CHALLENGES AND EXPERIENCES OF PATIENTS WITH STROKE AND THEIR SPOUSES IN BLANTYRE, MALAWI

Kalavina R1,2, Chisati E1, Mlenzana DN2, Wazakili DM11University of Malawi, Department of Physiotherapy, College of Medicine, Blantyre, Malawi, 2University of the Western Cape, Physiotherapy, Cape Town, South AfricaBackground: Stroke is the second major cause of death and disability worldwide. Most stroke survivors experience various challenges due to physical and mental impairments which increases the burden on spouses during care.Purpose: The broad aim of this study was to explore the challenges and experiences of patients with stroke and their spouses during and after rehabilitation at a rehabilitation centre in Blantyre, Malawi.Methods: This was a qualitative exploratory study. We conveniently selected 18 participants aged between 42 and 88 years. Half of the participants were patients with stroke and the other half were spouses of the patients with stroke. Semi-structured in-depth interviews and focus group discussions were utilized to collect, methodologically triangulate and enrich the data. In this study all the participants were interviewed separately at their homes or at the rehabilitation centre for an average of 30 to 45 minutes. Data were analyzed through a thematic content analysis.Results: Patients with stroke are challenged by loss of mobility and failure to perform basic functional activities, such as walking and feeding using the affected arm.This results in sudden dependence on spouse for basic self-care and daily activities. In addition spouses are burdened by care giving responsibilities and most participants have limited access to rehabilitation and health care services at grassroots level. Furthermore, the rehabilitation centre lacks privacy and is congested due to inadequate space.Conclusion(s): Patients with stroke struggle with loss of mobility, bowel and bladder incontinence, financial challenges, scarcity of medication and limited access to rehabilitation services. Spouses reported difficulties with caring for patients with faecal incontinence, speech impairment and anger management problems.Implications: Lack of health promotion and disability prevention programmes due to poverty is limiting access to rehabilitation services and increases the prevalence of disability. There is a need to introduce rehabilitation services at district hospitals to ease congestion and delayed onset of therapy which cause poor patient outcomes. Improved access to rehabilitation would yield better results for patients with in stroke. Therapists should know that a home program is necessary for patients with stroke. Therefore caregivers should be involved in therapeutic management. Policy makers should appreciate the need to introduce rehabilitation services to district hospitals and rural areas.Keywords: patients with stroke, spouses, rehabilitationFunding acknowledgements: We are grateful to SACORE for the sponsorship and University of Malawi College of Medicine for facilitating it.Topic: Neurology: stroke; Service delivery/emerging rolesEthics approval required: YesInstitution: University of Western Cape, University of Malawi College of MedicineEthics committee: Research grants and study leave, COM Research Ethics Committee,Ethics number: 13/2/29 UWC,P. 03/13/1369 UNIMAAll authors, affiliations and abstracts have been published as submitted.