{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T17:12:18Z","timestamp":1754154738302,"version":"3.41.2"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec026\">\n<jats:title>Background<\/jats:title>\n<jats:p>Stroke is a leading cause of death and disability, placing a significant burden on survivors and their families. To address the lack of African-specific data, we investigated the cost of stroke management and the recovery of health-related quality of life in the post-discharge period in Mozambique.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec027\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A prospective, cost-of-illness study examining the direct and indirect costs of acute stroke presentations to a first referral urban public hospital in Maputo, Mozambique (June-December 2019). Direct costs were derived from medical records to estimate the cost of hospital care. Indirect costs were derived from interviews using a semi-structured questionnaire administered to patients or their caregivers during the index hospitalization and 28-days post-discharge to estimate additional expenditure and loss of productivity due to disability which varied by employment status (informal, formal, pensioner and unemployed). Health-related quality-of-life was assessed at 28-days post stroke using the EQ-5D-3L questionnaire. Cost analysis was conducted from a societal perspective and reported in $USD.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec028\">\n<jats:title>Results<\/jats:title>\n<jats:p>50 of 80 patients admitted with an acute stroke were consecutively recruited during the study period. Median age was 61 (IQR 38\u201368) years, 56% were women and 44% presented with a hemorrhagic stroke. Median length of stay in the hospital was 7.0 (IQR 4.0 to 8.0) days. Within 28-days post-discharge 20% patients had died. Estimated total direct cost of hospital care for 50 patients (hospital days, medication, and investigations) was $36,315.28, the median cost per patient was $721.45 (IQR 582; $790). Estimated direct non-medical costs per patient during hospitalization median $12,59 (IQR, 8.19; 16.39) and mean $13.62 (SD 8.02). In the first 28 days after discharge the non-medical cost was: $32.04 (IQR, 19,01; 49.83) and mean $41.37 (SD, 36.11). Overall, loss of productivity was very high in informal employment and quality of life in survivors severely compromised. The mean EQ-5D index and VAS scores of stroke patients were 0.514 (SD, 0.298), and 49.39 (SD, 20.95), respectively. Anxiety\/depression 92.5% and Pain\/discomfort 82.5% were the most frequently reported issues.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec029\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The economic cost of stroke in low-income sub-Saharan African countries such as Mozambique is substantially high, with considerable out-of-pocket spending, poor survival rate and a compromised health-related quality-of-life. Health system reforms designed to mitigate the individual to societal burden imposed by stroke are required.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0328823","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T17:30:37Z","timestamp":1753378237000},"page":"e0328823","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The cost and health-related quality of life of stroke management and care of acutely hospitalized cases in Mozambique"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4256-7657","authenticated-orcid":true,"given":"Igor Samuel","family":"Dobe","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8551-3651","authenticated-orcid":true,"given":"Clifford","family":"Afoakwah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neide","family":"Canana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Stewart","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Mocumbi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,7,24]]},"reference":[{"issue":"5","key":"pone.0328823.ref001","first-page":"435","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"23","author":"GBD 2021 Stroke Collaborators","year":"2024","journal-title":"Lancet Neurol"},{"issue":"11","key":"pone.0328823.ref002","first-page":"935","article-title":"Stroke in developing countries: experience from Africa","volume":"17","author":"MO Owolabi","year":"2018","journal-title":"Lancet Neurol"},{"issue":"10","key":"pone.0328823.ref003","first-page":"795","article-title":"Global burden of stroke and risk factors, 1990\u20132019","volume":"20","author":"VL Feigin","year":"2021","journal-title":"Lancet Neurol"},{"volume-title":"Global Burden of Disease Study 2019 (GBD 2019) results","year":"2020","author":"Institute for Health Metrics and Evaluation (IHME)","key":"pone.0328823.ref004"},{"issue":"10","key":"pone.0328823.ref005","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"20","author":"GBD 2019 Stroke Collaborators","year":"2021","journal-title":"Lancet Neurol"},{"year":"2024","author":"World Life Expectancy","key":"pone.0328823.ref006"},{"issue":"11","key":"pone.0328823.ref007","first-page":"873","article-title":"Stroke care in Africa: current practices, challenges, and opportunities","volume":"20","author":"RO Akinyemi","year":"2021","journal-title":"Lancet Neurol"},{"issue":"1","key":"pone.0328823.ref008","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1186\/s12916-019-1397-3","article-title":"Socioeconomic status and stroke incidence, prevalence, mortality, and worldwide burden: an ecological analysis from the Global Burden of Disease Study 2017","volume":"17","author":"A Avan","year":"2019","journal-title":"BMC Med"},{"volume-title":"Dysphagia and post-stroke quality of life in Mozambique: observations from Hospital Provincial da Matola","year":"2024","author":"A Mavie","key":"pone.0328823.ref009"},{"issue":"1","key":"pone.0328823.ref010","first-page":"10","article-title":"Health-related quality of life after stroke in Africa: a systematic review","volume":"20","author":"UM Bello","year":"2020","journal-title":"BMC Neurol"},{"key":"pone.0328823.ref011","doi-asserted-by":"crossref","DOI":"10.1596\/0-1952-1606-7","volume-title":"The world health report 2002: reducing risks, promoting healthy life","author":"World Health Organization","year":"2002"},{"volume-title":"International statistical classification of diseases and related health problems, 10th revision (ICD-10)","year":"2010","author":"World Health Organization","key":"pone.0328823.ref012"},{"key":"pone.0328823.ref013","article-title":"Women and men in the informal economy: a statistical picture.","author":"International Labour Organization.","year":"2018","edition":"3"},{"article-title":"Sistema de Protec\u00e7\u00e3o Social Obrigat\u00f3ria: Instituto Nacional de Seguran\u00e7a Social (INSS).","year":"2020","author":"Minist\u00e9rio do Trabalho e Seguran\u00e7a Social M.","key":"pone.0328823.ref014"},{"key":"pone.0328823.ref015","volume-title":"Measuring medicine prices, availability, affordability and price components","author":"WHO\/HAI","year":"2008","edition":"2"},{"volume-title":"Making choices in health: WHO guide to cost-effectiveness analysis","year":"2003","author":"World Health Organization","key":"pone.0328823.ref016"},{"issue":"3","key":"pone.0328823.ref017","doi-asserted-by":"crossref","first-page":"424","DOI":"10.2105\/AJPH.57.3.424","article-title":"Estimating the cost of illness","volume":"57","author":"DP Rice","year":"1967","journal-title":"Am J Public Health Nations Health"},{"volume-title":"Boletim estat\u00edstico do mercado de trabalho","year":"2020","author":"Minist\u00e9rio do Trabalho e Seguran\u00e7a Social M","key":"pone.0328823.ref018"},{"key":"pone.0328823.ref019","first-page":"120","article-title":"The informal sector in sub-Saharan Africa: Outcomes, challenges, and policy options","volume":"30","author":"L Fox","year":"2018","journal-title":"Afr Dev Rev"},{"issue":"3","key":"pone.0328823.ref020","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/0168-8510(90)90421-9","article-title":"EuroQol--a new facility for the measurement of health-related quality of life","volume":"16","author":"EuroQol Group","year":"1990","journal-title":"Health Policy"},{"key":"pone.0328823.ref021","first-page":"21","article-title":"Comparing the standard EQ-5D-3L and EQ-5D-5L: measurement properties and respondent burden in a general population survey","volume":"6","author":"MF Janssen","year":"2008","journal-title":"Health Qual Life Outcomes"},{"issue":"1","key":"pone.0328823.ref022","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1478-7954-1-11","article-title":"How do Zimbabweans value health states?","volume":"1","author":"J Jelsma","year":"2003","journal-title":"Popul Health Metr"},{"key":"pone.0328823.ref023","volume-title":"Methods for the economic evaluation of health care programmes","author":"MF Drummond","year":"2015","edition":"4"},{"volume-title":"Taxas de C\u00e2mbio \u2013 2019","year":"2019","author":"Banco de Mo\u00e7ambique","key":"pone.0328823.ref024"},{"key":"pone.0328823.ref025","first-page":"8","article-title":"Categorizing population health measure values: a demonstration using the EQ-5D index","volume":"12","author":"BM Craig","year":"2014","journal-title":"Popul Health Metr"},{"issue":"5","key":"pone.0328823.ref026","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3109\/07853890109002087","article-title":"EQ-5D: a measure of health status from the EuroQol Group","volume":"33","author":"R Rabin","year":"2001","journal-title":"Ann Med"},{"volume-title":"Sal\u00e1rio m\u00ednimo nacional 