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Kankam SB, Habibzadeh A, Amirikah MT, Mensah PKN, Fordjour CO, Mate-Kole MN, Danso SE, Jalloh M, Osifala O, Kwapong FL, Afriyie AA, Zeto R, Fokorede O. Enhancing stroke care in Ghana: A systematic review of stroke rehabilitation services. J Stroke Cerebrovasc Dis 2024; 33:107756. [PMID: 38710462 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/27/2024] [Accepted: 05/01/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVE In Ghana, the shifting demographics of stroke incidence towards young adults have prompted the expansion of stroke care and rehabilitation efforts. Nevertheless, the precise impact of stroke rehabilitation remains unclear. We conducted a systematic review to explore the landscape and effects of stroke rehabilitation in Ghana. METHOD We identified articles on stroke rehabilitation services in Ghana through searches of PubMed, Scopus, Embase, and Web of Science from inception until February 2024. The Critical Appraisal Skills Programme (CASP) Qualitative Checklist was employed to assess the risk of bias in the included studies, supplemented by qualitative synthesis. RESULTS Among the 213 articles screened, 8 were deemed suitable for review. These studies primarily focused on two groups: stroke survivors (n = 335) and healthcare professionals (HCPs) (n = 257). Many stroke survivors reported significant benefits from telerehabilitation, with increased participation in rehabilitation activities correlating with improved physical and cognitive outcomes. The findings also underscored a lack of knowledge about stroke rehabilitation among HCPs, alongside variations in the availability of protocols and guidelines for stroke management across different hospital levels. CONCLUSIONS The review reveals several challenges in stroke rehabilitation in Ghana, including disparities in HCPs' perceptions and utilization of rehabilitation services. The findings emphasize the need for comprehensive, patient-centered approaches, standardized training for HCPs, improved resource allocation, and the integration of telehealth to overcome barriers and enhance stroke rehabilitation in Ghana. These insights hold significance not only for Ghana but also for guiding strategies in similar contexts worldwide, aiming to improve stroke rehabilitation outcomes.
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Affiliation(s)
- Samuel Berchi Kankam
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard, Medical School, USA; Harvard T.H Chan School of Public Health, Harvard University, Cambridge, USA; Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Adrina Habibzadeh
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran; USERN Office, Fasa University of Medical Sciences, Fasa, Iran
| | - Mike Tuffour Amirikah
- Harvard T.H Chan School of Public Health, Harvard University, Cambridge, USA; Department of Internal Medicine, University of Ghana Medical Center, Univerity of Ghana, Accra, Ghana
| | | | | | | | - Samuel E Danso
- Harvard T.H Chan School of Public Health, Harvard University, Cambridge, USA
| | - Mohamed Jalloh
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard, Medical School, USA
| | | | | | | | - Ruth Zeto
- General Medicine Division, Beth Israel Deaconess Medical Center, Boston, USA
| | - Olayinka Fokorede
- Harvard T.H Chan School of Public Health, Harvard University, Cambridge, USA
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Misgana S, Asemahagn MA, Atnafu DD, Anagaw TF. Incidence of stroke and its predictors among hypertensive patients in Felege Hiwot comprehensive specialized hospital, Bahir Dar, Ethiopia, a retrospective follow-up study. Eur J Med Res 2023; 28:227. [PMID: 37430339 DOI: 10.1186/s40001-023-01192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 06/23/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Globally, one in three adults has hypertension, a condition that causes 51% of all deaths from stroke. Stroke is becoming a major public health problem and the most common cause of morbidity and mortality among non-communicable diseases in the world and Ethiopia. Therefore, this study assesses the incidence of stroke and its predictors among hypertensive patients in Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia 2021. METHODS A hospital-based retrospective follow-up study design was used, simple random sampling technique was used to select 583 hypertensive patients that had follow-up registration between January 2018 and December 30th, 2020. Data were entered into Epi-data version 3.1 and exported to STATA version 14. The adjusted hazard ratio for each predictor with a 95% confidence interval was calculated using the Cox proportional hazards regression model, and a P-value ≤ 0.05 was used to denote statistical significance. RESULTS From 583 hypertensive patients 106(18.18%) [95% CI 15-20] were developed stroke. The overall incidence rate was 1 per 100 person-years (95% CI 0.79-1.19). Comorbidities (Adjusted hazard ratio(AHR): 1.88, 95% CI 1.0-3.5), stage two hypertension (AHR = 5.21, 95%CI 2.75-9.8), uncontrolled systolic blood pressure (AHR: 2, 95% CI 1.21-354), uncontrolled diastolic blood pressure (AHR:1.9, 95% CI 1.1-3.57), alcohol consumption (AHR = 2.04, 95%CI 1.2-3.49), age 45-65 (AHR = 10.25, 95%CI 7.47-11.1); and drug discontinuation (AHR = 2.05,95% CI 1.26-3.35) were independent predictors for the incidence of stroke among hypertensive patients. CONCLUSION The incidence of stroke among hypertensive patients was high and various modifiable and non-modifiable risk factors highly contributed to its incidence. This study recommends early screening of blood pressure, giving priority to comorbid patients and patients with advanced stage hypertension, and giving health education about behavioral risks and drug adherence.
