Osuntokun Award Lecture 2021: Challenges of Measuring the Burden of Stroke in Africa

Revisiting Africa's Stroke Obstacles and Services (SOS)

BACKGROUND

As one of the most common non-communicable diseases in Africa, Stroke ought to be dealt with properly with intensifying efforts to control its burden and to face obstacles in its management.

METHODS AND RESULTS

In this follow-up study we reanalyzed stroke services and related obstacles in 17 African countries that were previously studied in 2021/22 in aspects related to manpower, acute stroke services, rehabilitation programs, number of stroke units/centers, telestroke services, awareness campaigns, and national and international stroke registries through a survey that was sent to stroke specialists and national stroke societies. Overall, there is an improvement in many fields yet many obstacles in the implementation of telestroke services, acute management, secondary prevention, post-discharge services, and follow-ups whether governmental, medical, or societal are prevalent.

CONCLUSION

Stroke services in Africa are improving in 2024 compared to 2021/22 in many fields, stationary in some fields, and regressing in a few. Managing obstacles that are raised by stroke specialists collectively and on individual countries basis will pave the way for better services for the wellness of stroke victims in Africa.

Exploring challenges and recommendations for verbal autopsy implementation in low-/middle-income countries: a cross-sectional study of Iringa Region-Tanzania

BACKGROUND

Verbal autopsy (VA) plays a vital role in providing cause-of-death information in places where such information is not available. Many low-/middle-income countries (LMICs) including Tanzania are still struggling to yield quality and adequate cause-of-death data for Civil Registration and Vital Statistics (CRVS).

OBJECTIVE

To highlight challenges and recommendations for VA implementation to support LMICs yield quality and adequate mortality statistics for informed decisions on healthcare interventions.

DESIGN

Cross-sectional study.

STUDY SETTING

Iringa region in Tanzania.

PARTICIPANTS

41 people including 33 community health workers, 1 VA national coordinator, 5 national task force members, 1 VA regional coordinator and 1 member of the VA data management team.

RESULTS

The perceived challenges of key informants include a weak death notification system, lengthy VA questionnaire, poor data quality and inconsistent responses, lack of clarity in the inclusion criteria, poor commitment to roles and responsibilities, poor coordination, poor financial mechanism and no or delayed feedback to VA implementers. Based on these findings, we recommend the following strategies for effective adaptation and use of VAs: (1) reinforce or implement legislative procedures towards the legal requirement for death notification. (2) Engage key stakeholders in the overall implementation of VAs. (3) Build capacity for data collection, monitoring, processing and use of VA data. (4) Improve the VA questionnaire and quality control mechanism for optimal use in data collection. (5) Create sustainable financing mechanisms and institutionalisation of VA implementation. (6) Integrating VA Implementation in CRVS.

CONCLUSION

Effective VA implementation demands through planning, stakeholder engagement, upskilling of local experts and fair compensation for interviewers. Such coordinated endeavours will overcome systemic, technical and behavioural challenges hindering VA's successful implementation.