assess Epilepsy Care. Data collection occurred between July and August 2022. Our sample included all regional and general hospitals and a sample of randomly selected Health Centers in Southwestern Uganda. We used probability proportional to size sampling to determine which Health Centers to include in our sample. We had only public health facilities in our sample. Data were collected through in-person interviews conducted by trained research assistants. A three-tiered categorical score (full, intermediate, and low capacity) was used to describe epilepsy capacity. For scoring, hospitals were stratified into three groups/facility levels: tertiary care (regional referral hospitals), secondary care (district hospitals/health center IVs), and primary care (health center IIIs), as we hypothesized that available resources would differ between the groups. We did geospatial mapping to show the distribution of facilities.

    Ethical approval was obtained from the Makerere School of Public Health Research Ethics Committee (Protocol 1104), the Uganda National Council of Science and Technology (Protocol HS2344ES), and Duke University’s Institutional Review Board (Protocol 00110747).

    Results63 facilities were surveyed, with 100% completion in all facilities. 63 (100%) facilities provide care for epilepsy patients. None of the facilities surveyed had full capacity to treat epilepsy patients. Most of our sampled facilities had a low capacity to treat epilepsy: 100% of tertiary care facilities, 77.3% of secondary care facilities, and 83.8% of primary care facilities. Overall capacity was weakest in medication, equipment, and human resources and highest in infrastructure and guidelines. Conclusion While epilepsy services are present in Uganda’s southwestern region, a lack of vital medicines, staff shortages, and technology can limit service delivery. Task shifting and sharing have been widely implemented to address workforce shortages. The findings of this study can help inform policy to improve service delivery for epilepsy patients.

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    Medical pluralism in beliefs and practices surrounding epilepsy care in Uganda
    (2019-04-22) Smith, Caleigh
    Background: In the context of a massive epilepsy treatment gap in Sub-Saharan Africa, people with epilepsy consult multiple sources of treatment, including biomedical, traditional and pastoral providers. Thus, in this study, patient and caregiver beliefs about epilepsy etiology and their health-seeking behaviors were investigated as a first step towards exploring a possible basis for collaboration within Uganda’s pluralistic health system. Methods: 626 participants were interviewed in three hospitals in Uganda regarding their beliefs about epilepsy and care-seeking behaviors. Analyses were conducted to determine whether beliefs about epilepsy etiology tended to encompass solely biological explanations or whether they were more pluralistic, drawing upon biological, mystical and spiritual explanations for their conditions. The associations of these beliefs with various demographics and care-seeking behaviors were also investigated. Results: More than two thirds of the sample held pluralistic beliefs about epilepsy etiology, encompassing biological as well as mystical and spiritual concepts in their explanations for seizures. These pluralistic beliefs tended to be associated with greater delays in seeking biomedical care (p<0.005) and greater likelihood of accessing traditional or pastoral healers for care (p<0.1). People with pluralistic beliefs also tended to be younger (p<0.01), less educated (p<0.05) and have lower incomes(p<0.05) than those with only biological beliefs. Conclusions: These results suggest reveal the importance of understanding sociocultural beliefs in mediating treatment bottlenecks for epilepsy care associated with medical pluralism. In order to adequately treat patients with epilepsy, there needs to be more inclusive approach to health care delivery that respects pluralistic beliefs. Understanding the complex imbrications in beliefs, practices and health care systems related to epilepsy will be crucial for making progress towards the WHO’s strategic plans for integrating traditional and complementary medicine and for addressing the mental health gap.