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Affiliation(s)
- Solomon Misgana
- Amhara Regional Health Beauro,Bahir Dar, Bahir Dar, Ethiopia
| | - Mulusew Andualem Asemahagn
- School of Public health, College of Medicine and Health Science Bahir Dar University, Bahir Dar, Ethiopia
| | - Desta Debalkie Atnafu
- Department of Health System Management and Health Economics, School of Public health, College of Medicine and Health Science Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadele Fentabil Anagaw
- Department of Health Promotion and Behavioral Science, School of Public health, College of Medicine and Health Science Bahir Dar University, 079, Bahir Dar, Ethiopia.
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Jenkins C. ASOC Osuntokun Award Lecture 2022: Partnership for stroke prevention and treatment in Africa: Qualitative research processes and findings. J Stroke Cerebrovasc Dis 2023; 32:107060. [PMID: 36870865 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND/OBJECTIVES Africa has one of the highest rates of stroke and stroke deaths in the world. The burden of stroke is increasing with a 3-year mortality rate of up to 84%. Stroke disproportionately affects the young and middle-aged population contributing to morbidity and mortality affecting families, communities, health systems, and economic progress. My objectives of the 2022 Osuntokun Award Lecture at the African Stroke Organization Conference were to explore our qualitative research findings from our communities and to propose future qualitative methods for improving stroke outcomes in Africa. METHODS Qualitative research processes and findings related to stroke prevention, treatment/ongoing care, recovery, and knowledge and attitudes influencing ethical, legal and social implications related to stroke neuro-biobanking were explored. For each qualitative study, methods were developed by the research team including: (1) plans to implement aims and ethics review; (2) guides and detailed steps for implementation; (3) training for team; (4) pilot testing, data collection, transport, transcription, storage; (5) data analysis and manuscript development. RESULTS The research focused on genetics, genomics and phenomics of stroke and more recently on exploring the ethical, legal, and social implications of stroke neuro-biobanking. All included a qualitative component to obtain input and guidance from the community. As in quantitative research, questions were developed by the research team, reviewed for clarity by a small group of community members, and 1,289 community members (ages 22-85) participated in the focus groups and key informant interviews from 2014 through 2022. Answers to questions were diverse with some knowledgeable about the science of stroke prevention and treatment, but many had ideas about prevention and causes of stroke that were not supported by science and many reported using traditional healers for treatment and religious beliefs preventing brain biobanking. CONCLUSIONS In addition to our current qualitative research related to stroke in Africa and beyond, we must form research partnerships with communities that not only answer researchers' and community members' questions but identify and implement ways to prevent stroke and improve stroke outcomes.
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Affiliation(s)
- Carolyn Jenkins
- Professor Emerita and Ann Darlington Edwards Endowed Chair, Associate Dean for Research (retired) College of Nursing, Medical University of South Carolina, 1019 Casseque Province, Mount Pleasant, Charleston, SC 29464, USA.
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Gordon Perue G, Then R, Gayle F, Galav S, Thotamalla Y, Hepburn M, Rowe D, Suazo L, Villamán C, Manosalva H, Ortega-Gutierrez S, Yavagal D, Inoa V. Mission thrombectomy 2020 (MT2020+) surveys of Caribbean stroke services: A call for action in our region. J Neurol Sci 2023; 449:120640. [PMID: 37060622 DOI: 10.1016/j.jns.2023.120640] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
Stroke is the leading cause of death and adult-onset disability in the Caribbean region. Despite the tremendous advances in acute stroke care in the past 25 years, treatment in the Caribbean lags stroke standards of care. Mission Thrombectomy 2020+ (MT2020+) is a metrics based global campaign focused on increasing access to organized stroke care and mechanical thrombectomy. We conducted two consecutive online surveys across the MT2020+ Caribbean Region assessing access to thrombolytics, mechanical thrombectomy and stroke centers. The first survey - Mechanical Thrombectomy Access-Caribbean sub-study, allowed a comparison between global services and those in the MT2020+ Caribbean region. This survey provided a snapshot of the current state of stroke centers worldwide and confirmed lower available stroke resources in the MT2020+ Caribbean Region which has one certified stroke center, and 9 mechanical thrombectomy capable centers. The second survey - MT2020+ Caribbean Region infrastructure survey - was designed to determine the availability of stroke resources that are key components of stroke care in participating hospitals. Key infrastructural components such as 24/7 computerized tomographic scanners, access to thrombolytic therapy and access to mechanical thrombectomy capable centers were scarce. There were low volumes of mechanical thrombectomy performed in the Caribbean compared to other countries around the world. Limited resources and inadequate stroke infrastructure remains a major challenge in the Caribbean. We advocate for governmental support and investment, public and private partnerships and legislation to increase access and availability to acute stroke treatments to allow for equal access to care for all Caribbean citizens.
