Factors associated with the longer-term unmet supportive care needs of stroke survivors in Ethiopia: a multicentre cross-sectional study

The supportive care needs of stroke patients: A scoping review

The aims of the current review were to identify the current supportive care needs of stroke patients, categorize those needs according to the supportive care needs framework (SCNF), and to form a SCNF of stroke patients. Preferred Reporting Items for Systematic Reviews and Meta-Extension for Scoping Reviews (PRISMA-ScR) and Guidance for conducting systematic scoping reviews were followed. Ten databases were searched, including six English databases: PubMed, Embase, Web of Science, Cumulative Index to Nursing Allied Health Literature, Cochrane Library, and PsycINFO, and four Chinese databases: China National Knowledge Infrastructure, Wan Fang, China Biology Medicine Database and Chongqing VIP. The search period covers from the establishment of the database to December 31, 2022. Three thousand twenty-nine hits were screened resulting in the inclusion of 34 articles in the final literature review. The greatest need identified by stroke patients was information, followed by psychological, social, rehabilitation, practical, physical, emotional, and spiritual needs. The supportive care needs of stroke patients were identified. A preliminary SCNF of stroke patients was developed according to Fitch's SCNF. The multitude of existing needs of stroke patients need to be addressed. This review may represent the first time that SCNF for stroke patients has been developed. This work may lay the foundation for future research on the supportive care needs of stroke patients and provide a framework for the implementation of supportive care in clinical stroke units.

Treatment outcomes, types, risk factors, and common manifestations of stroke among admitted stroke patients in Ethiopia: Systematic review and meta-analyses

INTRODUCTION

Stroke is the sudden onset of a reduced cerebral perfusion-related localized or widespread neurologic impairment. The two main causes of poor treatment outcomes are uncontrolled blood pressure and hospital arrival delays. Identifying the risk factors, types of stroke presentation, and treatment options might be used in the prevention, early detection, and management of stroke to provide the best care to patients.

OBJECTIVE

This systematic review and meta-analysis aimed to assess the treatment outcomes, types, and risk factors of stroke patients in Ethiopia.

METHODS

A variety of databases were searched, including African Journals Online (AJOL), Google Scholar, Scopus, EMBASE (Ovid), and HINARI, and published and unpublished articles from the Ethiopian Universities repository. To pool the outcome variables, a weighted inverse variance random-effects model at 95% Cl was employed. Heterogeneity and publication bias were assessed using Cochrane I2 statistics and Egger's test with funnel plot, respectively. A subgroup analysis was conducted based on sample size, case definition, and region to detect source of heterogeneity.

RESULT

This study contained data from 26 studies, involving 6291 study participants, from different regions of Ethiopia. Out of 19 articles with I2 = 96.1%, p<0.001, the pooled prevalence of improved stroke treatment outcome was 47.50% (95% CI: 40.20-54.80), while the prevalence of mortality was 18.95% (95% CI: 15.62-22.29) from 19 articles with I2 = 87.9%, p<0.001. In Ethiopia, ischemic stroke accounted for 59.34% of all stroke cases (95% CI: 53.73-64.95). Among risk factors, substance abuse ranked second at 36.58% (95% CI: 25.22-47.93), after hypertension at 50.90% (95% CI: 43.77-56.27). According to the findings, hemiparalysis or hemiplegia was mentioned as a frequent clinical sign associated with stroke (56.87%) (95% CI: 45.65-68.06).

CONCLUSION

The improved treatment outcome was not satisfactory, and the most common type of stroke was an ischemic stroke. Hypertension was the most common risk factor, followed by substance use. As a result, there should be a strengthening of post-stroke care and the creation of awareness about the risk factors and clinical manifestations for prevention and early detection of stroke in Ethiopian people.

Neurology Training and Medical Education in Resource-Limited Settings: Building and Growing the First Neurology Residency Program in East Africa

The burden of neurological disease disproportionately affects low- and middle-income countries, where the lowest number of neurologists are located. Building local training opportunities in resource-limited settings is a foundational step to enhancing the neurological workforce and improving access to neurological care in these regions. In this article, we describe the development and growth of the first neurology residency program in East Africa, which was established in 2006 at Zewditu Memorial Hospital and the Tikur Anbessa Specialized Hospital, Addis Ababa University, Ethiopia. We highlight the impact of the program on clinical care, research, collaborations between neurologists across Ethiopia, and ways to build educational opportunities and mentorship while faced with limited resources. The main challenges in starting the residency program included lack of faculty with neurological expertise, lack of a precedent for subspecialty training in our setting, as well as limited resources and space. The formation of sustainable international collaborations with clinicians at established institutions in high-income countries and neurological societies has been a major source of support in developing the initial infrastructure, curriculum and educational content, knowledge assessments, and mentored research projects. Local partnerships with related medical specialties, including internal medicine, critical care, neurological surgery, and psychiatry, were also instrumental in creating training opportunities. As the program continues to evolve, many challenges remain, including limited diagnostics, lack of access to advanced treatment modalities, lack of fellowship training opportunities in various neurological subspecialties, and insufficient training and experience in scientific writing. Despite these challenges, the residency program has persevered and its creation resulted in many positive changes: since its inception in 2006, we graduated 80 neurologists and the number of practicing neurologists in Ethiopia has increased from 5 to 78, our institution has evolved into a national referral center for neurology, graduates have published 61 articles in the past 3 years and contributed to international neurology research, and alumni of the program have grown the Association of Ethiopian Neurologists. Future directions include development of fellowship opportunities, creation of international rotations, and implementation of teleneurology to further strengthen neurological care across Ethiopia.

Post-stroke limitations in daily activities: experience from a tertiary care hospital in Ethiopia

BACKGROUND

The disability of stroke patients remains an important global health problem; yet information on the extent of restriction from basic and instrumental activities of daily living is limited, particularly in lower-and middle-income (LMIC) countries. Therefore, we examined the issue under the caption, since it is the first step in planning several rehabilitation services.

METHOD

A facility-based cross-sectional study was done to assess the magnitude and predictors of post-stroke limitations in basic activities of daily living (BADL) using the Barthel Index (BI) scale and instrumental activities of daily living (IADL) using the Frenchay Activities Index (FAI) scale among patients who visited Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, Neurology Clinic from April-October, 2022. All patients having a diagnosis of stroke for more than six months duration were enrolled. Descriptive and inferential statistical analyses were done, and measures of estimated crude and adjusted odds ratio with 95% CI were constructed and a p-value less than 0.05 was considered statistically significant. The results are presented in figures and tables.

RESULTS

A total of 150 stroke patients were enrolled in the present study. The mean age of participants was 53 (14.9) years with slight male preponderance (51.3%). Ischemic stroke was present in 106 (70.7%) of them, while 44 (29.3%) had hemorrhagic stroke. Of this, 57 (38%) and 115 (79.3%) of them had limitations in basic and instrumental ADL, respectively. Comorbid cardiac disease (AOR = 6.9; 95%CI = 1.3-37.5) and regular substance use (AOR = 11.1; 95%CI = 1.1-115) were associated with limitations in BADL, while an increase in age (AOR = 1.1; 95%CI = 1.04-1.15) was associated with severe limitations in BADL. Initial stroke severity (AOR = 7.3; 95%CI = 1.2-44.7) was associated with limitations in IADL, whereas depression (AOR = 5.1; 95%CI = 1.1-23.2) was identified as a predictor of severe limitation in IADL.

CONCLUSION

Limitation in activities of daily living (ADL) after stroke is common among Ethiopian patients. Therefore, screening for post-stroke limitations in daily activities is essential for further management and rehabilitative plans.