Communication difficulties in adults with stroke at the Neurology Ward at Mulago National Referral Hospital

Abstract

Stroke is a focal neurological deficit attributed to vascular injury (infarction, hemorrhage) of the central nervous system. Stroke is the second leading cause of death and disability worldwide (Murphy & David, 2020). Globally, stroke is a leading cause of long-term disability worldwide, with communication difficulties being one of the most common and debilitating sequelae. Approximately one-third of stroke survivors experience aphasia, a language disorder that affects the ability to speak, understand, read, and write (Stefan T. Engelter, et al., 2019). Between 2000 and 2010, the relative rate of stroke deaths dropped by 35.8% in the United States. However, each year stroke affects nearly 800,000 individuals, with many survivors experiencing persistent difficulty with daily tasks as a direct consequence. More than two thirds of stroke survivors receive rehabilitation services after hospitalization (Carolee J. Winstein, et al., 2016). Communication difficulties, including aphasia and dysarthria, are among the most common and debilitating consequences of stroke, affecting up to 40% of stroke survivors (Berthier, 2005). Aphasia, a language disorder that impairs the ability to speak, understand, read, and write, occurs in approximately 21-38% of stroke cases, while dysarthria, a motor speech disorder, affects 20-30% of stroke survivors (Brady, et al., 2016). In Africa, the continent has one of the highest stroke mortality rates globally, with stroke accounting for 5.5% of all deaths in sub-Saharan Africa (SSA) (Kengne & Anderson, 2016). Communication difficulties in stroke survivors are often overlooked in African healthcare systems, where the focus is primarily on acute stroke management and physical rehabilitation (Urimubenshi, et al., 2018). Studies in sub-Saharan Africa highlight the significant impact of stroke-related communication impairments on patients' ability to reintegrate into their communities and resume their social roles (Kengne & Anderson, 2016). Africa faces a growing burden of stroke due to rapid urbanization, lifestyle changes, and the increasing prevalence of risk factors such as hypertension, diabetes, and obesity (Owolabi, et al., 2015). In East Africa, communication difficulties in stroke survivors are often compounded by cultural and linguistic diversity, which can complicate diagnosis and treatment. (Mushi, Burton, & Mtuya, 2011). In Tanzania, for example, a study found that stroke survivors with aphasia faced significant social isolation and stigma, further exacerbating their condition (Miller, et al., 2014). Similarly, in Kenya, the lack of specialized speech and language therapists has been identified as a major barrier to effective stroke rehabilitation (Peter, 2021). In Uganda, stroke is estimated to be the sixth highest ranking cause of death. The consequences of stroke on the persons' daily lives clearly reach beyond the person with stroke, affecting the whole family and their proximate social networks (Linda, et al., 2023). Communication-related difficulties may manifest as cognitive, language and/or speech impairments. Language impairments, such as aphasia, occur in an estimated 30% of persons affected with stroke (Martino, et al., 2013). This condition affects people’s ability to understand and/or use language for communicative purposes. Speech impairments, which can manifest as poor speech intelligibility, often include dysarthria, occurring in approximately 42% of stroke cases (Martino, et al., 2013)