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Affiliation(s)
- Gillian Gordon Perue
- Department of Neurology, University of Miami, Miami, FL, United States of America.
| | - Ryna Then
- Cooper Medical School of Rowan University, Camden, NJ, United States of America
| | | | | | | | - Madihah Hepburn
- Summa Health Neurosciences & Stroke Center, Akron, OH, United States of America
| | | | - Luis Suazo
- Centro de Medicina Avanzada y Telemedicina, Dominican Republic
| | - Cosme Villamán
- Dept. Neurointervención Clínica Corominas y Corazones del Cibao, Dominican Republic
| | | | | | - Dileep Yavagal
- Department of Neurology and Neurosurgery, University of Miami, United States of America
| | - Violiza Inoa
- Semmes-Murphey Clinic, Memphis, Tennessee, University of Tennessee Health Science Center, Memphis, TN, United States of America
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Walker R. Osuntokun Award Lecture 2021: Challenges of Measuring the Burden of Stroke in Africa. J Stroke Cerebrovasc Dis 2022; 31:106386. [PMID: 35317913 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Over recent years non-communicable diseases have dramatically increased in low- and middle-income countries, including those of sub-Saharan Africa. With continuing high levels of infectious disease, these countries now face the double burden of disease. Stroke has emerged as a major cause of hospital admission, disability, and mortality for which the major modifiable risk factor is hypertension, which is often not diagnosed and, even if diagnosed, not treated and, even if treated, not controlled. METHODS In this award lecture paper I outline my personal experience of measuring the burden of, and risk factors for, stroke in sub-Saharan Africa, along with the challenges faced. I will specifically describe the measurement of mortality and case fatality, prevalence and incidence as well as commenting on aetiology and risk factors and reflect on future initiatives and directions. RESULTS Over the past 5 decades there has been a dramatic increase in numbers of stroke patients admitted to hospital throughout sub-Saharan Africa, with high in hospital mortality rates, also reflected in high case fatality rates in those cohorts followed up following discharge from hospital. Community-based surveys assessing mortality from stroke using verbal autopsy have demonstrated very high age-adjusted rates. Age adjusted prevalence rates assessed by door-to-door surveys have generally shown lower prevalence than high income countries. The Tanzanian stroke incidence study, which incorporated verbal autopsy for those patients dying before reaching hospital, demonstrated some of the highest age-adjusted stroke incidence rates in the world. There were high rates of stroke in younger ages and high rates of intracranial haemorrhage though not as high as previously shown in hospital-based studies. Hypertension is the main modifiable risk factor but other risk factors such as HIV are important while, certainly in rural populations, raised cholesterol remains rare as does carotid artery stenosis and history of transient ischemic attack. Other vascular disease such as ischemic heart disease and peripheral vascular disease is also less common. CONCLUSIONS There is already a large burden relating to stroke in sub-Saharan Africa and this will only escalate further as the population ages. Hypertension is the biggest risk factor for mortality worldwide and in sub-Saharan Africa prevalence rates are very high with the majority of people suffering with stroke not being diagnosed with their hypertension prior to their stroke. The most important challenge is to improve primary prevention for which improving diagnosis and control rates for hypertension is the number one priority. For those who do have stroke there is a need to increase the number of suitably staffed stroke units as these have been shown to have a very large impact on improving both mortality and morbidity in high income countries. There are still many unanswered questions and a need for more research throughout sub-Saharan Africa on risk factors, and treatment, for stroke.
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Affiliation(s)
- Richard Walker
- Northumbria Healthcare NHS Foundation Trust, UK; Population Health Sciences Institute, Newcastle University, UK.
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Nichols M, Magwood G, Woodbury M, Brown K, Jenkins C, Owolabi M. Crafting Community-Based Participatory Research Stroke Interventions. Stroke 2022; 53:680-688. [PMID: 35105185 PMCID: PMC8885875 DOI: 10.1161/strokeaha.121.035306] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke exerts a tremendous burden on individuals, families, communities, and health systems globally. Even more troublesome are the striking disparities faced across diverse populations. These disparities are further exacerbated by the COVID-19 pandemic. Despite efforts to advance stroke research, substantial gaps remain in understanding factors that contribute to stroke disparities, including the Social Determinants of Health. Strategically designed studies and tailored interventions are needed to bridge the inequities high-risk populations face and to meet their specific needs. Community-based participatory research offers an approach to equitably partner with community members to understand and work collaboratively to address community-specific health priorities. In this focused update, we highlight the main processes of community-based participatory research studies and share exemplars from our team's work in stroke research and from the literature. As we continue to face an increasing prevalence of stroke, compounded by the COVID-19 pandemic and ongoing implications of the Social Determinants of Health, partnering with communities to address community-driven health priorities can inform interventions targeted to overcome the disparities faced by certain populations.