2019","year":"2019","author":"Minist\u00e9rio do Trabalho e Seguran\u00e7a Social","key":"pone.0328823.ref027"},{"volume-title":"IBM SPSS statistics for windows, version 20.0","year":"2011","author":"IBM Corp","key":"pone.0328823.ref028"},{"volume-title":"Epi info version 7","year":"2011","author":"Centers for Disease Control and Prevention (CDC)","key":"pone.0328823.ref029"},{"issue":"24","key":"pone.0328823.ref030","doi-asserted-by":"crossref","first-page":"2014","DOI":"10.1136\/hrt.2009.182436","article-title":"Education and risk for acute myocardial infarction in 52 high, middle and low-income countries: INTERHEART case-control study","volume":"95","author":"A Rosengren","year":"2009","journal-title":"Heart"},{"issue":"6","key":"pone.0328823.ref031","first-page":"303","article-title":"Management of hypertension in sub-Saharan Africa: challenges and opportunities","volume":"23","author":"J Addo","year":"2012","journal-title":"Cardiovasc J Afr"},{"issue":"9841","key":"pone.0328823.ref032","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/S0140-6736(12)60861-7","article-title":"Hypertension in developing countries","volume":"380","author":"MM Ibrahim","year":"2012","journal-title":"Lancet"},{"issue":"19","key":"pone.0328823.ref033","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1212\/WNL.0000000000001560","article-title":"HIV status and the risk of ischemic stroke among men","volume":"84","author":"JJ Sico","year":"2015","journal-title":"Neurology"},{"issue":"11","key":"pone.0328823.ref034","first-page":"90","article-title":"Stroke in HIV-positive individuals: epidemiology, pathophysiology, and clinical implications","volume":"16","author":"MA Baig","year":"2016","journal-title":"Curr Neurol Neurosci Rep"},{"issue":"2","key":"pone.0328823.ref035","first-page":"122","article-title":"Socioeconomic inequalities in the prevalence and management of hypertension in low-income and middle-income countries: a multicountry analysis","volume":"96","author":"R Kerr","year":"2018","journal-title":"Bull World Health Organ"},{"issue":"20","key":"pone.0328823.ref036","first-page":"2529","article-title":"The global burden of cardiovascular diseases and risk factors: 2020 and beyond","volume":"74","author":"GA Mensah","year":"2019","journal-title":"J Am Coll Cardiol"},{"issue":"4","key":"pone.0328823.ref037","first-page":"384","article-title":"Is \u2018patient-centredness\u2019 compatible with Scottish social policy values?","volume":"14","author":"M Mackenzie","year":"2011","journal-title":"Health Expect"},{"volume-title":"Health at a glance 2015: OECD indicators","year":"2015","author":"Organisation for Economic Co-operation and Development (OECD)","key":"pone.0328823.ref038"},{"issue":"10046","key":"pone.0328823.ref039","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/S0140-6736(16)30506-2","article-title":"Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study","volume":"388","author":"MJ O\u2019Donnell","year":"2016","journal-title":"Lancet"},{"key":"pone.0328823.ref040","article-title":"Barriers to evidence-based acute stroke care in Ghana: a qualitative study on the perspectives of stroke care professionals","volume":"10","author":"L Baatiema","year":"2020","journal-title":"BMJ Open"},{"issue":"9778","key":"pone.0328823.ref041","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1016\/S0140-6736(11)60325-5","article-title":"Stroke rehabilitation","volume":"377","author":"P Langhorne","year":"2011","journal-title":"Lancet"},{"issue":"6","key":"pone.0328823.ref042","doi-asserted-by":"crossref","DOI":"10.1161\/STR.0000000000000098","article-title":"Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"47","author":"CJ Winstein","year":"2016","journal-title":"Stroke"},{"issue":"4","key":"pone.0328823.ref043","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(18)30002-0","article-title":"Dominant modifiable risk factors for stroke in Ghana and Nigeria (SIREN): a case-control study","volume":"6","author":"MO Owolabi","year":"2018","journal-title":"Lancet Glob Health"},{"issue":"3","key":"pone.0328823.ref044","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/S1474-4422(07)70002-9","article-title":"Burden of stroke in black populations in sub-Saharan Africa","volume":"6","author":"MD Connor","year":"2007","journal-title":"Lancet Neurol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0328823","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T17:30:44Z","timestamp":1753378244000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0328823"}},"subtitle":[],"editor":[{"given":"Ryan G","family":"Wagner,","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,7,24]]},"references-count":44,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0328823","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2025,7,24]]}}}