Multilingual Validation of the Questionnaire for Verifying Stroke-Free Status in West Africa

Abstract

Background and Purpose The Questionnaire for Verifying Stroke-free Status (QVSFS), a method for verifying stroke-free status in participants of clinical, epidemiological and genetic studies, has not been validated in low-income settings where populations have limited knowledge of stroke symptoms. We aimed to validate QVSFS in 3 languages-Yoruba, Hausa and Akan- for ascertainment of stroke-free status of control subjects enrolled in an ongoing stroke epidemiological study in West Africa. Methods Data were collected using a cross-sectional study design where 384 participants were consecutively recruited from neurology and general medicine clinics of 5 tertiary referral hospitals in Nigeria and Ghana. Ascertainment of stroke status was by neurologists using structured neurological examination, review of case records and neuro-imaging (Gold standard). Relative performance of QVSFS without and with pictures of stroke symptoms (pictograms) was assessed using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results The overall median age of the study participants was 54 years and 48.4% were males. Of 165 stroke cases identified by Gold standard, 98% were determined to have had stroke while of 219 without stroke 87% were determined to be stroke-free by QVSFS. NPV of the QVSFS across the 3 languages was 0.97 (range, 0.93 – 1.00), sensitivity, specificity and PPV were 0.98, 0.82 and 0.80 respectively. Agreement between the questionnaire with and without the pictogram was excellent/strong with Cohen’s k=0.92. Conclusions QVSFS is a valid tool for verifying stroke-free status across culturally diverse populations in West Africa.

Incident stroke among Ghanaians with hypertension and diabetes: A multicenter, prospective cohort study

“…Stroke diagnosis was based on the World Health Organization definition [ 22 ], if participant had ever experienced sudden onset of weakness or sensory loss on one side of the body, sudden loss of vision, or sudden loss of speech. These questions were obtained from the 8-item questionnaire for verifying stroke free status (QVSFS) which has been validated locally [ [23] , [24] , [25] ]. QVSFS was used as neuro-imaging facilities were not available at any of the study sites at the time of the study.…”

Burden and Predictors of Poststroke Cognitive Impairment in a Sample of Ghanaian Stroke Survivors

“…Stroke-free status was ascertained using a pictorial version of a locally validated 8-item Questionnaire for Verifying Stroke Free Status (20). Control subjects were excluded if they had known background dementia (DSM IV criteria), psychiatric illnesses or were unable to provide consent or complete the evaluations required for the study.…”

Advancing stroke genomic research in the age of Trans-Omics big data science: Emerging priorities and opportunities

“…75 African ancestry populations are critically needed for discovery of novel loci associated with stroke and fine-mapping of known loci discovered in American and other populations to pinpoint the precise causal variant(s) and gene(s) and translate to clinical applications. 5, 47 The largest population of (continental) Africans with stroke in a single funded study are included in the Stroke Investigative Research and Education Network (SIREN) study 76 , part of the H3Africa Project, 31, 32, 49 which has >3000 case-control pairs, (with a targeted recruitment of 5000 case-control pairs) accurately phenotyped with the pictographic questionnaire for verification of stroke-free status (pQVSFS) 77, 78 , and ACCESS tool (for standardized phenotyping of ischemic and hemorrhagic strokes) 79, 80 . Cases and controls are comprehensively evaluated for stroke risk factors to ensure appropriate co-variate adjustment.…”