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Affiliation(s)
- Michelle Nichols
- College of Nursing, Medical University of South Carolina,
Charleston, SC, USA,South Carolina Clinical and Translational Research
Institute, Charleston, SC, USA
| | - Gayenell Magwood
- College of Nursing, Medical University of South Carolina,
Charleston, SC, USA
| | - Michelle Woodbury
- College of Health Professions, Medical University of South
Carolina, Charleston, SC USA
| | - Kimberly Brown
- South Carolina Clinical and Translational Research
Institute, Charleston, SC, USA
| | - Carolyn Jenkins
- College of Nursing, Medical University of South Carolina,
Charleston, SC, USA
| | - Mayowa Owolabi
- Department of Medicine, University of Ibadan, Ibadan,
Nigeria
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Mohammed AS, Degu A, Woldekidan NA, Adem F, Edessa D. In-hospital mortality and its predictors among stroke patients in sub-Saharan Africa: A systemic review and meta-analysis. SAGE Open Med 2021; 9:20503121211036789. [PMID: 34377477 PMCID: PMC8326621 DOI: 10.1177/20503121211036789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/13/2021] [Indexed: 01/01/2023] Open
Abstract
Objective To assess the in-hospital mortality from acute stroke and its predictors in sub-Saharan Africa. Method The literature search was conducted in the databases of PubMed/Medline, Embase, CINAHL, and Google Scholar. The retrieved studies were screened by titles and abstracts, and then full texts were assessed for eligibility. The methodological quality of the included studies was assessed using the Joanna Briggs Institute's critical appraisal checklist. The publication bias was assessed using the funnel plot asymmetry and the Egger tests. Data were analyzed using Stata software version 15.0 in a random-effect model. Result A total of 27 studies with a total sample size of 6331 were included in this systematic review and meta-analysis. The pooled estimated prevalence of in-hospital mortality due to stroke was 22% (95% confidence interval = 0.17-0.27). Stroke mortality in Western Africa (37%, 95% confidence interval = 0.24-0.50) was higher than in Eastern Africa (15%, 95% confidence interval = 0.12-0.19) and Southern Africa (18%, 95% confidence interval = 0.06-0.19). In three studies, mortality was higher in hemorrhagic stroke (25%) than ischemic stroke (14%). Risk factors associated with higher mortality were admission Glasgow Coma Scale, stroke severity, age, sex, presence of hypertension, and declined renal function. Conclusion The in-patient mortality of stroke in sub-Saharan Africa was high. Therefore, there is an urgent need for further stroke epidemiology studies in stroke subtypes and the performance of patient-level meta-analysis to understand the risk factors associated with mortality and herald appropriate intervention to curb the high mortality rate in the region.
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Affiliation(s)
- Ammas Siraj Mohammed
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Amsalu Degu
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy and Health Science, United States International University Africa, Nairobi, Kenya
| | - Nigist Alemayehu Woldekidan
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fuad Adem
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dumessa Edessa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Souza AMLBD, Bastos RDA, Guerra LM, Gondinho BVDC, Meneghim MDC, Leme PAT. Perceptions about the Therapeutic Itinerary after stroke: a qualitative research. Rev Bras Enferm 2021; 74:e20201140. [PMID: 34320094 DOI: 10.1590/0034-7167-2020-1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/10/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to analyze the understanding of the Therapeutic Itinerary of people affected by stroke in the Unified Health System context of a medium-sized city in the state of São Paulo. METHODS this is a clinical-qualitative, using in-depth semi-structured interviews, conducted in 2019 with 6 patients, a number determined by theoretical saturation. RESULTS qualitative content analysis allowed the construction of four categories that emerged from the data: a) You are having a stroke! - Identifying the problem; b) Anguish and expectations in waiting for assistance; c) Helplessness and guidance for rehabilitation after hospital discharge; d) Spirituality in rehabilitation after stroke. FINAL CONSIDERATIONS the affected people expressed feelings and meanings, such as fear, anguish, sadness, beliefs and uncertainties, in order to shed light on the complexity inherent to the experiences of Therapeutic Itinerary of stroke.
