Access to stroke rehabilitation services for patients discharged from the Mulago National Referral Hospital Neurology Unit, Kampala – Uganda : a cross-sectional study

Abstract

Introduction: Globally, stroke is the leading cause of disability, and rehabilitation is the primary form of therapy for stroke survivors. However, there is a dearth of information regarding access to stroke rehabilitation services following discharge from hospitalization. This study, therefore, examined access to stroke rehabilitation services for patients discharged from the Mulago National Referral Hospital Neurology unit, Kampala-Uganda. Methodology: This was a concurrent mixed-methods study using cross-sectional and phenomenological study designs. Telephone interviews with an interviewer-guided questionnaire were used to collect quantitative data among 120 participants, sampled consecutively. Firth’s penalized logistic regression was used to identify associated factors. Quantitative data were analyzed using STATA version 15.0. Qualitative data were collected through in-depth, face-to-face interviews with six purposively selected participants and analyzed thematically using ATLAS.ti version 25. Results: Only 7.5% of the participants had high access to stroke rehabilitation services. Among the dimensions of access, acceptability scored highest (66.4%), followed by accessibility (24.3%), availability (20.6%), accommodation (15.9%), and affordability (3.7%). No patient characteristics showed a statistically significant association with access to stroke rehabilitation. Key themes for experiences faced while accessing stroke rehabilitation services included transport challenges, high cost of care, adequacy of rehabilitation resources at hospitals, and organization of stroke rehabilitation services. Conclusion: Access to stroke rehabilitation services remains alarmingly low in this setting, mainly hindered by the affordability of rehabilitation care.