Investigation into the needs of informal caregivers of stroke survivors in Antananarivo, Madagascar

Background: Stroke is the second leading cause of disability in Madagascar, half of those affected are <50. All treatment must be paid for; however, 92% live on <2€/day, so informal caregivers are very important. Method: In 2017, 15 caregivers of stroke survivors were interviewed by a medical student, in the rehabilitation department of the university hospital in Antananarivo, Madagascar. A semi-structured interview guide was devised exploring their understanding of stroke, assistance in activities of daily living (ADL) (using visual cues), and care burden (based on caregiver burden tools). Audio recordings and notes were analysed using thematic analysis. Results/Findings: Caregivers often lacked understanding on preventing stroke recurrence and the extent of possible recovery. Care burden was considerable, including impact on own well-being and finances, and caregivers felt that they had little access to specialized equipment or help. Participants were desperate for information regarding stroke care and recovery; this may have influenced how they approached the interviewer, as a potential information source, and therefore not been as critical of the health service. Discussion: These findings are similar to other literature on stroke survivors and caregivers in high- and middle-income countries; no literature was found in low-income countries. Limitations to this study include that a high-income group were interviewed and a translator was used. There are no occupational therapists in Madagascar, which limits the exploration of their potential benefit. Conclusion: This study is the first to explore the needs of caregivers of stroke survivors in Madagascar, the findings of which can help to inform future work in low-income countries on stroke carers.