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Assessing the Determinants of the Wish to Die among the Elderly Population in Ghana. Geriatrics (Basel) 2021; 6:geriatrics6010032. [PMID: 33807000 PMCID: PMC8006009 DOI: 10.3390/geriatrics6010032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/01/2021] [Accepted: 03/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background: A wish to die is common in elderly people. Concerns about death wishes among the elderly have risen in Ghana, where the ageing transition is comparable to other low-and middle-income countries. However, nationally representative research on death wishes in the elderly in the country is not readily available. Our study aimed to assess the determinants of the wish to die among the elderly in Ghana. Methods: We analysed data from the World Health Organisation Global Ageing and Adult Health Survey, Wave 1 (2007–2008) for Ghana. Data on the wish to die, socio-demographic profiles, health factors and substance abuse were retrieved from 2147 respondents aged 65 and above. Ages of respondents were categorised as 65–74 years; 75–84 years; 85+ to reflect the main stages of ageing. Logistic regression models were fitted to assess the association between these factors and the wish to die. Results: Age, sex, place of residence, education, body mass index, hypertension, stroke, alcohol consumption, tobacco use, income, diabetes, visual impairment, hopelessness and depression had statistically significant associations with a wish to die. Older age cohorts (75–84 and 85+) were more likely to have the wish to die (AOR = 1.05, CI = 1.02–1.16; AOR = 1.48, CI = 1.22–1.94), compared to younger age cohorts (65–74 years). Persons who felt hopeless had higher odds (AOR = 2.15, CI = 2.11–2.20) of experiencing the wish to die as compared to those who were hopeful. Conclusions: In view of the relationship between socio-demographic (i.e., age, sex, education and employment), hopelessness, anthropometric (body mass index), other health factors and the wish to die among the elderly in Ghana, specific biopsychosocial health promotion programmes, including timely identification of persons at risk, for appropriate intervention (e.g., psychotherapy, interpersonal support, alcohol-tobacco cessation therapy, clinical help) to promote their wish for a longer life is needed.
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Abstract
Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.
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Risk factors, clinical outcomes and predictors of stroke mortality in Sierra Leoneans: A retrospective hospital cohort study. Ann Med Surg (Lond) 2020; 60:293-300. [PMID: 33204420 PMCID: PMC7649580 DOI: 10.1016/j.amsu.2020.10.060] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/25/2020] [Accepted: 10/25/2020] [Indexed: 12/17/2022] Open
Abstract
Background Stroke data from Sierra Leone is limited, despite the increase in global burden of the disease. The aim of this study was to assess the risk factors, clinical outcomes and predictors of stroke mortality at a tertiary hospital in Freetown, Sierra Leone. Methods This retrospective cohort study was conducted on stroke patients admitted at the Connaught Teaching Hospital between 1st January to December 31, 2018. Clinical data related to stroke, with variables including patients’ demographics, stroke subtype, vascular risk factors, modified Rankin Scale (mRS), and outcomes were documented. In-hospital mortality, associated risk factors and predictors of stroke were determined. The study was approved by the Sierra Leone Ethics and Scientific Review Committee. It was registered under Research Registry https://www.researchregistry.com/browse-the-registry#home/with the unique identifying number researchregistry6009. Result We studied 178 (95 male and 83 female) patients. The mean age was 59.8 ± 14.0 years, median was 58.1years (ranging: 29–88 years). The commonest risk factors were hypertension (84.3%), tobacco smoking (35.9%) and alcohol (31.4%). Ischemic stroke confirmed by CT scan was 76.3%. In-hospital mortality was 34.8% and at discharge, mean modified Rankin Score (mRS) was 3.89 ± 1.62. The independent predictors for stroke mortality were: hypertension [AOR = 2.2; C.I 95%: (1.32–3.80), p = 0.001], previous stroke [AOR = 2.31; C.I 95%: (1.43–5.74), p = 0.001], GCS < 8 [AOR = 6.06; C.I 95%: (3.17–12.79), p < 0.001], clinical diagnosis in the absence of imaging [AOR = 3.11; C.I 95%: (2.1–9.87), p = 0.001], hemorrhagic stroke [AOR = 2.96; C.I 95%: (1.96–9.54), p < 0.001], and aspiration pneumonia [(AOR = 3.03; C.I 95%:(1.44–6.36), p = 0.001]. Women had poorer outcome than men. Conclusion This study highlights a high stroke mortality in a resource limited hospital, with some stroke patients having difficulties in accessing Computer Tomogram (CT) scan services. It illustrates the need to establish a stroke care setting to improve the quality of stroke care. Globally, sub-Saharan Africa (SSA) has the highest incidence and case-fatality from stroke. In Sierra Leone, the dearth of stroke data limits the access to evidence-based standards of stroke care. We reported a high in-hospital stroke mortality, with majority of the deaths occurring in the first week, and this is comparable to some reported studies from SSA. The poor control of hypertension and aspiration pneumonia are major but avoidable contributors to poor stroke outcomes in SSA.
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Pandian JD, Kalkonde Y, Sebastian IA, Felix C, Urimubenshi G, Bosch J. Stroke systems of care in low-income and middle-income countries: challenges and opportunities. Lancet 2020; 396:1443-1451. [PMID: 33129395 DOI: 10.1016/s0140-6736(20)31374-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/18/2020] [Accepted: 06/09/2020] [Indexed: 12/27/2022]
Abstract
The burden of stroke is higher in low-income and middle-income countries (LMICs) than in high-income countries and is rising. Even though there are global policies and guidelines for implementing stroke care, there are many challenges in setting up stroke services in LMICs. Despite these challenges, there are many models of stroke care available in LMICs-eg, multidisciplinary team care led by a stroke neurologist, specialist-led care by neurologists, physician-led care, hub and spoke models incorporating stroke telemedicine (ie, telestroke), and task sharing involving community health workers. Alternative strategies have been developed, such as reorganising the existing hospital infrastructure by training health professionals to implement protocol-driven care. The future challenge is to identify what elements of organised stroke care can be implemented to make the largest gain. Simple interventions such as swallowing assessments, bowel and bladder care, mobility assessments, and consistent secondary prevention can prove to be key elements to improving post-discharge morbidity and mortality in LMICs.
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Affiliation(s)
- Jeyaraj D Pandian
- Department of Neurology, Christian Medical College, Ludhiana, India.
| | | | | | - Cynthia Felix
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gerard Urimubenshi
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jackie Bosch
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Eslam Abd Alkreem Allsassmah. MEASURING KNOWLEDGE OF JORDANIAN NURSES WORKING IN CRITICAL CARE UNITS TOWARD STROKE PATIENTS. WORLD SCIENCE 2020. [DOI: 10.31435/rsglobal_ws/31102020/7214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Background. Stroke is a devastating disease. It is a major cause for the neurological admission to hospitals all over the world. Limited knowledge among the critical care nurses about stroke in general and specifically about the risk factors, signs, and symptoms of stroke usually is a main source of delayed prompt stroke management and non-compliance with follow-up rehabilitation. Therefore, there is a need for a study that examines the impact of these factors in order to promote stroke management and improve nursing care outcomes.Aim. This study aimed at measuring the knowledge of Jordanian nurses working in critical care units toward stroke patients.Methods. This cross-sectional study used the descriptive approach in order to measure the knowledge of the Jordanian nurses working in critical care units regarding stroke patients in the Jordanian hospitals. Data were collected from Jordanian critical care units' nurses from seven hospitals; five private and two public hospitals. Critical care units’ nurses were selected conveniently based on specific inclusion criteria. Eligible participants were required to complete self–reported questionnaires about knowledge in addition to completing demographic questionnaires. The descriptive and inferential statistics were conducted using the SPSS software. Results. A total of (200) Critical care units’ nurses from public and private hospitals participated in the study. The nurses in this study exhibited poor knowledge on the study scales. There were statistically significant differences among nurses according to the type of hospital on the one scales (P< .05). There is a negative relationship between the knowledge and years of nursing practice in ER or ICU (P= .013).Conclusions. The measures of knowledge among the nurses in critical care units in the Jordanian hospitals towards stroke patients seem to be highly poor. Nurses in critical care units seem to have acceptable information, but inadequate to correctly enhance stroke awareness. There is a gap that should be stuffed via planning and implementation of educational and instructional programs focused on hospital nurses as well as community sectors in order to improve the stoke focus and experience and avoid the delay in accessing the medical help which would, in return, improve stroke management and reduce its effect in Jordan.
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Factors of Health Promotion Behaviour (HPB) and Elderly Health Diseases in Malaysia. JOURNAL OF POPULATION AGEING 2020. [DOI: 10.1007/s12062-020-09284-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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So-Armah K, Benjamin LA, Bloomfield GS, Feinstein MJ, Hsue P, Njuguna B, Freiberg MS. HIV and cardiovascular disease. Lancet HIV 2020; 7:e279-e293. [PMID: 32243826 PMCID: PMC9346572 DOI: 10.1016/s2352-3018(20)30036-9] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/24/2022]
Abstract
HIV-related cardiovascular disease research is predominantly from Europe and North America. Of the estimated 37·9 million people living with HIV worldwide, 25·6 million live in sub-Saharan Africa. Although mechanisms for HIV-related cardiovascular disease might be the same in all people with HIV, the distribution of cardiovascular disease risk factors varies by geographical location. Sub-Saharan Africa has a younger population, higher prevalence of elevated blood pressure, lower smoking rates, and lower prevalence of elevated cholesterol than western Europe and North America. These variations mean that the profile of cardiovascular disease differs between low-income and high-income countries. Research in, implementation of, and advocacy for risk reduction of cardiovascular disease in the global context of HIV should account for differences in the distribution of traditional cardiovascular disease risk factors (eg, hypertension, smoking), consider non-traditional cardiovascular disease risk factors (eg, access to antiretroviral therapy with more benign cardiovascular disease side effect profiles, indoor air pollution), and encourage the inclusion of relevant risk reduction approaches for cardiovascular disease in HIV-care guidelines. Future research priorities include implementation science to scale up and expand integrated HIV and cardiovascular disease care models, which have shown promise in sub-Saharan Africa; HIV and cardiovascular disease epidemiology and mechanisms in women; and tobacco cessation for people living with HIV.
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Affiliation(s)
- Kaku So-Armah
- Boston University School of Medicine, Boston, MA, USA.
| | - Laura A Benjamin
- UCL Queen Square Institute of Neurology, University College London, London, UK; Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Gerald S Bloomfield
- Duke Global Health Institute, Duke University, Durham, North Carolina, NC, USA
| | | | | | | | - Matthew S Freiberg
- Vanderbilt University Medical Center, Nashville VA Medical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
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Iddrisu MA, Senadjki A, Mohd S, Ramendran a/l SPR Subramaniam C, Yip CY, Lau LS. The Impact of HPB on Elderly Diseases (Diabetes Mellitus, Hypertension, Hypercholesterolemia, Minor Stroke, Kidney Failure and Heart Problem): a Logistic Analysis. AGEING INTERNATIONAL 2020. [DOI: 10.1007/s12126-020-09368-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Akinyemi R, Sarfo F, Abd-Allah F, Ogun Y, Belo M, Francis P, Mateus MB, Bateman K, Naidoo P, Charway-Felli A, Akpalu A, Wahab K, Napon C, Arulogun O, Ebenezer AA, Ekeng G, Scola G, Hamzat K, Zimba S, Ossou-Nguiet PM, Ademokoya J, Adebayo P, Ayele BA, Vaz DC, Ogbole G, Barasukan P, Melifonwu R, Onwuekwe I, Belson S, Damasceno A, Okubadejo N, Njamnshi AK, Ogeng'o J, Walker RW, Diop AG, Ogunniyi A, Kalaria R, Sandercock P, Davis S, Brainin M, Ovbiagele B, Owolabi M. Conceptual framework for establishing the African Stroke Organization. Int J Stroke 2020; 16:93-99. [PMID: 32026763 DOI: 10.1177/1747493019897871] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Africa is the world's most genetically diverse, second largest, and second most populous continent, with over one billion people distributed across 54 countries. With a 23% lifetime risk of stroke, Africa has some of the highest rates of stroke worldwide and many occur in the prime of life with huge economic losses and grave implications for the individual, family, and the society in terms of mental capital, productivity, and socioeconomic progress. Tackling the escalating burden of stroke in Africa requires prioritized, multipronged, and inter-sectoral strategies tailored to the unique African epidemiological, cultural, socioeconomic, and lifestyle landscape. The African Stroke Organization (ASO) is a new pan-African coalition that brings together stroke researchers, clinicians, and other health-care professionals with participation of national and regional stroke societies and stroke support organizations. With a vision to reduce the rapidly increasing burden of stroke in Africa, the ASO has a four-pronged focus on (1) research, (2) capacity building, (3) development of stroke services, and (4) collaboration with all stakeholders. This will be delivered through advocacy, awareness, and empowerment initiatives to bring about people-focused changes in policy, clinical practice, and public education. In the spirit of the African philosophy of Ubuntu "I am because we are," the ASO will harness the power of diversity, inclusiveness, togetherness, and team work to build a strong, enduring, and impactful platform for tackling stroke in Africa.
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Affiliation(s)
- Rufus Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, 58987University of Ibadan, Ibadan, Nigeria.,Centre for Genomic and Precision Medicine, College of Medicine, 58987University of Ibadan, Ibadan, Nigeria.,Division of Neurology, Department of Medicine, College of Medicine, 58987University of Ibadan, Ibadan, Nigeria
| | - Fred Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Foad Abd-Allah
- Department of Neurology, Cairo University Hospital, Cairo, Egypt
| | - Yomi Ogun
- Department of Internal Medicine/Neurology, Lagos State University, Lagos, Nigeria
| | - Mofou Belo
- Department of Neurology, Sylvanus Olympio University Teaching Hospital, Lomé, Togo
| | - Patty Francis
- Stroke Unit, Umhlanga Medical Centre, Umhlanga Rocks, South Africa
| | - M Bettencourt Mateus
- Department of Neurology, Hospital Américo Boavida-University Agostinho Neto, Luanda-Angola
| | - Kathleen Bateman
- Stroke Unit, Neurology Division, Department of Medicine, University of Cape Town, 71860Groote Schuur Hospital, Cape Town, South Africa
| | - Pamela Naidoo
- Heart and Stroke Foundation South Africa/University of the Western Cape, Cape Town, South Africa
| | | | - Albert Akpalu
- Korle Bu Teaching Hospital, Accra, Greater Accra Region, Ghana
| | - Kolawole Wahab
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Christian Napon
- Department of Neurology, Bogodogo University Hospital , Ouagadougou, Burkina Faso
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, College of Medicine, 58987University of Ibadan, Ibadan, Nigeria
| | - Ad Adams Ebenezer
- Stroke Association Support Network-Ghana (SASNET-GHANA), Accra, Ghana
| | | | - George Scola
- The Stroke Survivors Foundation, Johannesburg, South Africa
| | - Kolapo Hamzat
- Department of Physiotherapy, College of Medicine, 58987University of Ibadan, Ibadan, Nigeria
| | - Stanley Zimba
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | | | - Julius Ademokoya
- Department of Special Education, 58987University of Ibadan, Ibadan, Nigeria
| | - Philip Adebayo
- Aga Khan University, East Africa /Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Biniyam Alemayehu Ayele
- Department of Neurology, College of Health Science, 37602Addis Ababa University, Addis Ababa, Ethiopia
| | - Deise Catamo Vaz
- Division of Neurology, Department of Medicine, Central Hospital of Maputo, Maputo, Mozambique
| | - Godwin Ogbole
- Department of Radiology, University College Hospital; Department of Radiology, 58987University of Ibadan, Ibadan, Nigeria
| | - Patrice Barasukan
- Department of Neurology, University Teaching Hospital of Kamenge, University of Burundi, Bujumbura, Burundi
| | - Rita Melifonwu
- Stroke Action Nigeria, Ime Obi Ogbeoza, Onitsha, Nigeria
| | - Ikenna Onwuekwe
- Neurology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku- Ozalla, Enugu, Nigeria. Department of Medicine, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | - Sarah Belson
- World Stroke Organization, Geneva, Switzerland/ Stroke Association, London, United Kingdom
| | - Albertino Damasceno
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Njideka Okubadejo
- Neurology Unit, Department of Medicine, College of Medicine/Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | - Alfred K Njamnshi
- Department of Neurology, Yaoundé Central Hospital & Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Geneva, CH/Yaoundé, Cameroon
| | - Julius Ogeng'o
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Richard W Walker
- Department of Medicine, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, UK
| | | | - Adesola Ogunniyi
- Institute for Advanced Medical Research and Training, College of Medicine, 58987University of Ibadan, Ibadan, Nigeria.,Division of Neurology, Department of Medicine, College of Medicine, 58987University of Ibadan, Ibadan, Nigeria
| | - Rajesh Kalaria
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Peter Sandercock
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Stephen Davis
- National Stroke Research Institute, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Brainin
- Department of Clinical Neurosciences and Preventive Medicine, 31227Danube University Krems, Krems, Austria
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
| | - Mayowa Owolabi
- Centre for Genomic and Precision Medicine, College of Medicine, 58987University of Ibadan, Ibadan, Nigeria.,Division of Neurology, Department of Medicine, College of Medicine, 58987University of Ibadan, Ibadan, Nigeria.,Blossom Specialist Medical (Neurorehabilitation) Center, Ibadan, Nigeria
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Clinical characteristics and treatment outcomes among stroke patients hospitalized to Nekemte referral hospital, western Ethiopia. J Clin Neurosci 2019; 71:170-176. [PMID: 31471079 DOI: 10.1016/j.jocn.2019.08.075] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/08/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Stroke is the brain equivalent of a heart attack. It is one of the most common causes of morbidity and mortality worldwide and is a prominent cause of death, disability and dementia in sub-Saharan Africa (SSA). Hence, the purpose of this study was to assess the clinical characteristics and treatment outcomes among hospitalized stroke patients at Nekemte referral hospital (NRH). PATIENTS AND METHODS Retrospective cross sectional study design was conducted on randomly selected stroke patients admitted to medical wards of NRH from 2013 to 2017. RESULTS Among 364 patients included in the study, 208 (57.1%) were males and the mean age of the patients was 59.66 ± 13.4 years. Regarding types of stroke, 192 (52.7%) were diagnosed as having ischemic stroke. During admission 132 (36.3%) patients complained left side body weakness (hemiparesis) and the major risk factor identified was hypertension 230 (63.2%). Overall, 65.4% of patients had poor outcome while 34.6% of patients had good out comes (improved). Being illiterate /unable to read and write (AOR = 3.94, 95% CI: 1.31-11.76, P = 0.01), attending secondary school (AOR = 3.6, 95% CI: 1.4-9.17, P = 0.007) and length of hospital stay >5 days (AOR = 2, 95% CI: 1.04-3.86, P = 0.037) were independent predictors of poor treatment outcome. CONCLUSION About two third of the patients had poor treatment outcome. Educational status and mean length of hospital stays were independent predictors of poor treatment out-comes. An emergency care setup capable of early patient evaluation, identification and management of stroke complications is crucial to overcome early stroke related mortality.
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